The purpose is to promote culturally competent care among healthcare providers by identifying and describing how Hispanics in East Tennessee view health and what they do to prevent illness. A focus group of six to ten Hispanics of mixed genders over age eighteen moderated by a native Spanish-speaking interpreter. Questions explored how Hispanics define health and sickness, health maintenance practices, and alternative medicines and practices. Results were interpreted from Spanish to English to be analyzed. The Circle in Which You Live was described by members as consisting of relationships, physical health, and peace of the mind and soul. In Shutting Themselves in Their Stress, group members described Hispanic women specifically as experiencing stress most often. Members explored how the mind attracts illness, types of pain, and nonpharmacological remedies in The Problems Do Not End. Stress is a major concern for health. Hispanics have a very holistic view of health. Pain relief methods mentioned by participants include distraction, bags of ice, and relaxation. Healthcare providers need to take time to ask about specific stressors in patient’s lives, collaborate with the patient, and explore ways to decrease and manage stress in a culturally sensitive manner.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purposes of this study were to describe the relationship of sociodemographic and biomedical characteristics to health perceptions among individuals with rheumatoid arthritis (RA) and to identify which functional measures are associated with one's health perceptions. Data were extracted on 395 individuals with classical or definite RA for a secondary data analysis. These data had been collected between 1978 and 1982 using the Arthritis Impact Measurement Scales (AIMS), a reliable and valid self-administered questionnaire on health status. Sociodemographic information included age, sex, current marital status, occupation, income, and engagement in a productive role. Biomedical data included a respondent's disease duration, disease severity, and comorbid conditions. A dependent variable which classified health perceptions (HP) was constructed from two AIMS questions concerning self-assessed current health and belief in the ability to resist illness. Using subjects' sociodemographic characteristics and biomedical indicators as determinants of health perception classifications (HPC), repondents were grouped into nodes through a recursive partitioning technique (CART). Income, disease activity, current marital status, age, and comorbidity were identified by CART as important and interactive determinants of HPC. In the second phase of analysis, differences in function between HP groups on the nine AIMS scales were explored using subjects' self-assigned HP groups, while controlling for sociodemographic and biomedical characteristics and their potential interactive effects as they had been identified by the CART algorithm. Analysis of these differences demonstrated that the explanatory sociodemographic and biomedical variables used in this study both explained and masked significant differences between HP groups on certain functional measures. Finally, the analysis determined which functional measures were most associated with self-assigned HP using a stepwise logistic regression model. Anxiety, physical activity and household activity formed an overall explanatory model of HP. Physical activity and depression were associated with current health perceptions. Perceived resistance to illness was related to subjects' levels of anxiety and household activity. / 2031-01-01

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Thirty-two Antiguan women from a women's church group attended participatory group meetings to describe their priority health definitions, perceived health barriers, preferred health barrier solutions, and body size preferences and perceptions. Participants were 21-70 years old, and were divided into three age groups. Although 70% of the sample were either overweight or obese, weight issues received little priority as a health related factor. Instead, women under 30 defined health more in terms of personal appearance, and dietary inadequacy from lack of resources, with priority for mental and social health barriers, while those in their 30's were mainly concerned about barriers related to their mental and social well-being, and those ~ 40 years gave priority to dietary inadequacy and inactivity barriers related to chronic and general health factors. Although self-curing barrier solutions were most preferred~ religious and medical solutions were perceived as easier to attain. Using silhouettes, women under 30 frequently chose thinner ideals than those over 30, and perceived themselves as heavier than anthropometric measurements indicated, while those ≥40 years perceived themselves as lighter. / Master of Science

Doctor of Philosophy / Department of Human Ecology-Personal Financial Planning / Sonya L. Britt / There is limited research on physiological stress in the financial planning field. While the literature shows a clear relationship between physiological stress and physical health, little is known about the relationship between physiological stress and financial health perceptions. With Lazarus and Folkman’s (1984) theory of cognitive appraisal serving as the framework for this study, three multivariate regressions investigated the relationship between chronic physiological stress and financial health perceptions as measured by changes in financial satisfaction, changes in financial strain, and expectations about one’s financial situation in the future. The sample consisted of 703 individuals that were recruited from 2011-2014 to participate in the Midlife in the United States Refresher study. Based on non-imputed data, respondents were evenly split between male and female and between 25 and 76 years old with a mean age of 51 years old. Respondents were also mostly white, working, married, and had some college education. The sample reported mean household income of $71,052 and a net worth of $586,329. The mean salivary cortisol level was 16.06 Nanomoles per litre (nmol/L), and respondents reported better than the median score for self-reported health status. When comparing before the recession to present day, the mean responses from respondents indicated that their financial strain remained about the same, but financial satisfaction declined. Respondents reported better than the median score for expectations about their financial future. An ordinary least squares regression was used to model changes in financial satisfaction. A cumulative logistic regression was used to model changes in financial strain and expectations about one’s future financial situation. The model results provided support for several key hypotheses formed from the theoretical framework. In particular, salivary cortisol, the proxy for chronic physiological stress, had a statistically significant negative relationship with expectations about one’s future financial situation. An increase in chronic physiological stress was associated with lower expectations about the financial future. There was not a statistically significant relationship between salivary cortisol and changes in financial satisfaction or changes in financial strain. Given the sparse physiological stress research that exists in the financial planning field, this study provides researchers and practitioners with new information regarding the impact of chronic physiological stress on financial health perceptions. Measuring physiological stress in a non-experimental setting gives researchers a different approach to understanding the impacts of physiological stress. For practitioners, uncovering the relationship between chronic physiological stress and financial health perceptions might promote the use of stress reductions as part of holistic approach to financial planning.

Access to oral health care remains problematic for millions of Americans. Factors such as socioeconomic status, age, race, and lack of dental insurance benefits inhibit the ability of many to obtain preventative oral health care. The aim of this study was to explore the effect of preventive oral health treatment and education at reduced-fee dental hygiene facilities on the oral health behaviors and perceptions of socioeconomically deprived persons within the state of Georgia. This study was based on the health belief model constructs. A convenience sample of 102 participants was recruited from the individuals who visited two dental hygiene colleges to seek treatment for the first time. The independent variable was the receipt of reduced-fee dental hygiene treatment/education. The dependent variables were the oral health perceptions and behaviors of socioeconomically deprived persons, as well as the perceptions and behaviors of patients provided with a referral for follow-up treatment with a dentist. Mediating variables were sex, age, race, and socioeconomic status. Wilcoxon Signed Rank test and logistic regression were applied to detect potential differences in the dependent variables before and after treatment. The most significant changes were found in categories dealing with self-efficacy measures that patients could take to improve their own oral health. Also, the oral health behaviors and perceptions of younger, African-American of low educational and financial background were significantly more improved after treatment. The social change implication of this research may be that oral health practitioners can use these results to create preventative interventions more tailored for socioeconomically deprived persons who face complicated oral health issues.

There is a lacuna in the field of positive psychology as far as the conceptualisation of influences of environmental contexts on psychological well-being is concerned, and there is also a lack of credible empirical findings on the dynamics of processes involved. The aim of the current study was to test various models on the possible mediating role of subjective perceptions of health, personality factors and spirituality in the dynamics of context and psychological well-being. Psychological well-being was conceptualised and measured multi-dimensionally as defined from a general psychological well-being, hedonic, and eudaimonic perspective. Context was defined in terms of the historical stratification in South African society by socioeconomic differentials pertaining to race, socioeconomic indices and infrastructural resources. An availability sample of 5 14 participants from Potchefstroom (n=384) and Mafikeng (n=130) completed questionnaires on psychological well-being, subjective perceptions of health, personality factors and spirituality after informed consent was obtained. Psychological well-being was measured with the Affectometer 2 (Kammann & Flett, 1983), the Sense of Coherence Scale (Antonovsky, 1987) and Satisfaction with Life Scale (Diener, Larsen and Griffin, 1985). General psychological well-being was defined and operationalised in terms of the degree of sense of coherence, satisfaction with life and affect balance; hedonic well-being in terms of the degree of satisfaction with life and affect balance, and eudaimonic well-being in terms of the degree of sense of coherence and satisfaction with life. Subjective perceptions of physical health was measure with the General Health Questionnaire of Goldberg and Hillier (1979); Agreeableness and Extraversion as personality factors with the NEO- Personality Inventory - Revised of Costa and McCrae (1992); and Spirituality with the Spiritual Well-being Scale of Paloutzian and Ellison's (1979). The findings indicate, firstly, that perceptions of physical health (article I), personality factors (article 2) and spirituality (article 3) mediate the relationship between contexts and psychological well-being. Secondly, that the hedonic model of psychological well-being (albeit variably conceptualised in article 1 and articles 2 and 3) overall, yielded the highest amounts of variance. Thirdly, the results also indicated differences among the two predominantly black and white samples in terms of the roles played by subjective perceptions of health, personality factors and spirituality in the relationship between contexts and psychological well-being. It is concluded that due consideration must be given to social context and the dynamics of interaction between social ecology and individual factors in order to make a meaningful contribution to the understanding and promotion of psychological well-being. Theoretical and practical implications of these findings are indicated. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2006.

There is a lacuna in the field of positive psychology as far as the conceptualisation of influences of environmental contexts on psychological well-being is concerned, and there is also a lack of credible empirical findings on the dynamics of processes involved. The aim of the current study was to test various models on the possible mediating role of subjective perceptions of health, personality factors and spirituality in the dynamics of context and psychological well-being. Psychological well-being was conceptualised and measured multi-dimensionally as defined from a general psychological well-being, hedonic, and eudaimonic perspective. Context was defined in terms of the historical stratification in South African society by socioeconomic differentials pertaining to race, socioeconomic indices and infrastructural resources. An availability sample of 5 14 participants from Potchefstroom (n=384) and Mafikeng (n=130) completed questionnaires on psychological well-being, subjective perceptions of health, personality factors and spirituality after informed consent was obtained. Psychological well-being was measured with the Affectometer 2 (Kammann & Flett, 1983), the Sense of Coherence Scale (Antonovsky, 1987) and Satisfaction with Life Scale (Diener, Larsen and Griffin, 1985). General psychological well-being was defined and operationalised in terms of the degree of sense of coherence, satisfaction with life and affect balance; hedonic well-being in terms of the degree of satisfaction with life and affect balance, and eudaimonic well-being in terms of the degree of sense of coherence and satisfaction with life. Subjective perceptions of physical health was measure with the General Health Questionnaire of Goldberg and Hillier (1979); Agreeableness and Extraversion as personality factors with the NEO- Personality Inventory - Revised of Costa and McCrae (1992); and Spirituality with the Spiritual Well-being Scale of Paloutzian and Ellison's (1979). The findings indicate, firstly, that perceptions of physical health (article I), personality factors (article 2) and spirituality (article 3) mediate the relationship between contexts and psychological well-being. Secondly, that the hedonic model of psychological well-being (albeit variably conceptualised in article 1 and articles 2 and 3) overall, yielded the highest amounts of variance. Thirdly, the results also indicated differences among the two predominantly black and white samples in terms of the roles played by subjective perceptions of health, personality factors and spirituality in the relationship between contexts and psychological well-being. It is concluded that due consideration must be given to social context and the dynamics of interaction between social ecology and individual factors in order to make a meaningful contribution to the understanding and promotion of psychological well-being. Theoretical and practical implications of these findings are indicated. / Thesis (Ph.D. (Psychology))--North-West University, Potchefstroom Campus, 2006.

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Mental health has received more attention and stigma associated with it has decreased over time in the United States. However, subpopulations have differing views on mental illness since cultural factors can shape perceptions of and influence access to mental health information. Previous studies have investigated such cultural factors among Sunni Muslims (the majority sect of Islam) and less so among Shia Muslims (the minority sect). To address this gap, two research questions were investigated in this project: (1) What are the mental health attitudes among Shia Muslim adults in the United States, and (2) How much mental health knowledge or literacy do Shia Muslim adults in the United States have? A survey was created to assess Shia Muslim mental health attitudes (including stigma) and knowledge. Using snowball sampling, 256 responses were collected. Analysis showed Shia Muslims believe biological, sinful, spiritual, and external factors contribute to mental illness and have low social stigma towards the mentally ill. They also have high mental health knowledge/literacy. Barriers to care reported include cost, time, mistrust of the mental healthcare system, social/self-stigma, and lack of culturally competent care.