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Articles 31 - 60 of 8791
Full-Text Articles in Entire DC Network
Barriers And Facilitators To Health Literacy Among Black Americans With Overweight And Obesity In South Carolina: A Mini-Ethnographic Study, Shelly Campbell-Timmons
Barriers And Facilitators To Health Literacy Among Black Americans With Overweight And Obesity In South Carolina: A Mini-Ethnographic Study, Shelly Campbell-Timmons
Doctoral Dissertations and Projects
The purpose of this qualitative mini ethnography adapted from traditional ethnography with limited time and scope, was to explore and understand perceptions of barriers and facilitators to health literacy among Black Americans with overweight and obesity in three South Carolina counties. Population data showed that approximately 40.3% of U.S. adults are obese. Moreover, Non-Hispanic Black communities are disproportionately affected by overweight and obesity despite efforts to combat the weight-related health risk. Still, limited health literacy should be the focus of public health strategies like teach-back and plain language communication, to address overweight and obesity prevalence and disparities. The study was …
Music Educators’ Perceptions And Implementation Of Multiculturalism In The Classroom, Kennedy Mae Smith
Music Educators’ Perceptions And Implementation Of Multiculturalism In The Classroom, Kennedy Mae Smith
Doctoral Dissertations and Projects
The purpose of the study is to determine teachers' perceptions of multicultural education and its potential benefits in Sumter County. The purpose of this research is to understand the perspectives and approaches to preparing for the implementation of multiculturalism among public school music programs in Sumter, South Carolina. The rationale for this research is that there is a gap in the literature on multicultural implementation in music education in South Carolina. With proper technological implementation, multiculturalism could help prepare music educators to teach a culturally diverse group of students. As a result of the study, the researcher aims to gain …
Underrepresentation Of Women In C-Suite Positions In North American Technology Companies, Joy Lynn Obey
Underrepresentation Of Women In C-Suite Positions In North American Technology Companies, Joy Lynn Obey
Doctoral Dissertations and Projects
Women remain underrepresented in C-suite leadership within North American technology firms despite continued organizational attention to diversity and inclusion. The purpose of this flexible-design qualitative multiple case study was to explore how organizational cultures, structures, leadership-development practices, and succession-planning systems influenced women’s advancement toward executive leadership. Guided by a constructivist paradigm, Transformational Leadership Theory, and Social Role Theory, the study examined the experiences of 26 women who currently held, previously held, or occupied near-C-suite roles in North American technology firms. Data were collected through 26 semi-structured individual interviews and six focus groups. Member checking was completed by 25 participants, and …
Novice Nurses’ Perceptions Of Caring With Empathy In An Acute Care Hospital In The Northeastern United States: A Transcendental Phenomenological Study, Haley Zurcher
Doctoral Dissertations and Projects
The purpose of this transcendental phenomenological study was to understand the essence of the experience of empathy among novice nurses in an acute care facility in the Northeast United States. The Central Research Question (CRQ) for this study was: What was the perceived experience/understanding of empathy by novice nurses working in acute care settings in northeastern Pennsylvania, United States? The study was guided by Bandura’s (1977) self-efficacy theory to examine how confidence, environmental influences, and personal beliefs shaped the development and expression of empathy in early nursing practice. The study was conducted at a large acute care hospital. The sample …
The Relationship Between Resiliency Scores And Nurse Educators Intent To Stay In Academia: A Predictive Correlational Study, Michele Lee Blash
The Relationship Between Resiliency Scores And Nurse Educators Intent To Stay In Academia: A Predictive Correlational Study, Michele Lee Blash
Doctoral Dissertations and Projects
A shortage of both clinical nurses and nursing educators exists. These shortages have a multitude of impacts on the field of nursing, both at the bedside and in academia. The shortage of clinical nurses impacts the number of nurses available to provide quality patient care. The shortage of nursing educators can impact the number of students accepted into nursing programs and, in turn, the number of new nurses available to provide direct care to patients. The purpose of this quantitative non-experimental predictive correlational design study was to examine how the resiliency of nursing educators impacts their intent to stay in …
A Quantitative Content Analysis Of Major United States-Based Religious Organizations' Framing Of Mask-Wearing On X (Formerly Twitter) During Covid-19, Michael J. Farzinpour
A Quantitative Content Analysis Of Major United States-Based Religious Organizations' Framing Of Mask-Wearing On X (Formerly Twitter) During Covid-19, Michael J. Farzinpour
Doctoral Dissertations and Projects
The purpose of this quantitative content analysis was to examine how major U.S.-based religious organizations framed mask-wearing on X (formerly Twitter) during the COVID-19 pandemic and whether identifiable framing cues were associated with observable audience engagement. Grounded in framing theory and prospect theory, the study analyzed publicly available tweets posted by 14 nationally prominent U.S. megachurches and affiliated public-facing organizational representatives between March 2020 and December 2022. The final sample consisted of 1,288 tweets. Tweets were coded for gain- and loss-framed valence-framing cues, compliance- and resistance-oriented frame-orientation cues, and engagement outcomes measured through publicly visible likes, comments, and retweets. Because …
Changing The Way You Think: Renewing The Mind, Janine Robinson Anderson
Changing The Way You Think: Renewing The Mind, Janine Robinson Anderson
Masters Theses
Change Your Way of Thinking: Renewing the Mind is a creative nonfiction thesis exploring how patterns of thought shape faith, identity, emotional responses, relationships, and daily living. Grounded in Romans 12:2, the creative manuscript combines biblical reflection, personal experience, psychological insight, and practical reader guidance to examine renewal through four movements: recognizing destructive thoughts, examining them in light of truth, replacing false beliefs with biblical truth, and practicing renewed responses. The Artist Statement explains the project’s purpose, genre, audience, structure, and biblical and psychological framework. The Critical Paper examines authenticity as the primary craft element in Christian nonfiction, considering how …
Progress, Poetry, And Peace: Romantic Ideals And The Present Day, Kristen Dawn Morgan Hess
Progress, Poetry, And Peace: Romantic Ideals And The Present Day, Kristen Dawn Morgan Hess
Masters Theses
In the busy, technologized, and mechanized life that most people live today, it can be difficult to find true rest, comfort, and peace because the very technology and machinery that is marketed as providing these 21st-century amenities often fall short in their delivery. Taking a look backward at the Romantic era ideals presented in the poetry of William Wordsworth can offer people today the chance to gradually improve their mental, physical, and emotional health by slowing down, minimalizing, and moderating their lifestyles. This thesis talks about the historical background of three of Wordsworth’s poems— “Lines Written in Early Spring,” “The …
How The African American Contribution To Early American Literature Aided In Shaping The American Literary Identity, Jennifer E. Thompson
How The African American Contribution To Early American Literature Aided In Shaping The American Literary Identity, Jennifer E. Thompson
Masters Theses
This study argues that Jupiter Hammon’s early African American literature actively helped shape American literary identity rather than just mirroring it. By blending Christian morality with human rights, Hammon challenged Eurocentric narratives, validated Black humanity, and established a foundational tradition for anti-slavery writing. Traditional theories often contest this national inclusion through critical viewpoints. These views treat slavery as a distinct model, arguing that these texts represent separate responses to bondage rather than unified contributions to a shared national canon. This research redefines the American literary canon by showing how Hammon's historic publications dismantled eighteenth-century racist ideals about intellectual capacity. His …
Examining The Relationships Among Cultural Intelligence, Religiosity, And Cross-Cultural Adjustment Among Faith-Driven Expatriates Living And Working In Thailand, Jerry W. Bosken
Masters Theses
This quantitative correlational study examined the relationships among cultural intelligence, religiosity, and cross-cultural adjustment among adult faith-driven expatriates living and working in Thailand. Data were collected through an anonymous online survey using three established instruments: the Cultural Intelligence Scale, the Centrality of Religiosity Scale, and the Expatriate Adjustment Scale. The final analytic sample included 85 usable responses. Analyses included data screening, descriptive statistics, assumption testing, and multiple regression models. The results indicated that the four dimensions of cultural intelligence collectively predicted overall cross-cultural adjustment. However, motivational cultural intelligence was the only statistically significant individual predictor. Religiosity did not significantly predict …
A Mixed-Method Investigation Into A Possible Correlation Between Forced Terminations Among Church Members, An Exodus Of Young Adults, And An Exponential Decay In Church Attendance, Chastity Selma Jhingree
A Mixed-Method Investigation Into A Possible Correlation Between Forced Terminations Among Church Members, An Exodus Of Young Adults, And An Exponential Decay In Church Attendance, Chastity Selma Jhingree
Doctoral Dissertations and Projects
In the preservation of the biblical church, church members are mandated in the Face of God (Coram Deo) to feed all Christians with the Word of God. However, extant literature reveals a major crisis confronting the church: the exponential decay in church attendance. Therefore, the overarching question is: how can church members feed on and receive the Word of God when church attendance continues to decline? Forced terminations and an exodus of young adults from the church were examined in an investigation to determine whether they significantly contributed to the decline in church attendance. A mixed-methods research design was used …
Integration Of Industry 4.0 Technologies In Automotive Supply Chains, Christopher Mcdonald
Integration Of Industry 4.0 Technologies In Automotive Supply Chains, Christopher Mcdonald
Doctoral Dissertations and Projects
The purpose of the study is to empirically examine the relationship between Industry 4.0 technology integration and supply chain performance outcomes among automotive supply chain managers and executives with at least five years of direct professional experience. The study is guided by three research questions addressing the extent to which Industry 4.0 adoption correlates with disruption frequency, the relationship between cybersecurity implementation and supply chain resilience, and the moderating effect of organizational technological capability on the relationship between Industry 4.0 adoption and operational efficiency. Data are collected through a validated electronic survey instrument using multi-item measures of Industry 4.0 adoption, …
Exploring Self-Care And Mental Health Resilience Among Black Female Mental Health Therapists In Practice, Rhonda R. Mark
Exploring Self-Care And Mental Health Resilience Among Black Female Mental Health Therapists In Practice, Rhonda R. Mark
Doctoral Dissertations and Projects
Black women who serve as mental health therapists often carry a unique and invisible load, borne from caring deeply for their clients while also navigating the daily realities of race and gender bias, both inside and outside of their profession. In that context, this study examines how Black female therapists working in clinical practice care for themselves and stay emotionally resilient in the face of these challenges. It adopts a qualitative, phenomenological approach, and is grounded in intersectionality and Black feminist thought, with the goal of elevating the personal stories and lived experiences of 10 participants. Their reflections offer a …
Dynamic Domain Score Changes As Predictors Of Juvenile Recidivism: Evidence From Washington State's Pact, David Wayne Sattler
Dynamic Domain Score Changes As Predictors Of Juvenile Recidivism: Evidence From Washington State's Pact, David Wayne Sattler
Doctoral Dissertations and Projects
Juvenile probation agencies routinely administer risk-need assessments. However, evidence remains limited regarding the association between changes in scores from repeated risk-need assessments and recidivism among justice-involved youth. Grounded in general personality and cognitive social learning theory and the risk-need-responsivity model, this quantitative study examined whether changes in dynamic scores on the Positive Achievement Change Tool were associated with recidivism among youth on juvenile community supervision in Washington State. Using 24,929 paired initial and final Positive Achievement Change Tool assessments, the study analyzed total and domain-level dynamic score changes with recidivism measured during the 24 months following the final assessment. Logistic …
What We Love Online: A Deductive Thematic Analysis Of Thoughtforms, Parasocial Agent Connection, And Bidirectional Fictophilia In The Digital Liminal, Michael P. Ross
What We Love Online: A Deductive Thematic Analysis Of Thoughtforms, Parasocial Agent Connection, And Bidirectional Fictophilia In The Digital Liminal, Michael P. Ross
Doctoral Dissertations and Projects
As artificial intelligence (AI) systems become integrated into daily life, users are forming connections with non-human agents that are functionally useful, emotionally significant, and sometimes experienced as relational. This qualitative study examined how individuals make meaning of AI thoughtforms, how online disinhibition shapes perceived connection, and how personal histories and belief systems inform whether AI companions feel emotionally or symbolically “real.” Seven adults who reported meaningful AI interactions participated in semi-structured video interviews through Microsoft Teams. Interviews were recorded, transcribed, de-identified, and analyzed in NVivo 15 using deductive thematic analysis informed by parasocial attachment, fictophilia, social cognitive theory, and online …
The Role Of Leaders In Promoting Life Skills Development Among Youth Through Faith-Based Nonprofit After-School Programs: A Qualitative Study, Jacquelyne S. Snyder
The Role Of Leaders In Promoting Life Skills Development Among Youth Through Faith-Based Nonprofit After-School Programs: A Qualitative Study, Jacquelyne S. Snyder
Doctoral Dissertations and Projects
The purpose of this qualitative embedded multiple-case study was to explore how leaders at a faith-based nonprofit community center cultivated after-school programs that supported the development of youth life skills. The theory guiding this study was Burns’ transformational leadership theory, which explains the behaviors youth leaders fostered to create a supportive learning environment in after-school programs. The central research question explored how transformational leadership practices influenced the development of youth life skills in a faith-based nonprofit community center. The case study design enabled the researcher to explore how life skills developed naturally within the community center setting. The sample of …
Exploring The Role Of Single Pilot Operations In Night Cargo Aviation: A Phenomenological Study, Kollin Ellis
Exploring The Role Of Single Pilot Operations In Night Cargo Aviation: A Phenomenological Study, Kollin Ellis
Doctoral Dissertations and Projects
The purpose of this qualitative descriptive phenomenology was to examine the lived experiences of pilots who have operated alone at night in an aviation cargo environment. The design was guided by an epistemological philosophical assumption. Extreme advancements in the technology of artificial intelligence and their applications in the aviation industry have raised the question of the value of a single operator serving in commercial cockpits. Some experts argue that a two-person crew is unnecessarily redundant. A significant gap in the current literature of experiential data existed to prompt this study. Through the contextual lens of the Dual Process Theory and …
Enhancing Cognitive And Emotional Development In An Inclusive High School Setting: A Study Of Students With Intellectual Disabilities, Roxanne Miller
Enhancing Cognitive And Emotional Development In An Inclusive High School Setting: A Study Of Students With Intellectual Disabilities, Roxanne Miller
Doctoral Dissertations and Projects
Students with intellectual disabilities often experience cognitive deficits that limit the development of social cognition and critical thinking skills. Challenges in executive functioning, including reduced metacognitive awareness, emotional regulation, and self-regulation, further hinder their ability to plan, monitor, and adapt their thinking and behavior, creating barriers to success in inclusive educational settings. This mixed-methods pilot study examined the effects of the Feuerstein Instrumental Enrichment (FIE) program on the cognitive development of five high school students with intellectual disabilities enrolled in an inclusive Christian high school over one semester. Using a sequential explanatory design, quantitative data were collected via the MINDCAP …
Exploring The Lived Experiences Of Men Who Voluntarily Remain Childless, Sylvia Joan Muglia
Exploring The Lived Experiences Of Men Who Voluntarily Remain Childless, Sylvia Joan Muglia
Doctoral Dissertations and Projects
The purpose of this phenomenological study was to describe men’s experiences choosing to remain childless in Southeast (Detroit) Michigan. The theory guiding this study was Blackstone’s Theoretical Framework on Voluntary Childlessness. Rich, descriptive data were collected using a short demographic questionnaire and twelve semi-structured interviews that answered three research questions guiding this study: (1) How do men in Southeast (Detroit) Michigan describe experiences choosing to remain childless? (2) How do men in Southeast (Detroit) Michigan recount any impact from adverse childhood experiences which contribute to their decision to remain childless? (3) How do men in Southeast (Detroit) Michigan explain the …
The Effects Of Home Virtual Reality (Vr) Firearms Systems On Self-Efficacy, Gun Attitude, And Stress, Raffi R. Stambultsyan
The Effects Of Home Virtual Reality (Vr) Firearms Systems On Self-Efficacy, Gun Attitude, And Stress, Raffi R. Stambultsyan
Doctoral Dissertations and Projects
Advanced virtual reality (VR) firearms training systems have demonstrated benefits for military and law enforcement personnel; however, limited research has examined the psychological effects of commercially available home-based VR firearms systems. The purpose of this quantitative quasi-experimental study was to investigate the immediate effects of the GAIM and AceXR home VR dry-fire training systems on general self-efficacy, leadership self-efficacy, perceived stress, and gun attitude among firearms-trained military and law enforcement veterans. A total of 128 participants completed validated pretest and posttest measures following participation in a VR training session using either the GAIM or AceXR platform. A one-way multivariate analysis …
Mandated Reporting Experiences And Professional Quality Of Life Among Missouri K-12 Mandated Reporters, Kristina L. Gregory
Mandated Reporting Experiences And Professional Quality Of Life Among Missouri K-12 Mandated Reporters, Kristina L. Gregory
Doctoral Dissertations and Projects
Child maltreatment is associated with significant developmental, psychological, and behavioral consequences for children. Educators often serve as frontline identifiers of suspected abuse and neglect and are legally required to report concerns to the state’s child welfare agency. The purpose of this quantitative, cross-sectional, correlational study was to examine relationships among mandated reporting exposure, perceived reporting ambiguity, trust in Missouri’s Children’s Division, and professional quality of life among Missouri K–12 school-based mandated reporters. Professional quality of life was measured through compassion satisfaction, burnout, and secondary traumatic stress. This study brings these factors together to better understand how educators’ reporting experiences and …
From Broken To Becoming: A Phenomenological Study Of Life Purpose Among Christian Adult Survivors Of Childhood Trauma, Chenel M. Stewart
From Broken To Becoming: A Phenomenological Study Of Life Purpose Among Christian Adult Survivors Of Childhood Trauma, Chenel M. Stewart
Doctoral Dissertations and Projects
Childhood trauma often disrupts an individual’s sense of meaning, identity, and direction, leaving lasting effects that extend beyond psychological symptoms into how life’s purpose is understood and lived. While existing research has examined trauma, coping, and meaning in life, less is known about how survivors themselves experience and construct life purpose following traumatic experiences. This qualitative phenomenological study explored how Christian adult survivors of childhood trauma describe their lived experiences of trauma and healing, and the development of life purpose in adulthood. Semistructured interviews were conducted with seven Christian adults who self-identified as having experienced childhood trauma and healing and …
The Correlation Of Information-Seeking Traits With Perceptions Of Artificial Intelligence Output To Ill-Defined Problems, Joel Bouchard
The Correlation Of Information-Seeking Traits With Perceptions Of Artificial Intelligence Output To Ill-Defined Problems, Joel Bouchard
Doctoral Dissertations and Projects
Artificial intelligence (AI) has emerged as a new class of technological tool whose innovation exists in its ability to engage in reciprocal, socially fluent, undetermined response generation. How individuals come to trust such responses, especially as it regards classes of problems previously unavailable to programmed computational responses, is a question of importance. Prior research has addressed motivational dispositions towards epistemic decision-making, but work examining the relationship between these traits and perceptions of AI output in epistemically ambiguous circumstances is limited. The current study aimed to address this gap by exploring how trait curiosity and need for cognitive closure (NFCC) relate …
Beyond Transformational Leadership: The Moderating Role Of Leader Hexaco Personality Traits In Fostering Psychological Safety In Law Enforcement, Daniel Q. Lentz
Beyond Transformational Leadership: The Moderating Role Of Leader Hexaco Personality Traits In Fostering Psychological Safety In Law Enforcement, Daniel Q. Lentz
Doctoral Dissertations and Projects
Law enforcement agencies struggle to recruit and retain officers due to lack of public support, criticism, and declining well-being, which raises stress levels. While operational stress affects officers, organizational stress is more damaging. Transformational leadership can help create a psychologically safe work environment, but research on this link is limited and mixed. This study examined how each HEXACO personality trait (Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, Openness) moderates this relationship, drawing on social exchange and attribution theories. Conducted in U.S. law enforcement agencies, a survey assessed officers' perceptions of their leader’s transformational style, HEXACO traits, and psychological safety. Moderation and mediation …
Making Sense Of Organizational Culture Through Internal Communication: A Qualitative Descriptive Study Of University Staff Experiences, Candida A. Johnson
Making Sense Of Organizational Culture Through Internal Communication: A Qualitative Descriptive Study Of University Staff Experiences, Candida A. Johnson
Doctoral Dissertations and Projects
Guided by Craig’s sociocultural communication tradition, organizational culture theory, and Barnlund’s transactional model of communication, this qualitative study sought to understand how internal communication practices at a large public university are interpreted by staff as central to meaning-making, trust, and engagement among staff. Data was collected through semi-structured interviews representing multiple divisions, roles, and campus locations at the institution. Thematic analysis revealed: 1) authentic and effective communication, 2) information flow and access, 3) institutional belonging and commitment, and 4) crisis communication breakdowns. Findings revealed that while the institution employs multiple internal communication channels, staff frequently perceived institutional-level communication as delayed, …
Growing Up Without A Father: A Phenomenological Study Of The Lived Experience Of Black Women In The Church, Jada She'ree Adger Byrd
Growing Up Without A Father: A Phenomenological Study Of The Lived Experience Of Black Women In The Church, Jada She'ree Adger Byrd
Doctoral Dissertations and Projects
The purpose of this phenomenological study was to describe the lived experiences of Black women who grew up in the faith community without a present father in the Southern region of the United States. The central research question that guided this study was, "What are the lived experiences of Black women who grew up in the faith community without a present father?" The theory that guided this study was intersectionality (Crenshaw, 1989, 1991), as this theory provides a framework for the understanding of how intersecting identities, including race, gender, and spirituality, shape an individual’s interpretation of father absence. This study …
Belonging, Spirituality, And Online Student Satisfaction: A Quantitative Study, Kimberly Diana Ramona King
Belonging, Spirituality, And Online Student Satisfaction: A Quantitative Study, Kimberly Diana Ramona King
Doctoral Dissertations and Projects
The growth of online education has transformed higher education by increasing flexibility and accessibility while introducing challenges related to belonging, engagement, and student satisfaction. Research demonstrates that students’ sense of belonging, a fundamental human need for connection and inclusion, is critical to engagement and persistence. Grounded in the community of inquiry (CoI) framework and social presence theory (SPT), this quantitative, cross-sectional correlational study examined the relationship between belonging (X) and student satisfaction in online learning (Y), with spirituality (M₁) as a mediating variable. The study used a convenience sample of 155 graduate students and alumni (age 21 or older) who …
Coping Mechanisms: A Neurotypical Child's Response To A Sibling With Autism Spectrum Disorder, Heather G. Jones
Coping Mechanisms: A Neurotypical Child's Response To A Sibling With Autism Spectrum Disorder, Heather G. Jones
Doctoral Dissertations and Projects
Autism spectrum disorder (ASD) is a complex lifelong neurodevelopment disorder with the current prevalence estimation of 1 in 31 children. With the rising prevalence of diagnosed individuals with ASD, there is an increase in the number of neurotypical children (NTC) who live with a sibling that has a diagnosis of ASD. Research on how NTC copes with daily stressors of a sibling with ASD and how their relationship is affected with a sibling with ASD is underexplored. Knowledge of ASD and coping strategies should become a regular process in the NTC life to help manage the stress that may come …
The Effect Of Job Enlargement Programs On The Wellbeing Of United States Air Force Personnel, Joseph Earl Stone
The Effect Of Job Enlargement Programs On The Wellbeing Of United States Air Force Personnel, Joseph Earl Stone
Doctoral Dissertations and Projects
The purpose of this study was to examine the relationship between job enlargement programs and overall wellbeing among active-duty United States Air Force personnel using a mixed method, convergent parallel approach. Utilizing a sample of 125 active-duty personnel, these two variables were examined for a predictive relationship while controlling for eight covariates utilizing multiple regression analysis (quantitative) and assessed for contextual purposes using thematic analysis (qualitative), employing survey data from all participants. The study was framed by self-determination theory (SDT), which posits that the wellbeing of individuals is affected by three core needs of competence, autonomy, and relatedness. Quantitatively, no …
Re-Education On Chlorhexidine (Chg) Bathing Protocol Affects Patient Chg Bathing Compliance And Surgical Site Infection (Ssi) Rates, Mary Samantha Ross
Re-Education On Chlorhexidine (Chg) Bathing Protocol Affects Patient Chg Bathing Compliance And Surgical Site Infection (Ssi) Rates, Mary Samantha Ross
Doctoral Dissertations and Projects
Surgical site infections (SSI) are considered a hospital-acquired infection, leading to increased hospital length of stay (LOS), readmission rates, increased cost, morbidity, mortality rates, and poor postoperative outcomes. The literature review demonstrated the benefits of preoperative Chlorhexidine (CHG) bathing, but called for standardized protocols, improved education, and patient compliance. Research and clinical experience supported the need for improved patient compliance with CHG bathing. Consistent SSI rates even after protocol changes called for re-education of nursing staff in addition to addressing patient compliance issues. Therefore, providing re-education on the updated protocol, which addresses patient compliance issues, can lead to a reduction …