A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: Effective physician‐patient communication is critical to the clinical decision making process. The informed consent process for any intervention can be one of the most important moments for effective physician‐patient communication in regards to outcome and liability. We studied parental recall of information provided during an informed consent discussion process prior to performance of emergency medical procedures in a pediatric emergency department of an inner city hospital with a large bi‐lingual population. Methods: Parent/child dyads undergoing emergency medical procedures were surveyed prospectively in English/Spanish, post‐procedure for recall of informed consent information. Logistic regression analysis was used; outcome variables were the ability to name a risk, a benefit, and an alternative to the procedure and predictors were language, education, and acculturation. Results: Fifty‐five parent/child dyads completed the survey. Logistic regression analysis showed that respondents with less than high school education were approximately 80% less likely to be able to name a risk or a benefit, while respondents with a high school education were approximately 24 times more likely to be able to name an alternative procedure. Conclusion: A gap in communication exists between physicians and patients during the consent taking; it is significantly impacted by socio‐demographic factors like education level, language and acculturation.

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Thesis advisor: Susan Kelly-Weeder / Background: Sexual minority youth experience many sexual health inequities compared to heterosexual youth. Research conducted over the past several decades has concluded that both parent-adolescent sex communication and school-based sex education are effective in reducing levels of sexual risk behavior in heterosexual youth. A much smaller number of studies have examined the experiences and effectiveness of sex education or PASC among sexual minority youth. Purpose: This three-manuscript dissertation seeks to extend understanding about the experiences of sexual minority and heterosexual youth with learning about sex and sexuality at school and at home and how these learning experiences affect sexual risk behavior. The purpose of this dissertation is to examine parent-adolescent sex communication from the perspective of sexual minority youth and their parents, assess the impact of different types of sex education on sexual intercourse and contraceptive behavior of sexual minority and heterosexual adolescent females, and revise and extend a scale designed to measure sexual minority youth perceptions of sexual-minority-inclusivity in sex education. Methods: In the first manuscript, we conducted an integrated review that described how parents and SGM youth perceive their sex communication experiences and synthesized findings about the associations between parent-adolescent sex communication and sexual health outcomes among SGM youth. In the second manuscript, we used National Survey of Family Growth data to describe the total sex education content received by an individual, examine the impact of different sex education types on sexual intercourse and contraceptive behavior of adolescent females, and examine differences by sexual identity. In phase one of the last study, we revised a scale to measure SMYA perceptions of sexual minority-inclusivity in school-based sex education received before the age of 18 years. Phase two involved implementing a pilot study to measure the reliability and conduct a Rasch analysis of the revised scale. Results: The integrated review results suggest that parent-adolescent sex communication was complicated by barriers to communication and was limited, heteronormative, and influenced by SGM disclosure. Parent-adolescent sex communication may improve sexual health outcomes, but adequate parental education/guidance is lacking. Secondary data analysis results suggest that compared to their heterosexual peers, sexual minorities were more likely to report no sex education and less likely to report receipt of abstinence-only education. Nearly all types of education had a statistically significant effect on sexual behavioral outcomes (intercourse in the past 12 months and type of contraceptive use) as compared to no sex education. Scale revision and psychometric analyses suggested that the new scale has strong psychometric properties, including reliability, content validity, and measurement precision. Conclusion: Overall, this dissertation has highlighted the ways that home and school-based sources of sexual health information do not currently meet the needs of SM youth. The sexual health education of SM youth is complicated by a lack of comfort, knowledge, and resources experienced by both teachers and parents. Qualitative studies suggest that both sources of sexual health information tend to be focused on heterosexual needs, leaving SMY feeling frustrated and invisible. This dissertation has also highlighted the need for quantitative measures to extend understanding of the impact of parent-adolescent sex communication and sex education on sexual minority youth. The revised scale presented in Chapter 4 provides a promising measurement tool to inform the development and evaluation of sexual minority-inclusive sex education programs. The results of this dissertation will ultimately contribute to the development of programs and interventions to support SM-inclusivity in school-based, family-based, and healthcare provider-based sexual health education. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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The object of my dissertation is to introduce the issue of communication between the parent and the inexperienced teacher. The theoretical part is based on the research literature, and it is devoted to various forms of communication as well as to effective communication with parents. The practical part focuses on the experiences new teacher gain while having class meetings, tripartite meetings, on his dealing with conflicts, and on his everyday communication with parents. For the purposes of this analysis, it is essential to obtain information from other inexperienced teachers. The outcome of my research will be a comparison of my experience with other teachers' experiences. Keywords communication, parent, teacher, forms of communication, teacher's experience

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This thesis contains theorethical facts about communication of teachers with parents. The thesis is focused on effective cooperation between school and parents. Defines actual forms and other possible forms of communication at primary school.Provides different ways of involving parents in school activities. The aim of this thesis is to find out which measures can teachers use in communication with parents for successful educational and personal development of pupils. Practical part of the thesis is aimed at effective leading of tripartite meetings. Conclusion of thesis contains advices for effective leading of tripartite meetings. These advices were formulated according to results of interviews with experienced and starting teachers from primary schools. Key words: Communication, school, teacher, parent, pupil, forms of cooperation, tripartite meetings

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Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.

Children with complex health problems who are dependent upon medical technology require frequent hospitalizations, during which parents must make difficult decisions regarding their child’s care. Although principles of “family-centred care” have been widely adopted by paediatric hospitals, studies indicate that many parents are dissatisfied with their roles in decisions about their child’s care. Pierre Bourdieu’s Logic of Practice, specifically his concepts of field, capital, and habitus, as they relate to cultural and symbolic capital within the field of pediatric medicine, were used to guide the design of a parent briefing intervention aimed at improving parents’ satisfaction with decision making. Briefings were conducted during daily hospital rounds. Physicians and nurses were asked to sit while using a checklist as a communication guide. A two-part study was conducted to determine feasibility of a randomized controlled trial of a parent briefing. One component was a psychometric evaluation of an instrument to measure parents’ satisfaction with decision making. The other was a phase I single group, post-test study of the parent briefing. Eighty-two parents of children admitted to an in-patient unit in a large metropolitan pediatric health centre, with an expected length of stay ≥ 3 days, completed the Family Satisfaction with Decision Making (FS/DM) subscale and the Decisional Conflict Scale (DCS) prior to discharge. A subgroup of parents participated in the parent briefing study. The Cronbach’s alpha reliability coefficient of the FS/DM was 0.87, and it was inversely correlated with the DCS (r2= -0.635, p<0.0001). Eighteen physicians, 25 nurses, and 31 parents participated in the phase I trial of the briefing intervention. Sixty-eight out of an expected 93 briefings were carried out as per study protocol. Nineteen parents did not receive the required “dose” of the study intervention. Mean time to complete the intervention was 11.9 minutes (SD = 6.9). Parents and nurses rated the acceptability and usefulness of the intervention favourably, whereas physicians’ ratings were mixed. The FS/DM instrument is a suitable primary outcome measure for an RCT. However, more work needs to be done, to ensure the feasibility of the intervention, including more intensive clinician training.