Mexican Americans, the largest Hispanic subgroup in the United States, tend to underuse mental health services. Grounded in Andersen's behavioral model of health services use, the purpose of this nonexperimental study was to examine the likelihood of birth country, education, income, and insurance predicting which respondents would report seeking mental health services to treat depression. The Mini International Neuropsychiatric Interview was used to diagnose depression in 203 Mexican Americans whose data was archived from the primary study. This archived data was analyzed within this study. The results of the 2 x 2 chi-square tests of independence indicated a significant association between a person's birth country and the likelihood that a person will seek mental health treatment, with U.S.-born participants more likely to seek mental health treatment than foreign-born participants. There were no significant bivariate associations found between education, income, or insurance and seeking mental health treatment. The full model containing the 4 independent variables was statistically significant per the results of the binary logistic regression analysis. This finding indicates that the model reliably distinguished between respondents who reported seeking and not seeking mental health treatment. The results of the binary logistic regression analysis indicated education was the only independent variable that made a uniquely significant contribution to the model, with participants with 12 years or more of education more likely to seek mental health treatment. The implications for positive social change include the potential to provide communities and health care providers knowledge of the factors that influence whether Mexican Americans with depression access mental health.

The effectiveness of treatments for degenerative spine conditions, where the primary symptom is back pain, is typically determined using patient-reported quality of life (QoL) measures. However, patients may adjust their internal standards when scoring QoL based on factors other than their health. This response shift phenomenon could confound the interpretation of study data and impact effectiveness conclusions. In the current study, response shift was examined using structural equation modeling (SEM) and previously collected clinical trial data comparing 2 minimally invasive medical devices in lumbar spinal stenosis patients through 1 year postintervention. In subject QoL results, reprioritization shift between 3 months and 12 months that could confound standard analysis was identified. Treatment group did not influence response shift identified at 12 months. SEM provided an effective and practical tool for clinical investigators to assess response shift in available clinical study data. As response shift could lead to invalid conclusions when QoL measures are analyzed, clinical investigators should include response shift assessment in the design of clinical trials. This research into how response shift phenomenon can impact clinical trial results improves the ability of clinical investigators to interpret clinical trial data, potentially preventing erroneous conclusions. This research may also assist researchers and government regulators in the identification and reimbursement of beneficial, cost-effective medical treatments for patients worldwide. For clinical research designers, this study demonstrates a practical application of response shift assessment.

There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

Organization theory proposes that managers exert control over the behavior of salespeople and the outcomes salespeople are expected to deliver. The purpose of this quantitative, nonexperimental study was to examine the relationships between activity control, capability control, and outcome control and salesperson performance, as well as the moderating effects of product complexity, task complexity, and number of accounts on the control-performance relationships for business-to-business sales personnel. The framework for the study was based in the concept of organizational control. Data analysis included hierarchical regression of a convenience sample of 374 survey responses from salespeople to analyze the direct and moderating relationships between perceived sales management control and salesperson performance. Data were collected using Fluid Surveys. Although significant positive effects were identified between outcome control, activity control, and capability control on salesperson performance, as well as a significant negative effect of task complexity on salesperson performance, no moderating effects were found. Because sales management behavior impacts salesperson satisfaction, retention, and performance, identifying the positive impact of activity, capability, and outcome control, and the negative impact of task complexity on salesperson performance provides sales managers with important guidance when considering the elements of an effective approach to sales management. Finally, providing managers with specific guidance regarding management approach has implications for positive social change within organizations by improving salesperson satisfaction with their jobs, their manager, and the organization for whom they work.

Despite 30 years of research advancements, PTSD treatment remains a trial-and-error process as 22 veterans per day commit suicide to relieve their symptoms. Foa and Kozak's emotional processing theory informed this correlational study which included secondary data consisting of participants' self-rated scale scores to examine whether the independent variables number of deployments, guilt, depression, and anxiety predicted the dependent variable PTSD symptom reduction in a veteran sample with combat deployments and associated PTSD symptoms who completed accelerated resolution therapy (ART). An analysis of whether mean PTSD symptom reduction amounts differed by symptom severity levels was also completed. The study aimed to identify the first predictive treatment-matching model for PTSD symptom reduction by use of ART. A multiple regression analysis to determine whether the predictor variables predicted PTSD symptom reduction by use of ART resulted in nonsignificant findings (p = .517). A Welch ANOVA test to determine if mean PTSD symptom reduction differed among the low, moderate, and high PTSD symptom severity groups showed significant results (p = .002). Games-Howell post hoc analysis showed that mean differences in PTSD symptom reduction from the low to high PTSD symptom severity group was significant (p = .001) with a 26.1 point mean reduction for the high symptom severity group and a greater than 10-point mean PTSD symptom reduction for the low and moderate symptom severity groups. The findings confirmed a need for treatment-matching algorithm studies to predict which PTSD interventions most benefit veterans suffering with PTSD to reduce trial-and-error treatment approaches, associated comorbidities, and high rates of suicides.

Due to increased rates of childhood obesity since 2010, researchers have examined family environmental factors and family influences on children's consumption of healthy foods. While previous research has examined how factors such as food presentation and the food intake of other family members can predict a child's body mass index, there has been little research examining whether parent factors predict the amount of healthy foods children eat. This quantitative survey study examined whether certain parent factors, specifically parents' attitudes about food, parents' feeding styles, and parents' attachment styles, predicted the amount of fruits and vegetables children ate. Understanding the extent to which these factors predict children's actual consumption of healthy foods, rather than predicting their body mass index, will further inform the healthcare field about parents' role in their children's physical development. Family systems theory served as the theoretical foundation. Seventy-four parents of children ages 1 to 7 years completed an online survey containing items from the Caregiver Feeding Styles Questionnaire, the Relationship Structures Attachment Questionnaire, and the Parent Attitudes About Food Questionnaire. As well, they logged the amount of fruits and vegetables their child ate over a 1-week period. The results of the multiple regression analysis revealed an overall significance which suggested that the 3 parent factors together predicted the amount of fruits and vegetables that children ate; however, closer examination indicated that only parents' attachment style was a significant prediction of children's consumption of fruits and vegetables. The results of the study add to our understanding of the role that parents play in their children's eating habits and the influence of attachment on children's consumption of a nutrient-dense diet.

There is a dearth of validated self-efficacy (SE) measures in the field of preventive oncology. The objective of this study is to describe the development and validation of a measure to assess patients' perceived ability to obtain the recommended care following an abnormality suspicious for breast cancer. Guided by a social cognitive theory framework, a 51-item measure was developed to explore perceived capability to obtain follow up care under a number of barriers. A multi-step process was utilized to assess the instrument's psychometric properties. First, cognitive validity assessments with experts were conducted, and these aided in the wording refinement of several items. An exploratory factor analysis was performed, and a 4-factor solution emerged containing factors related to barriers to care such as costs, transportation, structural and communication barriers. Reliability analyses were conducted for the total scale and subscales. Then, relationships between theoretically-related constructs were explored to assess convergent validity (self-efficacy and outcome expectations, perceived control), and divergent validity (self-efficacy and depression). Findings provide evidence of both convergent and discriminant validity. This multi-step process aided in the reduction of the scale to 12 validated and reliable items.

This study is intended to provide researchers with empirically derived guidelines for conducting factor analytic studies in research contexts that include dichotomous and continuous levels of measurement. This study is based on the hypotheses that ordinary least squares (OLS) factor analysis will yield more accurate parameter estimates than maximum likelihood (ML) and principal axis factor anlaysis (PAF); the level of improvement in estimates will be related to the proportion of observed variables that are dichotomized and the strength of communalities within the data sets. To achieve this study's objective, maximum likelihood, ordinary least squares, and principal axis factor extraction models were subjected to various research contexts. A Monte Carlo method was used to simulate data under 540 different conditions; specifically, this study is a four (sample size) by three (number of variables) by three (initial communality levels) by three (number of common factors) by five (ratios of categorical to continuous variables) design. Factor loading matrices derived through the tested factor extraction methods were evaluated through four measures of factor pattern agreement and three measures of congruence. To varying degrees, all of the design factors, as main effects, yielded significant differences in measures of factor loading sensitivity, agreement between sample and population, and congruence. However, in all cases, the main effects were components of interactions that yielded differences in values of these measures that were at least medium in effect size. The number of factors imbedded in the population was a component in six interactions that resulted in medium effect size differences in measures of agreement between population and sample factor loading matrices. of factor loading sensitivity, general pattern agreement, per element agreement, congruence, factor score correlations, and factor loading bias; in terms of the number of interactions that yielded at least medium effect size differences in measures of sensitivity, agreement, and congruence. The number of factors design factor exerted a larger influence than any of the other design factors. The level of communality interacted with the number of factors, number of observed variables, and sample size main effects to yield at least medium effect size differences in factor loading sensitivity, general pattern agreement, per element agreement, congruence, factor score correlations, factor loading bias, and RMSE; in terms of the number of factors that included communality as a component, this design factor exerted the second largest amount of influence on the measures of sensitivity, agreement, and congruence. The level of dichotomization, sample size, and number of observed variables were included in smaller numbers of interactions; however, these interactions yielded differences in all of the outcome variables that were at least medium in effect size. Across the majority of interactions among the manipulated research contexts, the ordinary least squares factor extraction method yielded factor loading matrices that were in better agreement with the population than either the maximum likelihood or the principal axis methods. In three of the four measures of congruence, the ordinary least squares method yielded factor loading matrices that exhibited less bias and error than the other two tested factor extraction methods. In general, the ordinary least squares method yielded factor loading matrices that correlated more strongly with the population than either of the other two tested methods. The suggested use of ordinary least squares factor analytic techniques represents the major, empirically derived recommendation derived from the results of this study. In all tested conditions, the ordinary least squares factor extraction method identified common factors with a high degree of efficacy. Suggested studies for future would incorporate the limiting constraints associated with this dissertation into methodological studies to extend the generalizability of conclusions and recommendations into areas that are beyond the scope of this dissertation.

Despite over 30 years of research investigating alcohol expectancies, they have never been examined in terms of the anticipated pharmacological versus social rewards resulting from alcohol consumption, and both appear to play a central role in drinking motivation and behavior. The purpose of this study was to develop a two-dimensional instrument designed to assess both the pharmacological alcohol expectancies of pleasurable, internal states that result from alcohol consumption, as well as the social expectancies that drinking alcohol will result in higher social status and increased effectiveness in social situations. This measure, called the Pharmacological and Social Alcohol Expectancy Scale (PSAES), was developed and validated in a college sample using a two-phase design with three separate samples. Phase I results demonstrated that a respecified model of the PSAES adequately fit the proposed two-dimensional factor structure and provided justification for the items representing two distinguishable domains: social and pharmacological. The measure was then used to 1) assess patterns of drinking expectancies at various drinker levels and 2) investigate whether known risk factors for alcohol use disorders differentiate scores on the two factors. Phase II results indicated that pharmacological and social expectancies are both significantly positively associated with drinking behavior, and that sensation-seeking is significantly associated with pharmacological expectancies. The PSAES represents the first alcohol expectancy instrument to provide adequate coverage of pharmacological expectancies. Implications and limitations are discussed.

There are hundreds of thousands of children living in foster care in the United States on any given day. Mental health professionals may be called upon to assist with evaluating the parental capacity of these children’s parents in order to inform reunification decisions. One of the key parental capacity domains to be evaluated is the relationship between parent and child (Schmidt et al., 2007). The Working Model of the Child Interview coding scheme (WMCI; Zeanah et al., 1996) is one tool for evaluating this relationship. There is a significant practice-to-research gap with this measure. To date, no peer-reviewed studies have established the WMCI coding scheme’s psychometric properties; the need for such research with this measure has been cited in the literature (Sprang, Clark, & Bass, 2005). In this dissertation, the literature was reviewed on attachment theory and internal working models of caregiving, the WMCI and other measures of similar constructs, the importance of establishing a measure’s construct and criterion-validity, and forensic standards for measures. Then, it outlined a series of research questions aimed at exploring the psychometric properties of the WMCI Coding Scheme with mothers who have maltreated. Next, the methodology was described. Based on the results of the 403 biological mothers who completed the WMCI as part of court-appointed evaluations following child maltreatment, the items of the WMCI Coding Scheme were best conceptualized using two-factors: Quality and Content. This finding was consistent with the manual. Significant differences in item-level scores existed for all three WMCI descriptive classifications and for overall factor scores. Due to the instability of the two-item Content factor, this dissertation explored the use of a WMCI Total Score (combining the two factors) and using only the WMCI Quality factor and items. No significant relationships existed between any demographic characteristics and WMCI factor scores. Weak, negative correlations with other measures provided some evidence of convergent validity. In conclusion, some potential clinical/research implications for the WMCI Coding Scheme were made and limitations and future directions were described.