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Diabetes has alarming prevalence rates not only in the U.S., but also worldwide. Ethnicity plays a large role with Hispanic-Americans having one of the highest prevalence rates. Diabetes is a complicated disease that requires significant lifestyle modifications. The health belief model (HBM) has been investigated as a theory to explain behavior change. However, little research has been done to determine its utility to Mexican-Americans. In the current study, participants were Mexican-American adults (N = 66) with type II diabetes who were recruited from family medicine clinics. Self-report questionnaires included the General Acculturation Index (GAI) and the Multidimensional Diabetes Questionnaire (MDQ). Participants had the option to complete them in either Spanish or English. Laboratory values were collected from medical charts. A MANCOVA indicated that two variables were significant, perceived severity (PS) and misguided support behaviors (MSB), p < .05. With respect to the HBM, PS was identified as a component of an individual's perception, acculturation was a modifying factor, and MSB was a component of the likelihood to change factors. These three affected glycemic control. Odds ratios determined that individuals with better glycemic control had less perceived severity and less misguided supportive behavior. Individuals with the least acculturation were more likely to have best glycemic control. Significant results were found for each of the three main columns of the model suggesting that the HBM has utility for the Hispanic-American population with type II diabetes. Results suggest that health care personnel should be aware of the ramifications of patients' perceived severity of their illness as well as the amount the "nagging" type support they receive from friends and family on glycemic control. This awareness can lead to the development of interventions aimed at improving glycemic control and the quality of life in Mexican-Americans with diabetes. Specifically, programs focused on incorporating the family may lead to improved psychosocial and educational outcomes since familial relationships are crucial in this population.

Insufficient physical activity detracts from healthy living and has a disparate impact on African American women and their female children. The extensive body of prior research addressing preventable chronic disease and other consequences of insufficient physical activity includes limited information specific to African American single mothers. The purpose of this descriptive phenomenological study was to gain an understanding of African American single mothers' perceptions of physical activity. Specifically investigated were African American women's familial influences and potential effects of these influences on their children's health behaviors. The health belief model served as the theoretical framework for this study and provided a contextual lens to explore research questions to elicit African American single mothers' perceptions of physical activity. Six African American single mothers participated in semistructured interviews that produced data for this study. Use of Colaizzi's data analysis method revealed thematic single mother reports of healthy lifestyle, social support, resources/education, body/self-image, stress management, fear and embarrassment, motivation/inspiration, and injury/illness as factors affecting their engagement in physical activity. Future research opportunities include exploring multilevel interventions specific to African American single mothers and using common weight-related terminology. Study findings could benefit health educators, administrators, and providers. Positive social implications include improved physical activity and health outcomes for African American single mothers with ultimate decreased health care costs for the U.S. society.

Despite increased access to care and interventions aimed to change health behavior, socioeconomic health disparities have remained unchanged, even for preventable illness and disease. Health behavior theories and interventions heavily rely on perceptions of control over one's fate and thus ignore populations with low perceptions of personal control. Poverty is associated with an external locus of control (LOC), while both poverty and external LOC are associated with less health protective behavior. The purpose of this quantitative study was to explore the role of LOC as an adaptive response to poverty and to discover the risks and benefits to physical and psychological health associated with LOC orientation. Using cross-sectional survey methodology, 136 adult participants from the United States were recruited through snowball sampling to anonymously complete measures of the Multidimensional Locus of Control (MLOC), the Health Promoting Lifestyles II (LPII), the Kessler Psychological Distress Scale (KP10), and a demographic questionnaire. Hierarchical regression and bivariate analyses were used to test the hypotheses. According to the study findings, chance LOC mediated the relationship between socioeconomics and health lifestyles, while external-chance was associated with less healthy lifestyle choices than external-powerful others. Internality did not offer any psychological protections from anxiety and depression for low socioeconomic populations. Implications for social change are to further the understanding of the role of perceived control on health beliefs, behavior and psychological well-being for marginalized populations to promote the development of appropriately targeted, culturally sensitive health interventions.

When caregivers defer their personal routine dental care (RDC) in order to provide RDC for their children, they risk detrimental consequences in their personal health and the health of their children. The purpose of this qualitative case study was to identify the risk factors that led to the parental dental deferment decision. The oral health and personal care services conceptual models guided the development of the research questions, facilitated the selection of risk factors on the decision-making process, and provided the basis for the data analysis thematic categories. Ten caregivers who made the decision to defer their personal RDC for the sake of their children's RDC participated in the study. Interviews were transcribed verbatim and analyzed thematically. According to the results of the study, the oral health beliefs of caregivers shaped their decision to seek RDC for their children while financial barriers, dental fear, and distrust obstructed their capacity to seek RDC for themselves. Caregivers placed a higher priority on their children's wellbeing--including dental care--than on their own health, despite knowing the association between poor oral health and serious health conditions. These findings indicated, for caregivers, deferring personal RDC was not a lack of desire, education, or care but striving for constant balance between affordability and providing their children with every healthy opportunity in life. The positive social change implications of this study include increasing the proportion of adults receiving RDC yearly through development of targeted interventions that increase caregivers' access to and utilization of dental care services. Such efforts would support the strategies implemented to achieve Healthy People 2020 objectives.

The overall aim of this thesis was to provide knowledge on the one handSomalian-born immigrants´ experiences of living with diabetes mellitus (DM)in a new cultural environment, on the other hand their encounter with Swedishdiabetic care – this from both their own point of view and that of the health-care professionals. There was an endeavour to describe methodological aspectsof the interpreter´s role in respect of the trustworthiness of research performedin multicultural societies. A descriptive design was used, involving threequalitative interview studies with an interpreter (Studies II-IV) and onesystematic literature review (Study I). The latter served as a foundation forconducting the interviews with an interpreter and the Matrix Method was used.The same 19 patients with diabetes of Somalian origin participated in StudiesII-IV, joined by five health-care professionals in Study IV. The interviews weresubjected to qualitative content analysis in the case of Studies II and III, and to phenomenograpic analysis in the case of Study IV. In Study I, 13 empirical cross-cultural interview studies with aninterpreter involved were scrutinized. The findings showed that the interpreter’srole in the research process was given little attention. There was usually noaccount either of the style of interpreting, the interpreter’s previous experienceor the seating arrangements for the interviews. On the other hand most of thestudies offered direct or indirect information about the interpreter’s knowledgeof the aim of the research or participation in the transcription of the text or data analysis. The most frequent techniques used to established trustworthiness were prolonged engagement and member checks. A prominent problem for the participants in Study II was to give uptraditional eating habits. Difficulty in managing everyday life was mentionedespecially by women in connection with the need to keep to the diet regimebecause of a lack of understanding and support from family and friends. Tochanging lifestyle was considered as a hard work and a number of barriers wasmentioned especially when it comes to eating habits. The findings showed avariation how the participants managed the fasting month of Ramadan. Thosewho fasted did not see the diabetes as an obstacle, others did so and indicated that fasting was not compulsory for a sick person. In study III the findings showed that women used more supernaturalbeliefs than men when they described their experiences in connection with thediagnosis and their health beliefs. Most of the experiences of receiving thediagnosis consisted of ways of managing this information. Commonlymentioned by the participants, irrespective of gender, when they receiving thediagnosis was a attempt to find some advantages, or positive comparison. Other participants tried to repress the diagnosis and doubted it. Most of theparticipants, irrespective of gender, did not immediately respond with shock orother strong emotion when they received the diagnosis. In study IV the patients conceived the diabetes care as being of highquality but they also conceived limitation with the care. They conceived unmetneeds such as too long waiting times for appointments, not encountering thesame physician every time, lack of contact with specialists and failure toculturally adapt dietary advice. Health-care professionals conceived severalcultural challenges in the encounter such as managing language barriers,illiteracy and traditions such as fasting during Ramadan. In conclusion, this thesis generate knowledge which can serve as afoundation to securing the quality of diabetes care for this patient group andcontribute to working out local diabetic programmes for patients with anotherbackground than the Swedish. In addition the thesis can contribute to makingimprovements when it comes to working with an interpreter in qualitativeinterview studies as well as in clinical settings.

En 2015, les pathologies cardiovasculaires étaient responsables de 18 millions de décès par an dans le monde, ce qui en fait la principale cause de mortalité liée aux maladies non-transmissibles. Il a été mis en évidence que des changements de comportements multiples en termes d’activité physique, d’alimentation, de consommation de tabac, et d’observance médicamenteuse, représentaient des moyens efficaces de prévenir l’émergence de cardiopathies chez des populations générales, et des rechutes après un accident cardiaque. En psychologie sociale et de la santé, la compréhension des déterminants des comportements de santé s’est principalement appuyée sur deux approches : l’approche socio-cognitive et l’approche duale. Bien que ces modèles aient identifié plusieurs prédicteurs du comportement, ils sont porteurs de limites qui les rendent difficilement applicables au cadre du changement de comportements multiples. D’une part, ces approches proposent des déterminants spécifiques à un comportement, ce qui ne permet pas de comprendre ce qui détermine l’adoption de plusieurs comportements simultanément. D’autre part, ils ne prennent pas en compte la nature des comportements de santé. Or, les comportements diffèrent sur un certain nombre de caractéristiques, et les comportements pathogènes peuvent s’opposer aux comportements salutogènes, générant alors un conflit chez l’individu. Dans le cadre des changements de comportements multiples, une mauvaise gestion de ce conflit pourrait expliquer la prévalence des comportements pathogènes. Ce travail doctoral a investigué le rôle de deux processus de réduction du conflit pertinent dans le cadre du changement de comportements multiples : les cognitions compensatrices et le contrôle de soi. Plus précisément, ils ont cherché à évaluer (1) dans quelle mesure le mécanisme inter-comportemental des cognitions compensatrices pouvait perturber la formation d’intention envers des comportements de santé ; et (2) si le contrôle de soi était un déterminant aspécifique permettant l’émergence de plusieurs comportements de santé. Nous avons répondu à ces questionnements à travers quatre études empiriques décrites dans trois manuscrtis. Le premier a évalué le rôle délétère des cognitions compensatrices (en dissociant celles-ci selon la nature des comportements) sur la formation d’intentions envers différents comportements de santé, chez des individus atteints de cardiopathies. Les résultats ont montré que ces croyances peuvent avoir des effets négatifs sur les intentions à certains niveaux d’auto-efficacité et de risques perçus. Le deuxième manuscrit présente une étude qui a évalué dans quelle mesure le modèle du contrôle de soi, auquel nous avons intégré une mesure de l’état de la capacité de contrôle de soi, prédisait les comportements de santé. Nos résultats montrent des processus globalement différenciés selon le type de comportement : activité physique/sédentarité, alimentation équilibrée/déséquilibrée, et consommation de tabac. Plus précisément, ils suggèrent que l’effort de contrôle de soi prédirait les comportements pathogènes, et que l’état de la capacité de contrôle de soi prédirait les comportements salutogènes. Le troisième manuscrit a cherché à confirmer ces résultats chez deux populations, l’une d’étudiants, l’autre d’individus atteints de cardiopathies, en testant le modèle du contrôle de soi en contexte naturel et dans un devis longitudinal. Bien que des différences dans les patterns de résultats soient observés selon la population, les résultats semblent confirmer le rôle de l’effort de contrôle de soi sur les comportements pathogènes (sédentarité et alimentation déséquilibrée), et de la capacité de contrôle de soi sur les comportements salutogènes (activité physique). L’ensemble de ces résultats ouvrent la voie vers la construction d’interventions ciblant ces deux composants du modèle du contrôle de soi, afin d’améliorer l’adhérence aux comportements de santé chez des populations cardiaques. / In 2015, cardiovascular diseases caused 18 million deaths per year worldwide, which makes it the leading cause of death attributed to non-communicable diseases. Multiple health behaviors change in terms of physical activity, diet, tobacco consumption, and medication adherence represent one of the best ways to prevent cardiovascular diseases emergence on global population, and to prevent relapses on individual with cardiovascular diseases. To understand behaviors determinants, social and health psychology relies on two conceptual frameworks: socio-cognitive models and dual-process theories. These models identified several behavioral determinants, but two reasons could make their application difficult in the multiple health behavior change framework. First, these approaches proposed behavior-specific determinants that do not permit to understand what determines the simultaneous adoption of several behaviors. On the other hand, they do not consider behaviors characteristics. However, behavior characteristics could be different and unhealthy behaviors could confront healthy behaviors, and thus generate conflicts on an individual. Within the multiple health behavior change process, poor conflict-coping strategies could explain unhealthy behavior prevalence. This doctoral work has investigated role of two processes of conflict reduction within multiple health behavior change: compensatory health beliefs, and self-control. Specifically, they evaluated (1) to what extent compensatory health beliefs, a between-behavior belief, could harm intentions toward healthy behaviors; and (2) if self-control could be an unspecific determinant of multiple health behavior change. We conducted four empirical studies merged in three manuscripts to answer these questions. The first manuscript evaluated compensatory health beliefs harmful influences (by dissociating them according with behaviors nature) on intentions formation process toward several health behaviors, within individual with cardiovascular diseases. Results showed that these beliefs could harm intentions depending on certain self-efficacies and risks perception levels. The second manuscript presented a study that investigated to what extent the self-control model, with a measure of state self-control capacity, predicted health behaviors. Results highlighted different prediction patterns depending on behaviors domain: physical/sedentary activity, healthy/unhealthy diet, tobacco consumption. More precisely, results suggest that self-control effort predicted unhealthy behaviors, and state of self-control capacity predicted healthy ones. The third manuscript attempted to confirm these results on two populations. The first one was composed of students, and the second one was composed of individual with cardiovascular diseases, by testing self-control model on ecological context and with a longitudinal design. Despite differences within predictions patterns, depending on the population observed, results confirmed the role of self-control effort on unhealthy behaviors (sedentary time and unhealthy diet), and of state self-control capacity on healthy behavior (physical activity). Taking together, all these results pave the way to the development of interventions on these two self-control model components, in order to improve health behaviors adherence of individual with cardiovascular diseases.

Twenty five years after AIDS was first scientifically described, the disease continues to take its toll on the human population. HIV/AIDS disproportionately affects marginalized groups such as poor, underserved, minority populations. In the United States, Blacks become infected with and die from HIV/AIDS more than any other ethnic or racial group. Despite a vast body of literature on HIV/AIDS, little research has focused on black heterosexual men and even fewer studies have explored the context of risk among subgroups of black men. Using qualitative research methods and a socio-ecological framework, this study explored the intrapersonal, socio-cultural, and behavioral factors that influence sexual behaviors in ethnic subgroups of black men who identify as heterosexual. Further, the study examined black women's perceptions of the sexual behaviors of black men. Conducted in a metropolitan area in Southwest Florida, the study consisted of two phases: 1) semi-structured in-depth interviews were conducted among U.S.-born (N=15) and Haitian-born (N=14) heterosexual men who are 18 years and older and have lived in the U.S. for at least 3 years. 2) Using focus group methodology, phase 2 explored black women's (N=23) perceptions of black male sexual behaviors. Study findings have significant implications for public health education, research and practice. Findings reveal that while Haitian-born and U.S.-born men have high levels of knowledge about HIV, they also ascribe to HIV conspiracy beliefs and practice high risk sexual behaviors such as unprotected sex and partner concurrency. Results show that black men's sexual behaviors are influenced by socio-ecological factors such as family norms, hip-hop culture and religious beliefs. Female study participants perceived factors such as masculine ideologies, socialization, and the male-to-female ratio imbalance as critical influences on male sexual behaviors. While intrapersonal approaches are important to address HIV risk behaviors, ecological frameworks are necessary to inform the development of HIV prevention programs that address the socio-ecological factors that create an environment of risk. This inquiry underscores cultural and gender differences in the conceptualization of HIV/AIDS. Findings have implications for HIV prevention and demonstrate the need for gender-specific and culturally relevant HIV prevention approaches for U.S.-born and Haitian-born blacks.