Health Psychology Commons^™

A Qualitative Inquiry Exploring Help-Seeking Behaviors And Resilience Strategies Women With Disabilities Utilize When Experiencing Gender-Based Violence In Rural Communities, Kimberly Ann Aguillard

Dissertations and Theses (Open Access)

Women with disabilities (WWD) are at pronounced risk of experiencing multiple forms of severe and prolonged violence, and they face barriers to accessing help. A multitude of factors associated with disability and rurality may compound the experience of violence, including geographic and social isolation, forcing WWD in rural settings to navigate extremely dangerous situations with limited avenues for accessing help and securing safety. This research explored how women with disabilities experiencing violence while living in rural communities navigate programs and policies, make decisions about seeking and securing help, and build resilience despite experiencing violence. The current study methodology empowers this …

A Comparison Of Interdisciplinary Palliative Care Teams And Leadership Attitudes Of Nci-Designated And Non-Nci-Designated Cancer Centers In The United States From 2009-2018, Joseph Chen

Dissertations and Theses (Open Access)

Background: Interdisciplinary palliative care (PC) teams (IDTs) are essential to improving patient outcomes while cancer center executives have a key role in defining the future of PC. Objectives: To compare PC team compositions and executives’ attitudes towards PC between NCI (National Cancer Institute)-designated cancer centers (NCI-CCs) and non-NCI-designated cancer centers (non-NCI-CCs) in 2018 and to compare changes in team composition and executives’ attitudes and beliefs between 2009-2018. Methods: PC program leaders (PL) and cancer center executives at all 62 NCI-CCs and a random sample of 60 of 1252 non-NCI-CCs were surveyed from April-August 2018. The PL survey examined team composition …

Disparities In Patient Safety Events For Hospitalized Patients, Nnabuchi Anikpezie

Dissertations and Theses (Open Access)

Background: Twenty years post IOM’s landmark publication, “To Err is Human: Building a Safer Health System”, still no consensus on case definition for patient safety events (PSEs). Available data on incidence and magnitude of PSEs are more than 10 years old, while data on disparities are ambiguous. Objective: To examine the racial and socioeconomic disparities in reported patient safety events (PSEs) among hospitalized individuals. Design, Setting, and Participants: Cross-sectional study of patient safety events using the 2016 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP). A total of 6,753,100 discharges were identified as being at risk …

Determining The Racial And Ethnic Differences In Neonatal Intensive Care Unit Admission Rates, Youngran Kim

Dissertations and Theses (Open Access)

Background: Recent trends show that the utilization of neonatal intensive care unit (NICU) has extended beyond severely ill infants and increased substantially across all birth weights. However, little is known about what drives the growth of NICU admission rates and whether these trends differ by race/ethnicity. Methods: The study used 2008-2018 Natality Files with restricted use of state and county-level information. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between black and white infants and between Hispanic and white infants. Kitagawa decomposition and Oaxaca-Blinder decomposition analyses were conducted for the temporal increase in …

Causal Analysis Theory And Application To Alzheimer’S Disease (Ad) And Heart Failure (Hf), Shudi Li

Dissertations and Theses (Open Access)

Alzheimer's disease (AD) and heart failure (HF) are two complex diseases that are caused by the combination of genetic and epigenetic, environmental and other lifestyle factors. Understanding the relationships between genetic and epigenetic variants and other factors of such complex diseases could assist researchers discover disease mechanisms and develop targeted therapies. Much of the research in genetics/epigenetics studies regarding AD and heart diseases have been focused on association analysis. Many researchers have identified genetic/epigenetics variants and phenotypes that are significantly associated with disease pathology. While most of these studies utilize association analysis as the analytical platform, the signals identified by …

Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyou Li

Dissertations and Theses (Open Access)

The objective of this study was to estimate the relationship between heat stress and pulmonary function among OSRC workers following the Deepwater Horizon (DWH) disaster. Methods: Pulmonary function test results were analyzed from a cohort of oil spill response and cleanup workers 1-3 years following the DWH disaster (N=5,131). Proxies for heat stress was employed by using information on heat stress-related symptoms as well as a questionnaire on stopping work due to heat reported during a structured telephone enrollment questionnaire. Associations between heat stress proxies and lung function were estimated using multivariable linear models and binomial logistic regression models while …

Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyao Li

Dissertations and Theses (Open Access)

Objective: The objective of this study was to estimate the relationship between heat stress and pulmonary function among OSRC workers following the Deepwater Horizon (DWH) disaster. Methods: Pulmonary function test results were analyzed from a cohort of oil spill response and cleanup workers 1-3 years following the DWH disaster (N=5,131). Proxies for heat stress was employed by using information on heat stress-related symptoms as well as a questionnaire on stopping work due to heat reported during a structured telephone enrollment questionnaire. Associations between heat stress proxies and lung function were estimated using multivariable linear models and binomial logistic regression models …

Area-Level Landfill Density And Asthma Prevalence In Urban Texas Areas, Jessica Meighan Herrin

Dissertations and Theses (Open Access)

Environmental exposures, especially air pollutants, pose a threat for an increase in asthma prevalence. In particular, hydrogen sulfide (H2S) gas can cause severe health effects closely resembling asthmatic symptoms. Ambient concentrations of H2S gas correlates with the amount of solid waste found in landfills. The potential for adverse health risks associated with H2S emitted from landfills is of concern for those populations living in close proximity to landfills. Asthma is one of the adverse health effects that can occur due to H2S exposure. However, there is a lack of detailed studies characterizing possible associations between the density of landfills and …

Impact Of Substance Use In Social Networks On Antiretroviral Therapy Adherence For Hiv-Positive Younger Men Who Have Sex With Men, Natascha Del Vecchio

Dissertations and Theses (Open Access)

The community of young men who have sex with men (YMSM) has higher rates of substance use than the general population and the use of alcohol, cannabis, and illicit drugs has been shown to have a negative impact on the HIV care continuum. Our first aim was to understand the prevalence of substance use in the community through the use of self-reported, RDS-II, and RDS-SS estimates. We used multivariable logistic and negative binomial GEE with QIC selection to determine the factors important to having a prescription and staying adherent, respectively. Selected variables were included with a subset of substance use …

Effect Of The Expanded Prospective Payment System On Dialysis Initiation, The Usage Of Erythropoiesis-Stimulating Agents, And Medicare Expenditures, Lu Zhang

Dissertations and Theses (Open Access)

In January 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) implemented the expanded prospective payment system (PPS) for financing the management of end-stage renal disease (ESRD). Expanded PPS may not only change healthcare providers’ decisions about patient care by removing the financial incentives associated with the previous composite rate payment methodology, but also change the Medicare expenditures associated with various treatment patterns by using a constant base rate for all dialysis modalities. This study aimed to examine the effect of the expanded PPS on providers’ decisions on timing of dialysis initiation and ESA utilizations in ESRD patients as …

Hospital Market Analysis Using A Cohort Of Privately Insured Patients With Total Hip And Knee Replacement Procedures, Elifnur Yay Donderici

Dissertations and Theses (Open Access)

Background: Several recent studies have analyzed the contribution of hospital inpatient prices and utilization to variation in medical spending. However, it is still unknown how the drivers of spending for specific procedures differ within privately insured patients. Next, the market concentration of hospitals has been a matter of concern for several decades. However, researchers usually calculate Herfindahl-Hirschman index (HHI) as a measure of market concentration or power, but there is a drawback of using this measure. Hospitals sell differentiated products, and the HHI measure does not take this differentiation into account in its formulation (Gaynor and Town, 2011). Objective: First …

The Multilevel Factors Facilitating Or Impeding Healthcare Access Among Refugees Residing In Bexar County Texas, Howaida Werfelli

Dissertations and Theses (Open Access)

The goal of this study was to increase understanding of healthcare access among refugees by investigating the multilevel factors that facilitate or impede healthcare access among refugees who have resettled in Bexar County, Texas. The multilevel factors facilitating or impeding access to healthcare for refugees resettled in Bexar County were identified as follows: health literacy, level of educational attainment, proficiency (reading, writing and, speaking) in English, proficiency (reading, writing and speaking) in native language, translation services, public transportation, income level, a shortage of healthcare providers, navigation of the healthcare system, the fragmentation of the healthcare system, insurance status, staff shortages …

Health Disparities Across Funcitonal Disability Groups, Katherine Sanches

Dissertations and Theses (Open Access)

Background: People with disabilities experience higher rates of chronic disease and poor health status compared to those without disability. People with disabilities do not participate in community health programs to the same degree as those without disability due to social, programmatic, and environmental barriers. The Community Health Inclusion Index (CHII) is a community health assessment tool which evaluates the degree to which community-level health promoting opportunities to promote nutrition and physical activity are inclusive and accessible to people with disabilities. The CHII assess barriers to inclusion across five domains: build environment, equipment, program/services, staff, and policies. Objective: The purpose of …

Atitiudes Tow Ards Computer Games For Learning And Pl.A Yer Archetypes: An Exploration Of Measures On Preintervention Player Characteristics For Serious Game-Based Interventions, Benjamin Lee

Dissertations and Theses (Open Access)

Serious game-based interventions offer promising health outcome results with the aid of pre-intervention player tailoring and the development of measurements that evaluate pre-intervention player characteristics and subgroups. Video gaming measures can potentially provide helpful tailoring information that discerns individual video gaming preferences which could influence their overall user experience. It is critical that measures that target adolescent video gaming be psychometrically validated. There is a gap in the literature with psychometrically validated measures evaluating adolescent attitudes towards computer games for learning and gaming archetypes. Therefore the aims of this dissertation were to 1) evaluate the psychometric properties (i.e., reliability and …

Epidemiology Of No -Syndromic, Orofacial Clefts In A Registry­Based, Birth-Cohort In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez

Dissertations and Theses (Open Access)

Although orofacial clefts, which include cleft palate alone (CP) and cleft lip with or without cleft palate (CL±P), are among the most common birth defects, their etiology is complex and is generally not well understood. While some clefts are caused by rare syndromes, the majority occur in the absence of a syndrome, either in association with co-occurring defects or as isolated defects. Among these non-syndromic cases, epidemiologic studies have identified demographic variables that are associated with CP and/or CL±P, such as geographic location and infant sex, as well as several maternal characteristics, though some of these associations have been weak …

The Use Of Animal-Assisted Therapeutic Interventions In The Hospital Setting During The Covid-19 Pandemic, Alicia Cesare

Graduate Theses/Dissertations

Handlers of therapy and/or facility dogs working within hospital settings have experienced various barriers and challenges within their practice during the COVID-19 pandemic. Animal-assisted interventions, specifically therapeutic working dogs, are a valued source of support to individuals, communities, hospital settings, and disaster sites during times of community distress. The purpose of this study was to identify barriers and solutions to the continued use of animal-assisted therapeutic interventions in support of patients and families within the hospital setting during the COVID-19 pandemic. This researcher’s position within the research is the knowledge and experience of being a facility dog handler within the …

Feasibility And Validity Of Asking Patients To Define Individual Levels Of Meaningful Change On Patient-Reported Outcomes, Salene M.W. Jones, Yuxian Du, Ari Bell-Brown, Kaylin Bolt, Joseph M. Unger

Journal of Patient-Centered Research and Reviews

Purpose: Patient-reported outcomes (PROs) are frequently used in clinical care to monitor treatment response. However, most guidelines on PRO use treat all patients the same. This study tested the feasibility and validity of a method for determining individually meaningful change in PRO measures.

Methods: Participants (n = 398) completed 12 pain and distress questions to define individually meaningful change. This mixed-methods study used both quantitative and qualitative analyses, including descriptive statistics, inferential statistics, and content analysis.

Results: Two-thirds (67%) of the sample reported at least one medical condition, including depression and back pain. Most participants (70%–90%) were able to answer …

Hiv Preexposure Prophylaxis And Treatment As Prevention — Beliefs And Access Barriers In Men Who Have Sex With Men (Msm) And Transgender Women: A Systematic Review, Joshua J. Matacotta, Francisco J. Rosales-Perez, Christian M. Carrillo

Journal of Patient-Centered Research and Reviews

Purpose: While the annual rate of new HIV infections and diagnoses has remained stable for most groups, troubling increases are seen in transgender women and racial/ethnic-minority men who have sex with men (MSM), groups that are disproportionately affected by HIV. The primary purpose of this systematic review is to examine factors that impact attitudes and beliefs about preexposure prophylaxis (PrEP) and treatment as prevention (TasP) and to explore barriers to PrEP uptake in MSM and transgender women.

Methods: Using MeSH terms and relevant keywords, we conducted a systematic review of studies published between 2010 and 2019. We searched 4 literature …

Using Spatial Methods To Better Understand Food Insecurity And Snap Under-Participation In Texas, Ryan Ramphul

Dissertations and Theses (Open Access)

The overall objective of this research is to use spatial methods to better understand food insecurity and SNAP under-participation in Texas. Paper 1 assesses whether a sample of community dwelling Medicare and Medicaid beneficiaries, who screen positive for food insecurity at healthcare locations in Harris County, exhibit a spatial pattern in terms of where they live. In other words, it tests whether or not there are statistically significant neighborhood hot spots or cold spots of food insecurity against a null hypothesis of complete spatial randomness. This approach is novel because it uses address-level data on patients who report being food …

Physician Burnout: Slowing The Burn Through Positive Deviance Strategies, Swapna Reddy

Dissertations and Theses (Open Access)

Introduction: Affecting 42% of physicians in the United States, “physician burnout” is considered a public health crisis with adverse impacts for personal providers, patients and organizations. Though much research has been devoted to the existence and causes of burnout, to date few studies have been conducted to identify factors associated with physician fulfillment. Aims: This dissertation research was intended to increase and improve knowledge of factors effective in contributing to physician professional fulfillment utilizing a Positive Deviance based approach. To that end, two studies were conducted: the first, a narrative review of the literature to identify specific correlates of physician …

Bayesian Modeling Of Censored Data With Application To Meta-Analysis Of Immunotherapy Trials, Xinyue Qi

Dissertations and Theses (Open Access)

My dissertation builds on a systematic review of 125 clinical trials reporting on treatment-related adverse events (AEs) associated with PD-1/PD-L1 inhibitors published from 2010 to 2018. The motivating dataset contained the following study-level components extracted from each publication: trial name, number of treated patients, selected immunotherapy drug, dosing schedule, cancer type, number of AEs within each category, and the pre-specified criteria for AE reporting. The number of AEs were reported based upon all-grade (Grade 1-5) and Grade 3 or higher (Grade 3-5) severity. My overall objective was to increase our understanding of the toxicity profiles of five most common cancer …

Womanism & Wellbeing: A Manuscript Dissertation Exploring The Effects Of Shame, Loss And Gender Issues, Christy Angelle-Vidrine Bauman

Education Dissertations

The purpose of this study is to contribute to the research on gender issues and psychological well-being across the adult lifespan utilizing qualitative research examining factors (e.g., societal influences, sexual objectification, shame, loss, meaning-making, and internal identity) in developing resilience and mitigating mental health issues. This paper discusses the importance of addressing well-being through expression of loss, meaning-making, and social impact. This manuscript style dissertation will review publications in such areas as sexuality, spirituality, grief, shame, intimacy, social, and interpersonal relationships. The exploration of biopsychosocial impacts as it relates to meaning-making, resilience, and communal involvement. The three publications will be …

Situations Éthiques Vécues Par Des Infirmières En Lien Avec La Santé Et La Sécurité Au Travail, Chantal Caux, France Dupuis, Kathleen Lechasseur, Laurence Fortin-Pellerin, Jocelin Lecomte

Rapports de recherche scientifique

L’éthique de la santé fait partie intégrante de la pratique infirmière. L’éthique définit des principes, tels la bienfaisance ou le respect de l’autonomie, qui viennent baliser cette pratique. Ainsi, l’éthique est imbriquée dans toutes les interventions des infirmières et infirmiers (ci-après les infirmières). Il n’est pas rare toutefois que les infirmières vivent des expériences qui sont problématiques d’un point de vue éthique. On parlera souvent dans la littérature de dilemmes éthiques. Ces dilemmes peuvent avoir un impact négatif sur la santé de ces dernières. En effet, en raison de la détresse générée par ces dilemmes, les infirmières peuvent ressentir des …

Student Wellbeing And Open Studio Process In The School Curriculum, Maria Kim

Expressive Therapies Dissertations

This study aimed to explore whether Open Studio Process (OSP) increased wellbeing of middle and high school students when facilitated by teachers as a part of the regular art curriculum. It was hypothesized that OSP might increase the sense of wellbeing among middle and high school students as well as facilitating teachers. The research was conducted as a mixed methods study in South Korea where students need preventative interventions for their wellbeing. The researcher trained eight teachers to facilitate OSP and five of them implemented it with their classes for seven sessions. Quantitative data (K-YSR; pre- and posttest) were collected …

Exploring The Experience Of Psychological Distress For Young Adults With Cancer: Implications For A New Diagnosis Of Medical Traumatic Stress, Audrey Ryan

Counseling and Psychology Dissertations

The purpose of this qualitative study was to investigate how a serious medical diagnosis, such as cancer, can act as an acute or prolonged trauma. This was explored through the lived experiences of psychological distress of young cancer survivors. Participants were 12 men and women who had been diagnosed with cancer within the past seven years when they were between the ages of 18 and 39. From these interviews several themes emerged that describe the phenomenon of what I have termed medical traumatic stress.

Trauma from a medical event does not currently meet criteria for PTSD in the DSM-5 …

The Effectiveness Of Implementing A Collaborative Mental Health Approach On Quality Of Life For Individuals Of Low Socioeconomic Status, Tyler Z. Tooley

Graduate Theses/Dissertations

The ultimate purpose of this study is to provide insight and education to mental health clinicians, politicians and the general public of the numerous effects poverty has on mental health, in addition to the most beneficial ways to combat those insidious effects. The specific barriers met by individuals of low socioeconomic status severely affect psychological and physical health, as well as social and environmental relationships, which therefore diminish overall quality of life. The aim of this study is to examine the effectiveness of implementing a collaborative mental health approach for low income individuals on length of engagement in services and …

Safe Patient Handling – A Case For National Legislation, David O. Oba

Dissertations and Theses (Open Access)

Introduction: This study examined the effectiveness of Safe Patient Handling (SPH) legislations in difference states across the country. In January 2006, the state of Texas legislated the Safe Patient Handling and Movement Practices Act which required all hospitals and nursing homes to implement safe patient handling and movement program. To date, 10 other states have enacted law or regulations to control work-related musculoskeletal disorders (MSDs) among healthcare workers (HW). Despite the effectiveness of these policies in the individual states, MSDs remain prevalent among HW nationwide. Hence, the call for national legislation. Methods: Using the state-level incidence rate data from the …

Physician Hospital Arrangement Influence On Nonprofit Hospital Quality,Financial Performance And Community Benefit Expenditures, Andrea Cervin

Dissertations and Theses (Open Access)

Federal policy has encouraged hospitals to provide certain quality outcomes and cost containment. Hospitals have responded by forming physician hospital organizations in attempts to achieve quality outcomes and capture reimbursements. At the same time, federal policy has awarded hospitals with nonprofit status with the requirement to provide community benefits in exchange for the tax exemption they receive. With the formation of physician hospital organizations, there remains the question of whether hospitals are achieving desired quality metrics and whether hospitals are financially viable. There is also public and media interest recently regarding whether nonprofit hospitals fulfill their obligations for community benefit …

T​He​ E​Ffect​ ​Of​ U​Nconventional​ G​As​ ​And​ O​Il​ D​Rilling​ E​Missions​ ​On​ A​Sthma​ ​And​ R​Espiratory D​Iseases​ ​In​ ​The​ B​Arnett​ S​Hale​ ​Of​ T​Exas, Stella A. Okoroafor

Dissertations and Theses (Open Access)

Unconventional gas and oil drilling (UGOD) has increased substantially in the United States for more than a decade. The resultant environmental unsafe air pollution effects of UGOD both locally and regionally have been well documented in the literature. Despite the dramatic increase in unconventional well drilling and the toxicant exposure, the health consequences of UGOD remain largely uncertain. This study assesses the relationship between active wells and healthcare use for respiratory diseases by zip code from 2004 to 2008 in the Barnett shale area of Texas. The first modern shale gas well was drilled in the Barnett shale area of …

A Geospatial Examination Of The Association Between Geographic Food Access And Food Insecurity In Central Texas: The Role Of Race/Ethnicity And Urbanicity, Kathryn Janda

Dissertations and Theses (Open Access)

Food insecurity is a public health issue that affects one in ten Americans, one in seven Central Texans, and is associated with malnutrition, chronic disease, and obesity. Geographic food access is the most intervened upon aspect of food insecurity and is often measured objectively through mapping software, such as ArcGIS. Yet when geographic food access is only measured in terms of distance to food retail, analyses do not full capture the nuances of community context. Thus, other sources of data, like survey data, and demographic indicators, such as race/ethnicity and urbanicity, should be incorporated into the research exploring the association …