Type 2 Diabetes Mellitus (T2D) is a major public health issue. Diabetes prevalence is growing and is the 7th leading cause of death in the US. Virginia has a slightly higher prevalence than the national average. Community-based diabetes lifestyle management programs that include a physical activity component are effective at improving glycemic control and influencing lifestyle behavior changes among people with T2D. The Balanced Living with Diabetes (BLD) program uses an active learning approach to improve glycemic control and healthful lifestyles. The Lifelong Improvements through Fitness Together (LIFT) program uses behavioral strategies to improve functional fitness, participant engagement, and program adherence. Participant retention is a challenge for community-based program. Participants may start the program, but then fail to complete the program and/or adhere to program recommendations. Two pilot studies were conducted to evaluate strategies for increasing participant retention and improving outcomes. The first evaluated the implementation and impact of a retention plan implemented in BLD programs conducted from 2015-2017. There were more participants returned to the reunion class session prior the development of the retention plan. There were improvements in some health behavior and self-efficacy indicators in programs that used the retention materials, however, impacts on outcomes were mixed. Preliminary findings showed that the retention plan could be a tool for providing additional support to participants, however strategies for dissemination of the retention plan needs to be reevaluated. The second study evaluated the impact on participant engagement and program outcomes when the LIFT program is incorporated with the BLD program. There was an increase in participant retention, self-efficacy and one health behavior for physical activity and health behaviors related to diet in BLD+LIFT programs. Extension Agents are willing to implement the BLD+LIFT programs, however, clarity of program logistics is needed prior to implementation. Extension Agents indicated that implementation of these programs in locations with older adults that have greater disability may not be the best locations. Having larger studies on the effect of incorporation of LIFT with the BLD with older adult populations that have fewer co-morbidities are needed to determine the impact of addition of the LIFT program with the BLD program on program outcomes. / Doctor of Philosophy / Type 2 Diabetes is a chronic disease in which the body does not use insulin as it should or does not produce enough insulin. The Centers for Disease Control and Prevention (CDC) indicates that the prevalence of diabetes was 23.1 million among US adults in 2015. The prevalence of diabetes in Virginia is slightly higher than the national average. Community-based diabetes lifestyle management programs that include a physical activity component are effective in improving glycemic control and influencing lifestyle behavior changes among people with T2D. The Balanced Living with Diabetes (BLD) program uses an active learning approach to influence better glycemic control and healthful lifestyles. The Lifelong Improvements through Fitness Together (LIFT) program uses behavioral strategies to improve functional fitness, participant engagement, and program adherence. The challenge with implementing community-based programs is retention. Participants may initially agree to participate in a program, but then fail to complete the program and/or follow program recommendations. Two pilot studies were conducted to evaluate strategies for increasing participant retention and program outcomes. The first evaluated the implementation and impact of a retention plan implemented in BLD programs conducted from 2015-2017. There were more participants returned prior to the development of the retention plan. There were improvements in some health behavior and self-efficacy indicators in programs that used the retention materials, however, impacts on outcomes were mixed. Findings showed that the retention plan could be a useful tool for providing additional support to participants, however distribution of the retention plan needs to be reevaluated. The second study evaluated the impact of program outcomes when the LIFT program is combined with the BLD program. There was an increase in participants' self-confidence to perform physical activity and making changes in their diet in BLD+LIFT groups. Extension Agents were enthusiastic about conducting more BLD+LIFT programs, however, program procedures and the time commitment needs to be understood before doing so. Expanding the conduct of BLD programs that incorporate the LIFT program can be effective in improving glycemic control and increasing physical activity, however, working with organizations that service people that have diabetes with fewer health conditions that limit physical activity may be more effective.

Abstract  Background: Growing global concerns about sustainability highlight the importance of environmental sustainability, particularly environmentally conscious behaviors. There has been a growing focus on pro-environmental behavior (PEB) as a way for individuals to minimize their environmental impact. Global environmental challenges underscore the pressing need for proactive environmental action, particularly the growing emphasis on the importance of motivating individuals' daily actions and choices, as they directly contribute to environmental conservation and pro-environmental behavior. In the context of Sweden, the country is widely recognized for its commitment to environmental sustainability. Moreover, considering the increasing number of international university students in Sweden, it contributes to the academic environment and allows for the exploration of environmental behaviors within a diverse population. Given this, understanding, and promoting pro-environmental behaviors among this demographic in Sweden is essential, and it also helps contribute to the societal commitment to environmental conservation.  Purpose: This thesis aims to investigate the determinants that influence pro-environmental behavior among international university students in Sweden, employing social cognitive theory and the reciprocal determinism model. Focusing on personal (internal) factors like environmental knowledge and attitudes as well as environmental (external) factors like subjective norms and place attachment, this thesis also explored the interaction between pro-environmental behavior and its associated factors. By understanding these factors’ roles, this thesis aims to contribute to the development of effective strategies for promoting pro-environmental behavior among this population. Method: This thesis adopts a quantitative approach to examine the interplay of variables via an online survey. Data were collected from 203 individuals in Sweden, focusing on investigating the relationships between different factors and pro-environmental behavior based on eight formulated hypotheses. Respondents were selected using judgmental sampling, and data analysis was conducted using techniques such as Pearson’s correlation and multiple regression analysis in SPSS.  Conclusion: The results of this thesis reveal a significant association between different factors and pro-environmental behavior among international university students in Sweden. Specifically, environmental attitude and place attachment were found to positively influence pro-environmental behavior. Moreover, subjective norms were shown to have a positive impact on both environmental knowledge and attitude. However, neither the relationship between place attachment and environmental knowledge nor the relationship between environmental knowledge and subjective norms had any significant impact on pro-environmental behavior.

Doctor of Philosophy / Department of Family Studies and Human Services / Kristy L. Pederson-Archuleta / Viewership of reality television has been indicated to influence behaviors among individuals and groups, as existing literature has linked reality television viewership to an increase in the likelihood of demonstrating other non-financial behaviors. The literature notes increases in risky sexual and dating behavior, increases in tobacco, drug, and alcohol use, and increases in violent behavior. This dissertation examined the perceptions of the influence of reality television on financial behavior. Situational reality television programming was found to have the greatest influence on the financial behaviors of college students. Ten college students were interviewed using a phenomenological qualitative approach. There were four primary findings from this study. The first was that reality television has the ability to inform the financial behavior of college students. Second, an individual’s connection to his or her social system has an influence on financial behavior. Third, reality television does have the ability to influence financial behavior change and fourth, reality television influences the meaning of money as perceived by the respondents. The results of this study provide valuable information to promote further inquiry as to how reality television and other forms of media influence financial behavior.

Within the past decade little research has been conducted in the United States to examine the preparedness of beginning speech-language pathologists; the seminal article used for this research study comes from the United Kingdom (Horton, Byng, Bunning, & Pring, 2004). Literature from the past few decades indicates that there may be deficiencies in the way that beginning speech-language pathologists are being trained clinically. The review of the literature suggests that the field may lack a clear and broadly supported learning theory or framework for the clinical supervision and training of speech-language pathology graduate students. The literature further supports the importance of work-embedded learning and problem-based learning, as well as suggests a theoretical framework that may be utilized for supervision and clinical training in the future. The purpose of this exploratory phenomenological study is to understand and describe how speech-language pathology graduate students perceive their clinical training and supervision obtained during graduate school prepared them for their first externship placements. The literature suggests that a framework for the transfer of theoretical knowledge into the clinical setting is often not present in graduate academic programs (Horton & Byng, 2000b). Models of highly effective practices that are grounded in adult learning theory and empirical research regarding clinical training and supervision should be taken into account. In this way, department-level leaders may be able to design more effective models for clinical training and supervision. The data from participant interviews conducted for this study were organized into two over-arching themes: supervision and clinical experiences. The data in each theme were further organized into more specific categories. The theme of supervision includes five categories: a) most helpful supervisor characteristics, b) least helpful supervisor characteristics, c) differences in supervision, d) feedback from supervisors, and e) working with different supervisors. In addition, the theme of clinical experiences includes four categories: a) differences between in-house experiences and externship experiences, b) significant aspects of clinical training, c) limitations of clinical training, and d) limitations of clinical coursework.

Vocational disruption for survivors of interpersonal trauma has been noted by both practitioners and researchers. While limited empirical support exists, a firm theoretical framework and a full range of outcomes have not been explored. Guided by the framework of social cognitive career theory (SCCT), a promising framework recommended in the previous literature, the aim of the current study was to explore the function of contextual barriers and supports as predictors of career decision self-efficacy (CDSE). Due to the lack of consistency in previous research and absent theoretical specification of the particular mode of intervening variables, both mediation and moderation were explored using multiple regression. The results indicate the relationship between background factors (i.e., childhood maltreatment) and CDSE was fully mediated by an indirect pathway via personal factors (i.e., trauma-related symptoms) and learning experiences (i.e., anxious and avoidant attachment with a career-related mentor) in the prediction of CDSE. The results also indicate that personal factors (i.e., trauma-related symptoms) function as a moderator between background factors (i.e., childhood maltreatment) and learning experiences as anxious attachment with a career-related mentor. Finally, learning experiences as anxious attachment with a career-related mentor moderated the relationship between personal factors (i.e., trauma-related symptoms) and CDSE. Overall, within the SCCT model, the proposed predictors help explain differences in CDSE as related to childhood maltreatment through mediation and moderation. Theoretical and practical implications of the results are discussed.

Bakgrund: Andelen äldre i vårt samhälle ökar och alltfler äldre är fysiskt inaktiva, vilket kan ses som ett folkhälsoproblem. Att utforska inaktiva äldres syn på fysisk aktivitet kan bidra till värdefull kunskap när det gäller att stödja dessa personer till en ökad fysiskt aktiv livsstil.  Syfte: Att ta reda på vad inaktiva äldre upplever har betydelse för att vara fysiskt aktiva, samt vad de anser kan få dem att förändra sitt beteende till en mer fysiskt aktiv livsstil. Metod: En kvalitativ studie med semistrukturerade intervjuer genomfördes med ett bekvämlighetsurval med sex kvinnor, 65–74 år. Data analyserades induktivt med kvalitativ innehållsanalys där koder och kategorier sorterades fram.  Resultat: Fysisk miljö och yttre stöd ansågs ha betydelse för att inaktiva äldre skulle vara mer fysiskt aktiva. Vardagliga aktiviteter prioriteras framför fysisk aktivitet. Yttre stöd, förändrade rutiner i samband med pension, kunskap och erfarenheter samt känslor och attityder kring fysisk aktivitet ansåg de äldre ha betydelse för den fysiska aktivitetsnivån. Slutsatser: De psykosociala faktorerna uppfattades ha stor betydelse vad gäller fysisk aktivitet, deltagarna betonade omgivningens betydelse, yttre stöd ansågs ha en stor betydelse för att en beteendeförändring skulle kunna ske. / Background: The number of elderly in our society is increasing and the quantity of physically inactive seniors is growing along with it, this observation can be viewed as a global health issue. By exploring inactive elderly people´s view of physical activity it can contribute to valuable knowledge for supporting this age group into a more physical active lifestyle. Aim: To find out what elderly experiences have importance for being physically active, and what they think can make them change their behavior into a more physically active lifestyle. Method: The study was qualitative, semistructured interviews were made, a convenient sample of six women, 65-74 years old, were included. Data were interpreted inductive with a qualitative content analysis and then sorted into codes and categories. Result: Physical environment and external support was considered to be important by elderly inactive people to be more physically active. Ordinary everyday activities are prioritized over physical exercise. External support, changed habits after retirement, knowledge, experience and attitudes regarding physical activity. This altogether results in an impact on the level of physical activity amongst elders.   Conclusion: The psychosocial factors  were perceived to have great importance in terms of physical activity. The participants expressed how the support from the surroundings has a great importance for a behavioural change.

Bakgrund:Som yrkesverksam fysioterapeut inom primärvården finns det flera olika behandlingsmetoder för långvarig ländryggssmärta att välja mellan, men inga tydliga riktlinjer att följa. Grundat i det kliniska resonemanget tar fysioterapeuter beslut som påverkas och förändras i mötet med patienten. Då det finns lite forskning som undersökt hur fysioterapeuter utbildade inom Mekanisk diagnostik och terapi (MDT) beskriver sitt kliniska resonemang till patienter med långvarig ländryggssmärta syftar denna studie till att åskådliggöra fysioterapeuters syn på ämnet.    Syfte:Att undersöka hur fysioterapeuter beskriver sitt kliniska resonemang gällande användning av MDT till patienter med långvarig ländryggssmärta.    Metod:Kvalitativ semistrukturerad intervjustudie med induktiv ansats och deskriptiv design. Datainsamling skedde genom sex intervjuer. En kvalitativ innehållsanalys användes vid analys av materialet.    Resultat:Analysen genererade 22 underkategorier fördelade i sju kategorier. Informanterna beskrev sitt kliniska resonemang vid användning av MDT i form av sin syn på metoden, patientdelaktighet i undersökning, struktur och tydlighet, fynd som påverkar behandling, hypotestestning, patientansvar i behandling och värdering av egna förmågor.   Slutsats:Studiens resultat visade att informanterna beskrev sitt kliniska resonemang vid användning av MDT vid långvarig ländryggssmärta inom primärvården främst påverkades av biomekaniska fynd hos patienten. Psykologiska fynd beskrevs som sekundära faktorer att ta hänsyn till, och sociala faktorer beskrevs lite eller inte alls trots att de är viktiga att ta hänsyn till för att åstadkomma en beteendeförändring. Därmed har ett utvecklingsområde för MDT inom fysioterapi tydliggjorts då det finns evidens för att ett biopsykosocialt arbetssätt vid långvarig ländryggssmärta är att föredra. / Background: As a physiotherapist in primary care, there are several different treatment methods for persistent low back pain to choose from, but no clear guidelines to follow. Based on the clinical reasoning, physiotherapists take decisions that are affected and changed in the patient encounter. Since there is a lack of research that have investigated how physiotherapists educated in Mechanical Diagnosis and Therapy (MDT) describe their clinical reasoning to patients with persistent low back pain, this study aims to illustrate the physiotherapists' view of the topic.   Aim: To explore how physiotherapists describe their clinical reasoning regarding the use of MDT for patients with persistent low back pain.   Method: A qualitative semi-structured interview study with an inductive approach and a descriptive design was conducted. The data collection included six interviews. A qualitative content analysis was used to analyze the data.   Result: The analysis generated 22 subcategories divided into seven categories. The informants described their clinical reasoning when using MDT as their view of the method, patient participation in examination, structure and clarity, findings that affect treatment, hypothesis testing, patient responsibility in the treatment and evaluation of own abilities.   Conclusion: The study's results showed that the informants described their clinical reasoning when using MDT with persistent low back pain in primary care were mainly influenced by biomechanical findings with the patient. Psychological findings were described as secondary source to take into consideration, and social factors were described very little or not at all even though they are important to take into consideration in order to achieve a behavioral change. Thus, a development area for MDT in physiotherapy has been clarified as there is evidence that a biopsychosocial approach to persistent low back pain is preferable.

Bakgrund: Digitala patientmöten ökar med visionen om ökad e-hälsa, det kan användas för att nå fler patienter och verka kompletterande till traditionell fysioterapi. Det finns lite information om digitala patientmöten med fokus på att kunna stödja beteendeförändring. Syfte: Syftet med studien var att undersöka hur fysioterapeuter beskriver sina möjligheter och begränsningar att kunna stödja beteendeförändringar hos patienter i digitala patientmöten.Metod: Studien utfördes som en kvalitativ intervjustudie med en induktiv ansats. Sex fysioterapeuter deltog i studien och data från intervjuerna analyserades med en kvalitativ innehållsanalys. Resultat: Intervjuerna resulterade i fem kategorier med tolv underkategorier. Dessa kategorier var: behov att överbrygga det fysiska avståndet, digital fysioterapi passar kortare, enklare kontakter, krävs mer tydlighet i digitala möten för att få med patienten, avsaknaden av fysisk kontakt vid digital fysioterapi hindrar samt rutin för uppföljning. Slutsatser: Deltagarna beskrev det digitala patientmötet som positivt för enkla och snabba patientkontakter. Dock menade de att det inte kan ersätta traditionell fysioterapi då avsaknaden av den fysiska kontakten och den bristande uppföljningen begränsar deras möjligheter att stödja beteendeförändringar. Studien ger grund för fortsatt forskning om organisatorisk implementering av stödjande arbetssätt för beteendeförändringar i digital / Background: Meeting patients in a digital format increases with the vision of increased e-health. It can be useful to reach more patients and work complementary to traditional physiotherapy. There is little information on digital patient meetings with a focus on being able to support behavioral changes. Aim: The aim of this study was to investigate how physiotherapists describe their possibilities and limitations to support behavioral changes in digital patient meetings.Method: The study was conducted as a qualitative interview study with an inductive approach. Six physiotherapists participated in this study and data from the interviews were analyzed with a qualitative content analysis. Result: The interviews resulted in five categories with twelve subcategories. These categories were: the need to bridge the physical distance, digital physiotherapy fits for shorter, simpler contacts, more clarity is required in digital meetings to engage the patient, the lack of physical contact during digital physiotherapy prevents and routines for follow-up. Conclusions: The participants described the digital patient meetings as positive for simple and quick patient contacts. However, they meant that it could not replace the traditional physiotherapy since the lack of physical contact and the lack of follow-up limits their ability to support behavioral changes. This study provides support for continued research on the organizational implementation of supporting working methods for behavioral change in a digital environment.

Doctor of Philosophy / Department of Human Ecology-Personal Financial Planning / D. Elizabeth Kiss / Maurice M. MacDonald / The purpose of this study was to investigate the determinants that explain and predict an individual’s propensity to perform responsible financial actions and make on-time mortgage payments. The research was guided by Social Cognitive Theory (SCT) (Bandura, 1986) and explored personal factors, environmental influences, and attributes of behavior as co-factors within a combined causal framework. Data for this study came from the publicly available, 2009, 2012, and 2015 National Financial Capability Study (NFCS) datasets. These datasets were selected for the specific questions, timeframe, and richness of the financial information provided by the respondents. Responses for each survey were weighted to be representative of Census distributions according to the American Community Survey (FINRA Investor Education Foundation, 2017). The data are weighted to be representative of each state based on age, gender, ethnicity, and education. The two variables of interest were the responsible financial actions index and mortgage payment history. To isolate the determinants of these two variables more accurately, this research adopted a multi-step approach to the analytical procedure. The analyses began with the construction of the responsible financial actions index – unifying the most fundamental responsible financial actions recommended by financial professionals into a single value. Once confirmed as a valid and reliable measure, the responsible financial actions index was explored empirically as both a dependent variable and a target variable. Further analyses involved the application of the SCT Triadic Model to develop OLS and Multinomial Logistic regression models. Utilizing a series of regression models, this study explored empirically the hypothesized relationships among variables categorized as personal factors, environmental influences, attributes of behavior, and on-time mortgage payment history. When exploring variables to predict the responsible financial actions index, the OLS regression models provided consistent findings when analyzing data from the 2009, 2012, and 2015 surveys. As predicted by the SCT Triadic Model, the following personal factors, age, subjective and objective financial knowledge, financial self-efficacy, and financial risk tolerance were significant across all three survey years. The following environmental influences were significant: income, educational attainment, and marital status. To estimate the odds of paying a mortgage on-time, a series of Multinomial Logistic regression analyses were conducted. When evaluating these results, key findings were identified across all three years of data in two models. Model 1, never late vs. late once, and Model 2, never late vs. late more than once. In Model 1, for all three years, self-efficacy was found to be predictive of on-time mortgage payment history. In Model 2, for all three years, both financial self-efficacy and the financial actions index were found to be predictive of on-time mortgage payment history. These findings contribute to the body of empirical literature related to consumer economics and personal financial planning providing insight and understanding for how financial outcomes can be improved through basic responsible financial actions. This has important implications for financial professionals, counselors, and educators given the applicable value for the responsible financial actions index. For example, these results should encourage educators to work towards identifying new pedagogical approaches for improving financial self-efficacy among students.

In 2016, the U.S. Census Bureau indicated only 39.1% of women occupied management and leadership occupations. The absence of women in leadership roles minimizes career aspirations, reduces the benefits of gender diversity, and lowers growth opportunities for women. The purpose of this interpretive hermeneutical phenomenological study was to unveil the lived experiences of a sample of minority women managers and leaders in the finance and insurance sector in Central Florida who encountered general career barriers and self-imposed career impediments that hindered them from advancing. The conceptual framework that guided this study was the social cognitive career theory coupled with the self-efficacy theory. Data were collected through semistructured interviews with 8 minority mid-level managers and leaders in the finance and insurance industry in Central Florida. Data were analyzed using the modified van Kaam method reformed by Moustakas. Five themes emerged from the data: General career barriers, self-imposed career impediments, career challenges, career management strategies, and career barrier counsel. These results may contribute to social change by raising awareness about career impediments that can discourage career paths of women and illuminating strategies regarding how to maneuver through interferences. Women can take control of their lives and modify their career paths. When organizational managers and leaders become more self-aware of the perceived career obstructions, they can initiate the appropriate training to help their employees maneuver, overcome, and navigate through difficulties.