2016 PhD Dissertations

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Dr. Roman Samiley successful defense was held on Friday, May 27.

Roman dissertation

Title: Push-Pull Tensions: A Grounded Theory on Social Experience of Use of Healthcare Services Among Homeless Veterans.

The purpose of the study was to develop, from the perspective of the user, a better understanding of the factors that influence use of healthcare services by homeless veterans in the U.S.  The study employed the Grounded Theory (GT) methodology and was guided by Critical Social Theory (CST) and Symbolic Interactionism (SI) as the philosophical underpinnings. There is a scant but growing number of studies on the social experience of homeless veterans in accessing care at the Department of Veteran Affairs (VA).  Understanding these issues is important because of the myriad health, psychiatric, and substance abuse problems they encounter.  As many VA programs have implemented programs for homeless veterans, an investigation of the current social experience is imperative for homeless veterans. CST, or critical theory, was useful in understanding the sociopolitical and historical contexts of health and healthcare and important in understanding the power relations between the U.S. government and the homeless veterans within the healthcare setting.  This approach enabled the development of knowledge from the subjective perspective.  CST was useful in exploring injustices related to homeless veterans’ access to VA healthcare because this approach exposes the hidden relations of domination and powers inherent in society’s fundamental structures and ideologies.  SI provided a tool to understand the social interaction of veterans acquiring healthcare. Eighteen homeless veterans were recruited and interviewed at one homeless shelter and two transitional housing programs in the Skid Row area of Los Angeles and the Westside. The qualitative methodology of GT was employed to understand the perspective of the participant or agent, which is in line with the emancipatory aims of CST. The GT developed from these data led to the focus of the theory, which is on the tensions involved in push and pull forces and the outcomes that arise as a result.  Hence the theory has two major concepts:  Push/pull tensions and outcomes.   

 

Dr. Eden Brauer successful defense was held on May 26, 2016.

eden brauer

Title:  Improving to Where?: Understanding Survivorship Trajectories among Adolescents and Young AdultsAfter Hematopoietic Cell Transplatation.

Committee: Dr. Patricia Ganz, Dr. Carol Pavlish, Dr. MarySue Heilemann (chair) and Dr. Huibrie Pieters.

 

Dr. Kia Skrine Jeffers successful defense was held on May 16, 2016

kia

Title: Learning and Playing the Game: A grounded Theory about Surviving Structural Racism and Diabetes Among Older African Americans

Committee Members: Dr. Linda Phillps (chair), Dr. Mary Cadogan, Dr. MarySue Heilemann, Dr. Sarah Haley and Dr. Elizabeth Thomas.

Despite being a manageable chronic condition, type 2 diabetes is among the leading causes of death and disability in the United States.  Of the 29.1 million people who have diabetes in the U.S., almost half are adults ages 65 years and older. African American seniors are more likely to develop the condition, and experience diabetes-related complications compared to other racial groups. These complications lead to end stage renal disease, non-traumatic lower extremity amputations, heart disease and premature death at two to four times the rates of their non-Hispanic White counterparts. Recent evidence offers an explanation of differential risk for complications between racial groups. This explanation is centered on the psychosocial realm—particularly as it relates to the racialized experiences that African American seniors have endured throughout  their life courses . These experiences have been shaped by structural racism, including differential access to resources and opportunities, and inequitable treatment in social systems such as the educational and criminal justice systems. Growing evidence has shown that the accumulation of structural barriers over the course of marginalized groups’ lives increase their vulnerability for excessive morbidity and premature death.

This study utilized a constructivist grounded theory methodology to understand the potential relationships between this study’s sample (N=15) of African American seniors’ experiences with structural racism across their life courses, and their experiences with uncontrolled type 2 diabetes in older age. The author’s interpretation of the fit between participants’ narratives about structural racism and diabetes was centered on the processes through which participants dealt with social- and health-related threats. The findings revealed behavioral patterns that clustered into three major constructs: Identifying Threats, learning to negotiate those threats in concert with others (termed “Learning and Playing the Game”), and Exercising Agency by taking control of themselves in spite of the structural limitations that surrounded their lives.

Dr. Marlon Garzo Saria Successful Defense was held May 20, 2016

Marlon PhD

Title:  The Hidden Morbidity of Cancer: An Exploratory Study of Burden in Caregivers of Patients with Brain Metastases

Committee: Dr. Annette Stanton, Dr. Adey Nyamathi, Dr. Linda Phillips, Dr. Sally Maliski (chair)

 

Dr. Maria Yefimova successful defense was held May 20, 2016.

Maria Y PhD

Title: Using in-Home Monitoring Technology to Identify Deviations in Daily Routines Preceding Changes in Health Trajectory of Older Adults

Committee Members: Dr. Betty Chang, Dr. Jan Mentes (chair), Dr. Lynn Woods, Dr. Wendie Robbins

The boom of in-home monitoring technology offers unprecedented information about an individual’s interaction with the environment. A variety of low cost sensors can continuously and unobtrusively collect information about activities in the living space. Capturing early changes in the daily routines of vulnerable older adults residing in these “smart homes” may allow clinicians to predict and prevent negative health consequences through timely intervention. However, the current state of science is hampered by the lack of theoretically driven approaches to analyze sensor data in relation to clinically meaningful health outcomes. The aims of the study are 1) to characterize an older adult’s daily routine, as captured with smart home sensors, 2) to assess if deviations from it are indicative of changes in their health trajectory, such as falls, ER visits or unplanned hospitalizations, and 3) identify between person factors that affect the characteristics of the daily routine. It used previously collected data from 10 residents of TigerPlace, a unique retirement facility that evaluates health technology affiliated with University of Missouri, Columbia. Older adults live in apartments equipped with network of motion, depth and bed sensors that unobtrusively collect information about daily activity of its resident. Thirty months of continuous sensor data were analyzed in the context of bi-annual clinical assessments and nursing notes extracted from the electronic health record. A retrospective multiple case study approach is guided by the conceptual model developed for this study that is grounded in nursing and gerontological literature. Changes in the temporality and frequency of daily activity were found for common geriatric symptoms, such as urinary symptoms and confusion. Seasonal and weekly effect was evident across participants in the duration of time spent in various areas of the apartment. Participants varied in their baseline daily routines, but for the majority of symptoms there were prodromal changes in at home activity that was detected with sensors. As the cost of technology adoption decreases, nurses can use these innovative tools to coordinate care and intervene early to prevent or mitigate the functional decline associated with vulnerable older adults.

 

Dr. Fayette Nguyen Truax successful defense was held May 19, 2016

Faye PhD

Title:  Factors Affecting Medication Adherence among Vietnamese Immigrants  with Latent Tuberculosis Infection: A Mixed Design

Committee Members:  Dr. Felicia Hodge, Dr. Morisky, Dr Lynn Brecht and Dr. Sally Maliski (not shown).

 Completion of latent tuberculosis infection (LTBI) treatment among foreign-born Asians in the United States (US) is suboptimal, thus leading to high rates of reactivation tuberculosis (TB) among this population. Approximately 77% of TB cases in the US are from reactivation TB and foreign-born Asians have a higher reactivation rate compared to Blacks, Hispanics and Whites. In Orange County (O.C.), the annual TB case rate continues to remain steady at 6.0 cases per 100,000 in 2014 with foreign-born persons from Vietnam leading with a TB rate of 49.7%, Mexico at 14.4% and the Philippines at 12.6%. Overall the high number of active TB cases among Vietnamese immigrants, coupled with low LTBI treatment completion rate of approximately 50.1% in the overall Asian population, presents an important challenge to the national strategy of eliminating TB (Li et al., 2010). At this time, there is limited data on Vietnamese immigrants with LTBI in the US. 

 The purpose of this mixed methods study is to identify the factors related to LTBI treatment acceptance and completion in addition to exploring the decision-making process of LTBI treatment adherence among Vietnamese immigrants. Predictors for phase 1 included: socio-demographic characteristics, basic health history, behavioral survey scores measured by Morisky Medication Adherence Scale (MMAS-8), Champion Health Belief Model Scale (CHBMS-29) and the Self-Efficacy for Appropriate Medication Use (SEAM-9).  Significant predictors for multivariate analysis for treatment acceptance included individuals with a history of smoking and recent contact with an infectious TB case.  For treatment completion, the top two most significant predictors in the univariate analysis included age group between 18-44 years and current employment. No significant predictors were identified in the multivariate analysis for treatment completion. There were also no significant correlations identified between the psychosocial measurements (SEAM-9, CHBMS-29, MMAS-8) and treatment completion.

 In phase 2, a decision-making grounded theory model entitled “The Decision-Making Model for Latent TB Infection Treatment Acceptance and Completion” was developed from the stories and testimonies of 17 Vietnamese participants. Three primary decision-making points were identified that was critical to the development of the proposed model: treatment acceptance, treatment initiation and treatment completion. Three categories emerged from participants’ data that were directly related to the decision to accept LTBI treatment, “beliefs”, “TB awareness” and “trust in healthcare”. Findings revealed the only category to influence treatment initiation was “barriers” to scheduling. Lastly, the decision to maintain adherence and complete treatment were strongly influenced by self-determination, medication side effects, and having family support.

 Based on this study’s findings, target screening of Vietnamese immigrants at highest risk for latent TB reactivation should be done more frequently in private community clinics and focus on reducing barriers to treatment acceptance, initiation and completion.

Dr. Avis Ing-Randolph successful defense was held May 4, 2016.

avis_ing

Title: Effect of a Group Music Nursing Intervention on Anxiety Among Individuals with Mild to Moderate Dementia in Los Angeles Assisted Living Facilities
Committee Members: Eunice Lee (chair) Sophie Sokolow, Linda Phillips, Frank Heuser


This study tested the hypothesis that an active-passive group music intervention will decrease anxiety among individuals diagnosed with
mild to moderate dementia in assisted living facilities (ALFs) as compared to a control group engaged in care as usual. This study also described the feasibility and acceptability of active-passive group music interventions delivered by an RN without a university or college degree in music intervention techniques to individuals with mild to moderate dementia in an ALF.  The study used a quasi-experimental cross-over design with a simplified cluster randomization strategy; simplified because there were only two sites.  Thirteen participants were invited, 8 from one facility and 5 from the other.  The sample comprised of participants ranging from age 74 thru 98 with Global Deterioration Stages ranging from 2-5.  The majority of participants were female, White and were college educated.  Music was considered moderately important to very important.  Music was used to effect anxiety levels.  Altogether 12 intervention sessions were offered or 6 for each arm.  There was a 4 week wash-out period.  Four RAID measures were taken during each arm at baseline.  Specific Aim 1:  Insignificant decreases to anxiety existed by group, however, a trend showing decreases to anxiety levels existed over time (p=0.002):  Intervention Group 1 = 18.00 at point 1 to 14.83 at point 4; Intervention Group 2 = 17.20 at point 1 to 10.80 at point 4).  During control periods, RAID were:  Group 1= 13.33 point 1 to 10.83 point 4; and Group 2 – 13.60 point 1 to 10.40 point 4.  Specific Aim 2:  With music education, the use of RNs to deliver group music interventions and supervise music interventions in healthcare is promising.  

 

Dr. Tiffany Montgomery successful defense was held May 12, 2016. 

Tiffany-dissertation-abstract

Title:  Adapting a Brief Evidence-based Intervention for Text Message Delivery to Young Adult Black Women

Committee Members:  Dr. Deborah Koniak-Griffin (chair) , Dr. Vickie Mays, Dr. Adey Nyamathi, Dr. MarySue Heilemann.

Young adult Black women have the highest sexually transmitted disease rates among all U.S. women. There are several evidence-based interventions (EBIs) targeted toward this population, yet they each require travel to a healthcare facility or other location. With the increased use of mobile devices, mobile health technology is being utilized more frequently to deliver health interventions. Instead of creating entirely new technologically savvy interventions, the CDC recommends adaptation of EBIs. The purpose of this study was to adapt an EBI for delivery via text messages.

This two-phase, mixed methods pilot study was guided by several philosophical underpinnings (empiricism, critical theory, pragmatism, and intersectionality) and theories (Social Cognitive Theory, Theory of Planned Behavior, and Theory of Gender and Power). A modified version of the ADAPT-ITT model was also used to guide the study. During phase one, a research advisory board was recruited to assist with intervention adaptation, phase two recruitment strategies, and interpretation of study results. In phase two, the newly adapted intervention was pilot tested among a sample of young adult Black women (n = 88), who were randomized to the intervention or control group. Study outcomes included intervention acceptability and feasibility, and preliminary changes in condom use, condom-use self-efficacy and intention, and sexual relationship power.

Acceptability and feasibility of the intervention were high. The overwhelming majority of comments from intervention group participants were positive. Between baseline and follow-up, condom use frequency increased among participants in both study groups. However, there was no significant time by group interaction. Furthermore, while condom use self-efficacy and intention significantly increased among participants in both groups, no time by group interaction was found. Finally, intention was identified as a main predictor of condom use at baseline and follow-up.

The results of this study provide support for intervention modifications that may strengthen outcomes in a future efficacy study of the revised S2S text messaging intervention. It is important that women’s health researchers and educators continue to adapt and evaluate interventions using technologically advanced methods of delivery. Text messaging is a promising method of delivery for EBIs aimed at the reduction of high-risk sexual behaviors among young adult Black women. Intervention adaptation using other types of technology should be investigated as well.

Young adult Black women have the highest sexually transmitted disease rates among all U.S. women. There are several evidence-based interventions (EBIs) targeted toward this population, yet they each require travel to a healthcare facility or other location. With the increased use of mobile devices, mobile health technology is being utilized more frequently to deliver health interventions. Instead of creating entirely new technologically savvy interventions, the CDC recommends adaptation of EBIs. The purpose of this study was to adapt an EBI for delivery via text messages.

This two-phase, mixed methods pilot study was guided by several philosophical underpinnings (empiricism, critical theory, pragmatism, and intersectionality) and theories (Social Cognitive Theory, Theory of Planned Behavior, and Theory of Gender and Power). A modified version of the ADAPT-ITT model was also used to guide the study. During phase one, a research advisory board was recruited to assist with intervention adaptation, phase two recruitment strategies, and interpretation of study results. In phase two, the newly adapted intervention was pilot tested among a sample of young adult Black women (n = 88), who were randomized to the intervention or control group. Study outcomes included intervention acceptability and feasibility, and preliminary changes in condom use, condom-use self-efficacy and intention, and sexual relationship power.

Acceptability and feasibility of the intervention were high. The overwhelming majority of comments from intervention group participants were positive. Between baseline and follow-up, condom use frequency increased among participants in both study groups. However, there was no significant time by group interaction. Furthermore, while condom use self-efficacy and intention significantly increased among participants in both groups, no time by group interaction was found. Finally, intention was identified as a main predictor of condom use at baseline and follow-up.

The results of this study provide support for intervention modifications that may strengthen outcomes in a future efficacy study of the revised S2S text messaging intervention. It is important that women’s health researchers and educators continue to adapt and evaluate interventions using technologically advanced methods of delivery. Text messaging is a promising method of delivery for EBIs aimed at the reduction of high-risk sexual behaviors among young adult Black women. Intervention adaptation using other types of technology should be investigated as well.