Thesis (Ph.D.)--Indiana University, Dept. of Health Behaviour and the School of Health, Physical Education and Recreation, 2005. / Source: Dissertation Abstracts International, Volume: 66-06, Section: B, page: 3090. Chair: Mohammad R. Torabi. "Title from dissertation home page (viewed Dec. 4, 2006)."

Thesis (Ph.D.)--Indiana University, Dept. of Applied Health Science, 2006. / Source: Dissertation Abstracts International, Volume: 67-04, Section: B, page: 1953. Advisers: Michael Reece; Stephanie Sanders. "Title from dissertation home page (viewed June 19, 2007)."

Despite a wealth of research which has taken place aiming to improve self-care in adolescents with type 1 diabetes, a paucity of studies could be identified assessing the utility of support proved by peers. This is in spite of evidence which suggests that, for older adolescents, it is peers who provide the greatest support and are therefore likely to offer a weightier resource towards effective self-care (Cattelino et al., 2014; Choukas-Bradley, Giletta, Widman, Cohen, & Prinstein, 2015; Mercken, Steglich, Sinclair, Holliday, & Moore, 2012; Pezzulo et al., 2013; Visser, de Winter, Veenstra, Verhulst, & Reijneveld, 2013). The current thesis therefore represents a significant attempt to understand the role of peer support in adolescents with type 1 diabetes. This doctoral research comprises three studies utilising a mixed methods design. Study 1 employs mixed methodology to understand the lived experience of peer support in a clinical sample. Whilst global peer support was found to be positively related to improved psychosocial and diabetes outcomes, diabetes-specific support was found to be higher in those with poorer glycaemic control. Indeed, when diabetes-specific support behaviours were discussed in semistructured interviews, these behaviours were labelled as unwanted, harrssing and nagging. These findings together indicate the potential for global peer support to offer maintenance of a normal self-concept. Study 2 proposes and assesses an adaptation of the stress-buffering hypothesis (S. Cohen & Wills, 1985) specifically focusing on the psychophysiology of peer support in relation to glycaemic control. Findings suggested that this mechanism was not significant, though limitations with the methodology are acknowledged. Instead, a positive role of stress in relation to improved glycaemic control was found in male, but not female, participants. These results lend support to assertions regarding individualised care plans. Finally, Study 3 assesses the comparability of psychosocial experience between a clinical and reference population of adolescents. Despite differences in peer support, adolescents with and without type 1 diabetes achieve a markedly similar psychosocial profile, minimising the impact of type 1 diabetes on the lives of adolescents. Therefore, the desire for normality outlined in Study 1 seems to be achieved for the most part. Overall, the findings indicate a role for peer support in the attainment and maintenance of a normative self-concept, separate from the sick role. This thesis suggests that peer support offers a different utility to parental support, and is worthy of further investigation. Taken together, these studies underline the importance of considering the person-centred nature of care, with emphasis on the potential benefit of individualised care plans, and particular attention paid to age and gender differences.

<p> Arabic-speaking populations suffer from unique stressors including but not limited to acculturation, making it more crucial than ever to have a validated tool to measure stress in this population. The Stress Overload Scale (SOS), which measures stress perceived as overwhelming relative to one&rsquo;s resources, has proven effective in predicting illness in English-speaking populations; but no Arabic version of the 30-item SOS yet exists. The current study aimed to construct an Arabic SOS, and determine if it maintains its validity in native Arabic speakers in the United States. The 30-item SOS was translated into Arabic using the Cross-Cultural Adaptation method, including back translation. The sample consisted of 90 native Arabic speakers, aged 18 years and over from a large public university, who completed the measures online. The study demonstrated that the Arabic SOS generally paralleled the original version in terms of a two-factor structure (Personal Vulnerability and Event Load) and reliability. The Arabic SOS also demonstrated construct and criterion validity by showing significant positive correlations with the Arabic Perceived Stress Scale and the Patient-Health Questionnaire-15, respectively. Limitations of this study and suggestions for future validation in different Arabic-speaking samples and settings are discussed. It is concluded that the Arabic SOS may offer a better tool for evaluating pathogenic stress in Arabic-speaking populations than current existing measures.</p><p>

<p> Autism spectrum disorder is a neuropsychiatric condition characterized by abnormal interactions, communicative deficits, and perseverative thoughts and behaviors. In addition to these core symptoms, autism is associated with a cognitive endophenotype of spared and impaired executive abilities. People with other neuropsychiatric disorders like schizophrenia also show executive dysfunction. Intact executive function requires prefrontal cortex and its connections to other cortical areas. Measures of executive control in adults with neuropsychiatric disorders are predictive of adaptive functioning, so research should seek methods for minimizing these impairments. A helpful tool in this search is the laboratory mouse. Mice possess homologous prefrontal cortex and assays exist for quantifying rodent cognition. The core domains of autistic behavior can be evaluated in mice as well. Mouse models can therefore be used to investigate neuropsychiatric symptoms. BTBR, <i>LgDel</i>, and <i>Cntnap2</i> mice are valid models of neuropsychiatric disorder. Using visual discrimination tasks presented in an automated operant touchscreen apparatus, three separate studies on these models were performed to determine the cognitive profiles of these mice. BTBR mice and C57 mice were assessed on a series of tasks. BTBR did not differ from C57 on the acquisition or reversal of the visual discrimination. They did, however, show deficits on a novel task that required contextual inhibition of a prepotent response. <i> LgDel</i> mice and wildtype littermates were tested on the visual discrimination acquisition and reversal. <i>LgDel</i> mice were impaired on one measure of the acquisition and several measures of reversal, including learning errors which is thought to depend on medial prefrontal cortical circuitry. Additionally, frequency of layer 2/3 projection neurons in this region significantly correlated with cognitive performance. Lastly, <i>Cntnap2</i> null mice were compared on touchscreen tasks to wildtype and heterozygous littermates. Like <i>LgDel</i>, <i>Cntnap2</i> null mice were impaired on a measure of acquisition and some reversal measures including learning errors. Separately, these studies contribute validation to the behavioral phenotypes of the three mouse models of neuropsychiatric and neurodevelopmental disorder. Together, they also provide evidence of the utility of computer-automated touchscreen systems for revealing subtle cognitive deficits that correlate with prefrontal cortical structures.</p><p>

Background. Self-categorisation theory and the identity-based motivation perspective suggest that people’s motivation to engage in a particular behaviour is stronger when that behaviour is congruent with their salient social identity. In situations where a certain social identity is made salient, or where people identify strongly with a particular group, the social norm associated with that group may have a strong effect on individual behaviour. This perspective can be used to enhance the understanding of health-related intentions and behaviour. The aim of this thesis is to investigate the usefulness of adding concepts related to social identity to existing social cognitive models of healthy eating. The prediction being made is that members of groups that value healthy eating might be more likely to engage in healthy eating when their membership in that particular group is made salient. Five experimental studies tested the effect of social identity salience and group identification on healthy eating intentions and behaviour. Both intentions and behaviour were measured in each of the five studies, to allow for investigating the existence and potential causes of the intention-behaviour gap for healthy eating. Methods and Results. All five studies included random assignment of participants to conditions, and an experimental manipulation of social identity salience or social image healthiness. In Study 1 (n = 149), conducted among female university students, participants’ female, family, or personal identity was made salient. The results showed that increasing the salience of female or family identity led to stronger healthy eating intentions, but did not increase the likelihood of picking a healthy snack over an unhealthy one. Study 2 (n = 115) did not include a successful manipulation of salient social identity, but it showed a positive association between female identification, measured as a trait, and healthy eating intentions, even after controlling for attitude, subjective norm and perceived behavioural control. Study 3 (n = 156) included a manipulation of social identity salience (female or student) and a manipulation of social image healthiness (images presenting in-group members engaging in either healthy or unhealthy behaviour). The results corroborated the earlier finding that female identification is positively correlated with healthy eating intentions. Also, the results indicated that when participants were shown social images of their in-group members engaging in healthy or unhealthy behaviour, they expressed intentions in line with the social images only if they did not express strong identification with the in-group. Study 4 (n = 87) was conducted in the context of Australian identity and included a manipulation of social images healthiness. The findings provided evidence for the existence of a vicarious licensing effect for healthy eating. Namely, for participants who highly identified with their social group, exposure to pictures of other in-group members engaging in healthy behaviour resulted in choosing less healthy food items from a restaurant menu. Study 5 (n = 117) demonstrated the existence of a vicarious licensing effect in the context of female identity, where participants’ food intake during a taste test was predicted by the interaction of the social image healthiness and their group identification. Conclusions. By examining the predictors of both healthy eating intention and behaviour, the research presented in this thesis sheds light on some of the phenomena potentially underlying the intention-behaviour gap for healthy eating, particularly among women. It appears that the healthy eating norm is internalised by women and translated into healthy eating intentions, to the extent that women who identify more highly with their gender group, and those whose female identity is made temporarily salient, also express stronger healthy eating intentions. The association between female identification and healthy eating behaviour, however, appears to be much less consistent, and in most studies the correlation between healthy eating intentions and eating behaviour was poor, even though a variety of measures of behaviour was used. These findings suggest that actual eating is often not predicted by intentions, but depends on contextual factors, such as being given an opportunity to reinforce the healthy eating goal, or the availability of information about in-group members’ eating behaviour. The results also have implications for health-psychological interventions, in suggesting that people’s response to health-related content (such as social images that may be used in health promotion interventions) may be different depending on their level of group identification. In line with the vicarious licensing effect, individuals who report high levels of group identification might be less likely to respond to interventions aimed at their specific social groups.

<p> <b>Background:</b> Annually, two million adults are admitted to US hospitals due to traumatic injury. The trauma recovery process often brings physical and psychological challenges. The Trauma Survivors Network (TSN) is a multimodal program designed to improve outcomes for this population. However, despite early efforts at dissemination, widespread adoption of the program remains low. Understanding barriers and facilitators to adoption and implementation is a common challenge in intervention development and dissemination generally, representing a knowledge gap in planning for the implementation of complex, behavior change interventions more specifically. </p><p> <b>Purpose:</b> The purpose of this project was to qualitatively assess the implementation of the TSN at 6 trauma centers using a combination of prospective documentation and retrospective interviews. The implementation process at each of the participating centers was analyzed and compared to rate implementation strength. Specific barriers and facilitators to program implementation were identified. </p><p> <b>Methods:</b> In this qualitative multiple case study, data sources included implementation logs (6), diary entries (147), and semi-structured interviews with key informants (37). Each of the centers was considered an analytic case. Data analysis followed a primarily deductive approach, using a coding framework based on the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Matrices of themes and cases were constructed, allowing the evaluation constructs at the case and study level. </p><p> <b>Results:</b> The result of this research is the development of a model of program implementation proposing the factors most likely to result in successful implementation of the TSN. Implementation requires leaders at local centers to recognize the need for the program, and working with a dedicated coordinator and engaged opinion leaders, provide the time, support, and resources necessary to demonstrate program continuity and value to staff. This process is facilitated by external, national level support for the program, including the potential incorporation of the TSN into guidelines for trauma center verification, as well as the design of internal processes intended to integrate the program into the center, ensuring acceptance and longevity for the program. The results of this study can assist future adopters of the TSN, improving the likelihood of successful program implementation.</p>

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% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p < .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p < .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients.

This study was conducted to examine the perception of others towards individuals with upper limb amputation and to determine how their ratings were affected by the presence of a prosthesis. The survey included 469 participants from a university in the southeastern United States. Participants read a brief background scenario and then rated pictured individuals with or without amputation, and with and without prostheses. Our assumption was that if one type of image was rated more negatively than others, this discrepancy would quantify stigma and stereotype. After viewing the images, participants rated several attributes associated with disability stereotypes and perceived functional ability using a semantic differential and ability rating scale. Multiple significant findings were observed including higher competence, warmth, and ability ratings of amputees with prostheses as compared to both non-amputees and amputees, lower competence and ability ratings in females as compared to males, and higher ability ratings for individuals with myoelectric prostheses as compared to body-powered prostheses. Perceptions of amputees are important in understanding amputees' experience in many areas such as employment opportunities and psychosocial functioning.

Many college students are in a developmental period in which they are transitioning from pediatric to adult health care. This time period can be challenging for all college students and especially for students with a chronic condition. The current study investigated the association between various health-related factors (health locus of control [HLOC], health literacy, health self-efficacy, and health-related quality of life [HRQOL]) and health behaviors in college students, as well as the moderating effect of having a chronic condition on those associations. These health behaviors were further operationalized as healthy lifestyle behaviors (preventative and wellness behaviors, dietary behaviors, physical activity) and risky behaviors (substance use and risky sexual behaviors). A total of 393 undergraduate students (66.1% female, 24.8% White, 26% chronic condition) completed electronic questionnaire packets. Findings suggested HLOC, health literacy, and HRQOL were significant predictors of engagement in healthy lifestyle and risky behaviors. Chronic condition status moderated a number of associations between HLOC, health literacy, health self-efficacy and both healthy lifestyle behaviors and risky behaviors. Based on these findings, researchers and practitioners should focus on improving and managing these health-related factors, especially among college students with chronic conditions, in order to help students achieve better health outcomes.