Childhood trauma and stress can lead to widespread changes in brain function that can lead to lifelong learning and living difficulties and disability that impact parental stress levels. Increasingly, parents are turning to social media to find systems of support. This Interpretive Phenomenological Analysis explores the online talk of 17 participants to better understand how they make meaning out of their participation in an online, faith-based parenting community designed for parents raising children with complex trauma exposure. Findings based on the data analysis included five overarching main themes: a) A community of experts; b) The community dethrones the experts; c) The community empowers women to navigate status from victim to warrior; d) The community provides support for members to grieve what seems "irreparably broken;" and e) Participants express faith that God will "mend what is broken." The findings were overlayed on Bronfenbrenner's bioecological theory (Bronfenbrenner & Evans, 2000) to provide a construct for the professionals interacting with parents of children with trauma. Professionals, therapists and religious leaders interacting with parents of children with trauma may want to incorporate a pluralistic, multileveled perspective, recognizing parents' interpersonal conflicts or personal experiences exist in a broader more nuanced system, thus fostering a nuanced and individualized approach to providing support for parents of children with trauma.

The availability of online support communities creates new opportunities for caregivers of children affected by health conditions to manage their illness-related uncertainty. This dissertation includes two studies that examined the presence of uncertainty management behaviors in online interactions among parents (caregivers) of children with clubfeet, and empirically tested the applicability of the uncertainty management theory to online behaviors. The Uncertainty Management Theory provided the theoretical foundation for both studies. For the first study, a content analysis of messages exchanged in an online support community dedicated to parents of children with clubfeet was conducted. Most messages were authored by women. The majority of the emotions expressed in the messages were positive. The most frequent information-seeking behaviors were direct questioning and self-disclosure. Information exchanges as a strategy to manage uncertainty included names of health care professionals and medical information. Five major types of social support (informational, tangible, network, esteem, and emotional) were identified. Informational support was the most frequent type of support provided, followed by emotional and esteem support. A third of the messages included combinations of two or more types of social support. For the second study an online survey was distributed using a snow-balling technique. Based on the survey data structural equation modeling was used to empirically test the uncertainty management framework. Positive relationships were identified between knowledge and information seeking, information seeking and social support, social support and sense of virtual community, uncertainty and stress. The results suggested that the uncertainty management theory may need to be adapted for use in online contexts. Uncertainty seems to be an important part of the experience of parents caring for children with clubfoot. Online communities dedicated to these parents represent a promising setting for studying illness-related uncertainty and its potential causes. Such studies can be a critical source of information to inform priorities for research and practice. This dissertation is the first step in better understanding the audience and provides an initial exploration of uncertainty management and communication processes present in an online support community. As we learn more about the parent audience, the importance of communicating with them becomes increasingly clear.

The purpose of this study was to improve our understanding of uncertainty in Adolescent Idiopathic Scoliosis (AIS), which is a chronic illness involving curvature of the spine and is typically diagnosed in late childhood or early adolescence. The timing of most AIS diagnosis and its subsequent treatment occurs at a critical point developmentally and may place strain on adolescents with AIS and their parents. This dissertation includes two studies. The first study used Cash's (2011) cognitive-behavioral perspective on body image as the framework to assess whether brace treatment had a negative impact on body image appraisals in female adolescents participating in a clinical trial. Contrary to previous studies, this study found that brace treatment did not have a negative impact on female adolescents' body image and that poor body image did not result in brace treatment non-adherence. However, this study found significant correlations in adolescents with AIS between poorer body image and poorer quality-of-life. The second study used Uncertainty Management Theory as the framework for exploring adolescents' and parents' AIS-related uncertainties that were participating in online support groups. Results from this study suggest that adolescents with AIS and parents of a child with AIS are managing their uncertainties regarding the illness and its treatment however, the way they manage the uncertainty is different, in particular regarding appraisals of the uncertainties, whether they are seeking or avoiding information, and the types of social support that is being sought and provided. Parents of a child with AIS tended to seek information regarding the uncertainty surrounding the AIS condition, including information regarding doctors/hospitals and research, while adolescents tended to be participating in the online support groups for the purposes of seeking and providing support to other adolescents that have been or currently are in similar situations, such as wearing a brace. These findings are critical, because differences in uncertainty management behaviors between adolescents and parents, such as the ones that were found in the AIS-related online support group, could result in differences in understandings, concerns, preferences, and expectations regarding the illness and its treatments, which may result in family conflict, poor clinical health outcomes in adolescents and poor psychosocial outcomes in adolescents and in their parents. This study is significant in that it explored AIS-related uncertainty in two entirely different settings where theoretical applications are rare, in a clinical trial and in online support groups. The results from this dissertation suggest that Uncertainty Management Theory and Cash's (2011) cognitive-behavioral perspective on body image may be adapted for these contexts. The synthesis of the findings from across this dissertation suggests that the clinical and psychosocial health outcomes of adolescents with AIS and the psychosocial outcomes of their parents, may be improved through communication tools, such as adolescents, their parents, and providers working together through a treatment decision flow chart to elicit AIS-related current understandings, concerns, preferences, and expectation, which will result in shared decisions. Finally, as new technologies expands and are integrated into decisions regarding illness, findings from this dissertation can be used to improve health communication, support interventions, and policy development.

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