published_or_final_version / Nursing Studies / Master / Master of Nursing

published_or_final_version / Sociology / Master / Master of Social Sciences

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Parents of children with developmental disabilities experience a greater level of stress than parents of typically developing children. Parental stress disrupts parental functioning, setting a vicious cycle of coercive parent-child interactions and further stress. The current study aims to break this vicious cycle by evaluating the effectiveness of the Incredible Years Basic Parent Training (IYPT) for Chinese preschoolers at risk for developmental disabilities in a community clinic setting in Hong Kong. Fifty-two parents of children with developmental delays (age 3-6 years) were randomly assigned to either a parenting program (EXP) or a waitlist-control (WLC) condition. Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 12-week intervention. Medium intervention effects were found in primary-caregiver parents’ self-reported parental stress index. Medium-to-large intervention effects were found in both primary-caregiver parent-report and spouse-report measures of children’s oppositional behaviors. While primary-caregiver parents did not report a significant change in their parenting practices, their kins/spouses nonetheless reported improvements of a small effect size in the primary-caregiver parents’ parenting practices. Blinded observations of parent-child interactions during a structured play activity indicated significant short-term effects on positive parenting and coaching. Parents had a high attendance rate and reported high satisfaction with the program. Treatment effects did not seem to correlate with demographic and other characteristics of the parents, suggesting that the treatment effect was robust across different profiles of parents. Preliminary results suggest that the Incredible Years Basic Parent Training is an effective and feasible intervention in the community settings for Chinese preschoolers at risk for developmental disabilities and their parents in Hong Kong. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

The central problem of this study is to identify and develop a model for the administration of rehabilitation services to the handicapped which can be applied to identify needed services in any country, such as Kuwait. The method used in developing the model entailed obtaining basic information about how selected nations administer services for the handicapped through: (1) Published sources and reports; (2) Unpublished material; (3) Interviews of selected officials responsible for the handicapped. The review of literature consists of two parts. Part one reviews organizational strategies: (1) The engineering strategy; (2) The behavioral strategy; (3) The systems strategy. The second part focuses on rehabilitation services in the eight countries selected for this study. These are discussed in the order of their difference from the State of Kuwait: the United States, the United Kingdom, Denmark, Japan, Yugoslavia, Thailand, Kenya, and finally Kuwait. Each is discussed in the following terms: (1) Overview; (2) History of Rehabilitation Services; (3) Structure of Service Delivery System; (4) Legislation of Rehabilitation Services. The study was preceded by an analysis of tasks organized within the framework of the International Classification Matrix Model with a view to establishing an approach to prospective evaluation. A matrix can be defined as a rectangular array of elements arranged in rows and columns; the matrix used in this study was formulated on the basis of information and data collected in the eight selected countries in terms of: (a) General Cultural/Social Orientation Pattern (i) "ascriptive/traditional," (ii) "mixed-attributes," and (iii) "achievement/innovative"); (b) Degree of Cultural Materialism; (c) Cultural Attitude Toward Handicapped; (d) Percent of Population Classified As "Handicapped"; (e) Per Capita Income; (f) General National Political Orientation; (g) General National Administrative Structure; (h) Degree of Bureaucratization; (i) Types of Delivery Service. This study classifies nations for the purposes of general evaluation of their approaches to national administration of services for the handicapped and application of these approaches to a specific country, Kuwait.

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The experience of successfully ending a relationship with an abusive partner is seldom explored, although abuse has been experienced by 29% of married Canadian women (Johnson, 1996, cited in Morrow & Varcoe, 2000). This study used a phenomenological design and a critical social science approach to explore the lived experience of women who ended a relationship with an abusive partner. Seven in-depth interviews were analyzed, and encounters with social support from the justice system, counselling agencies, and transition houses were examined. A five-stage model to describe the change process emerged from the data. Metathemes illuminated important internal and external aspects of change during each stage. Childhood gender socialization influenced participants to stay in abusive relationships. Nevertheless, resistance to abuse was seen to have occurred from the beginning. Changing beliefs about gender roles and relationship expectations emerged as an important part of learning and influenced decision-making. Loss of hope and realization of harm led to a shift in decisional balance that culminated in determination to end the relationship. Simple goals evolved to become complex goals as change continued. Participants who attempted to understand their experiences reached a stage that included evolving and healing. Healing also involved a balanced lifestyle, in accordance with the bio-psycho-social-spiritual model. The model's terminology describes a woman in the successive stages of change as a learner, an actor, an evaluator, a survivor, and a thriver. The model is compared with the Transtheoretical Model of Change, and surprising reports of very low self-efficacy at the point of ending the relationship are discussed.

An estimated 9 to 14 million persons in the United States have latent tuberculosis infection (LTBI) and are therefore at risk for progression to active disease. Diagnosis and treatment for LTBI has been identified by the Centers for Disease Control and Prevention (CDC) and the Institute of Medicine as a major strategy for elimination of tuberculosis (TB) in the U.S. Approximately 200,000 - 300,000 Americans are treated for LTBI each year. This dissertation investigates patient characteristics that are associated with LTBI treatment completion and assesses the impact of a peer-based experimental intervention on adherence to, and completion of, LTBI treatment. A review of the literature (Chapter 2) demonstrates that LTBI treatment completion rates in the U.S. and Canada generally fall below established targets and have been reported to range from 20 to 65% for a 6-month course of self-administered treatment. Associations between patient factors, clinic facilities, or treatment characteristics and adherence to LTBI treatment were found to be inconsistent across studies. Additionally, adherence interventions have been developed but no single intervention has shown consistent effectiveness. This suggests that a 'one-size-fits-all' approach to LTBI treatment adherence is not likely to succeed across all settings. The remainder of the dissertation focuses on predictors of LTBI treatment completion and the impact of a peer-based experimental intervention on adherence to, and completion of, LTBI treatment in two separate randomized controlled trials. Data for these analyses are drawn from two sequential randomized controlled trials designed to compare a peer-based intervention to usual care for ensuring completion of treatment for LTBI in an urban clinic setting: the Pathways to Completion Study (recruitment from 1996 through 2000) as well as from the Tuberculosis Adherence Partnership Alliance Study (TAPAS ) (recruitment from 2002 through 2005). Chapter 3 describes the change in demographic, social, and behavioral characteristics between the two study populations. The first analysis (Chapter 4) examines predictors of LTBI treatment completion in this population. Our results suggest that foreign birth, homelessness, marriage, and alcohol or drug use all influence completion of TLTBI through complex interactions. Overall, married persons had better completion rates, but married foreign-born patients were substantially more likely to complete therapy than unmarried foreign-born patients. Similarly, alcohol users were less likely to complete therapy, but homeless alcohol users were more likely to complete treatment than other homeless patients. The latter is probably an artifact of our clinic population, which includes patients from alcohol and substance abuse rehabilitation programs. Residence in such programs may have a positive effect on treatment completion. Race/ethnicity did not appear to be associated with treatment completion, although the differences between the two study populations made this difficult to assess. Following from this, an analysis of the effectiveness of a peer-based experimental intervention on adherence to, and completion of, LTBI treatment in two separate randomized controlled trials (Chapter 5) finds peer support experimental intervention to be very effective in the Pathways population but not in the TAPAS population where completion rates increased substantially for both the intervention and control groups. The power for detecting an intervention effect in TAPAS was reduced by the higher than expected completion rates in both groups; however, the effect of the TAPAS intervention is statistically significant in the adherence model. Adherence analysis in TAPAS suggests that it is important to intervene early in the treatment as the first two months of treatment present a danger period where patients tend to default treatment. The most common reasons reported for not adhering to treatment were forgot, ran out of medications, and other priorities. Identifying reasons for missing medications can suggest possible foci for interventions in the early months, such as weekly reminders to take the medications and ensuring that prescriptions are refilled on schedule. Taken together, the findings of this research have significant implications for improving adherence to and completion of LTBI treatment. Currently, the primary intervention for improving LTBI adherence consists of educational programs to increase knowledge and modify attitudes. Our findings suggest that tangible assistance would be more effective in encouraging treatment completion. Additionally, adherence analysis in TAPAS suggests that it is important to intervene early in the treatment. Close follow-up of patients during the first two months of treatment, with prompt intervention to encourage completion among those stopping treatment, may yield better outcomes and reduce costs over the long term.

This ethnographic project examines sexual communication and negotiation in the context of the political economy of migration. Using participant observation as well as in-depth and life history interviews and secondary sources, the research goals are to explicate the meanings and practices related to gender and sexuality among the transnational population of mid-life heterosexual Mexicans in New York; map ideologies and practices regarding family size and family planning, including histories of negotiation within the context of relationships and couples, embedded within processes of sexual socialization and historical-political-economic structures in the selected population; map experiences with accessing health care services, in the context of this community of low-wage, undocumented, uninsured workers; and explicate the relationships between gender, sexuality, reproduction, parenthood, and labor migration, within the political economy of Mexican migration to New York. The research population consists of Mexican-born women and men in Queens, New York City, ages twenty-two to forty-five. This project aims to contribute to our understanding of how culture changes through interactions between agents and structures; to contribute to an area of sexuality research that has received insufficient attention, which intersects the fields of gender, migration, demography, and health; to increase our understanding of sexual communication among mid-life cohabiting adult migrants; to identify gaps between service needs and utilization; and to offer suggestions on how to improve health programs and services for this emerging immigrant population.

Increases in the number of enlisted veterans transitioning from active duty to the civilian world have drawn attention to a need for research in terms of unemployment to examine how separated service members experience transition from their perspective. Fifteen separated enlisted veterans from four of the five military branches were selected and interviewed in this study. The focus was to understand better the complexities of reintegrating into the civilian workforce, as experienced by veterans from the enlisted military population. By using qualitative methodologies including exploratory interviews and a focus group, the findings revealed four major themes on how service members described their transition experience: (a) perception that military leadership does not provide adequate support when transitioning and the need to become more self-directed in one’s own learning; (b) belief that the military TAP class is helpful but needs major changes to truly be effective; (c) description of a battle buddy or a family member as a positive influence in helping with the transition process; and (d) experiencing significant challenges with civilian employers when transitioning out of the military. An analysis of the findings led the researcher to conclude that transitioning veterans must become self-directed in their learning in order to transition successfully. Moreover, because they are at varying levels of being self-directed when they transition, additional guidance is needed from military leadership, family, and other veterans for the purpose of their development. The analysis also yielded a principal recommendation for military leadership to advocate for quality training programs that are specified from the separated enlisted population for what resources they need to assist with transition to the civilian sector. Additional recommendations were presented to transitioning service members on the importance of managing their own success and believing in their abilities to be resilient, valuable members of the civilian community.