Research has shown that Family Centered Care (FCC), or a partnership between parents and health care professionals, has a positive impact on child outcomes when a child is hospitalized and post discharge as well as on psychosocial wellbeing for the family as a whole (Glang, McLaughlin, & Schroeder, 2007; Harrison, Romer, Simon, & Schulze, 2007; Bamm & Rosenbaum, 2008; An & Palisano, 2014; Foster, Whitehead, & Maybee, 2010). However, throughout the literature it is evident that FCC principles, including parent participation, are not being implemented effectively in pediatric inpatient rehabilitation, leading to a disparity between what theory and evidence supports and what is seen in actual practice (An & Palisano, 2014; Aarthun & Akerjordet, 2012; Foster et al., 2010; Arcuri, McMullan, Murray, & Silver, 2015). The aim of this doctoral project was to better understand the factors that are influencing this problem as well as explore evidence-based solutions to this problem. A literature review on these topics was used to develop an educational program for pediatric occupational therapists called Engaging Families: A Continuing Education Course on Family Centered Care Principles and Practice. Engaging Families is a two-day training course educating pediatric occupational therapists on FCC strategies and implementation of these strategies in order to effectively incorporate parents in their child’s inpatient occupational therapy process.

<p>  </p> <p>Pregnancy poses unjust dangers to Black women in the United States, who are currently faced with higher rates of maternal mortality and pregnancy-related adverse events than women of other races. The maternal mortality ratio for non-Hispanic Black women is 41.4/100,000 compared with 13.7/100,000 for White women (Hill et al., 2022). Although there are available statistics and other forms on expert knowledge on these dangers, risk perceptions and related behaviors are derived from subjective individual interpretations within a dynamic communicative context. While there is extensive evidence on the dangers pregnancy and childbirth pose to Black women, less is known about Black women’s conceptualizations of their own risks, the role of communication (with their healthcare providers and other sources), and the ways in which they enact agency in response to these risks. Using a multi-methodological approach that draws on in-depth interviews, qualitative network analysis and an environmental scan, this dissertation foregrounds Black women’s own narratives to explore the social construction of pregnancy risk, the role of communication with healthcare providers in the amplification or attenuation of these risks, and the broader communicative context that shapes Black women’s pregnancy experiences. In doing so, this study found that Black women’s pregnancy risk perceptions are socially constructed through communication in a socio-political context shaped by gendered racism, and Black women enacted agency in response to these risks in a variety of ways constrained by gendered racism, including intentional decision-making, extensive research, and self-advocacy. Insights from in-depth interviews and the qualitative network analysis were contextualized in an environmental scan that included a review of relevant policies, interviews with community leaders, and a review of community organizations efforts to support Black women. This dissertation concludes with a discussion of contributions to theory and insights for Black women, healthcare providers, community organizations, media and policy makers. </p>

The United States healthcare system cares for and supports a diverse patient population. Patients come from various ethnic backgrounds, speak different languages, hold distinct religious affiliations, and more. These differences can create a chasm in the patient-provider relationship, impacting the quality of care or health outcomes. Specifically, language-discordance can affect patient-provider communication; however, technological interventions, such as access to electronic medical record tools and digital translators, can facilitate this dyadic communication. This scoping review examines the literature present on the use of digital tools to facilitate multilingual patient-provider communication. The initial search in PubMed with MeSH terms resulted in 531 studies. After studies were screened for the inclusion criteria in abstract and full-text screening, seven studies remained for data extraction. Results revealed no strong patterns regarding either type of digital technology studied, medical specialization, or clinical setting. Only one randomized controlled trial was identified. Findings highlight the need for more research in this field to determine more specific impact of the usage of technology in healthcare communication.

Thesis advisor: Joyce Edmonds / Background: Systemic racism contributes to the persistent and large inequities in perinatal health outcomes for pregnant people of color, particularly Black pregnant people. Poor communication between pregnant people of color and their providers contributes to these health inequities and perpetuates systemic racism in perinatal health. Pregnant people of color report being dismissed, ignored, discriminated against, and disrespected within the perinatal care system. One of the ways that patients communicate with their providers is via the patient portal. According to the Health Information National Trends Survey, around 80% of U.S. adults utilized information technology, such as patient portals, to track health data or communicate with their provider. Researchers have identified lower usage of patient portals in pregnant people of color compared to their White counterparts. Lower levels of utilization may perpetuate the digital divide for the low-resourced communities of color. Aims: The dissertation has three aims. The first aim was to synthesize and critically analyze patient-provider communication in pregnant people of color. The second aim was to examine the relationship between the quality of patient-provider communication (PPC) and the extent of patient portal use in pregnant people of color and to determine if digital health literacy is a moderating factor in this relationship. The third aim was to explore pregnant people of color’s access, use and perceptions of the patient portal in order to identify barriers and facilitators to quality digital communication with their prenatal providers. Methods: An integrative review method was applied to the empirical literature to achieve aim one. A multi-method, cross-sectional survey study with a non-probability convenience sample of 130 pregnant people of color receiving prenatal care at a large safety net hospital in Boston was conducted for aims two and three. Logistic regression and moderation models were utilized to analyze the quantitative survey data to achieve the second aim. Content analysis was used to analyze the responses to four open-ended survey questions to achieve the third aim. Results: A three-manuscript dissertation was completed. In the first manuscript, 26 articles were identified and the factors, outcomes and recommendations from communication between pregnant people of color and their prenatal providers were evaluated. There were two overarching themes: Racism and Discrimination and Unmet Information Needs along with multiple factors, outcomes and recommendations. The second manuscript reported on the quantitative results responses from 130 pregnant people of color. Participants that did not use the patient portal and who had public insurance had lower odds of rating higher quality PPC. Digital health literacy was found to be a moderating factor in the association between PPC and portal use at the level of portal users. The third manuscript reported on the content analysis and found main facilitators to communication between pregnant people of color and their providers were Provider behaviors and functionality of myChart and barriers were quality of response, multiple providers and digital access and literacy. Conclusions: The findings from this dissertation may be translated into clinical practice by informing perinatal providers on the pregnant people of color’s ratings of respectful communication and facilitators and barriers to quality health communication. Policies and strategies may be developed to improve digital health communication in order to provide inclusive and person-centered care in pregnancy. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: Chronic kidney disease (CKD) affects approximately 26 million individuals in the United States and is a top priority in the objectives for Healthy People 2020. Despite efforts to improve awareness, discussion of CKD is often minimal or ineffective in the primary care setting. This leads to a lack of patient awareness and knowledge of self-care skills to prevent or slow progression of the disease. A lack of communication of has been attributed to the provider's lack of confidence and knowledge to discuss CKD and to avoid unnecessary stress. Purpose: The purpose of the DNP project is to provide a systematic review of patient-provider communication processes used to influence self-management or behavioral change in primary care and propose a tool to enhance communication and slow progression of CKD. Methods: A systematic review was conducted following the method guidelines of the Cochrane Collaboration. Six electronic databases were searched. Inclusion criteria were adult humans, primary research studies, systematic and literature reviews, focus on communication of self-management or behavioral change strategies, primary outcomes of improving self-management and/or patient outcomes and availability of full-text online or by request. Outcomes: Of the 5765 articles initially identified, 28 studies met inclusion criteria. The studies revealed a lack of evidence directed towards CKD and communication was not directly addressed in a majority of the studies. Interventions most successful in improving patient outcomes were individualized, elicited collaboration or interaction with the patient and provider, were motivational or encouraging and aided in barrier identification and problem solving. A communication tool was developed from the evidence in order to stimulate more meaningful conversation between the patient and provider.

This study examined the relationships between cultural characteristics, communication variables, and medical outcomes in HIV-positive racial/ethnic minority patients. Participants included 33 patients and 5 providers across two urban, community medical clinics. The patient sample was 61% African American, 24% Latino, and 15% Other/Mixed. The majority (73%) were male. Providers included one White female physician, one White male nurse practitioner, two White female nurse practitioners, and one White male physician assistant. In this descriptive study, patients completed self-report ratings of their desire for engagement in decision-making prior to their scheduled medical consultation. After their consultations, patients rated their provider regarding engagement in decision-making, interpersonal communication, and working alliance. Patients also completed measures of acculturation, fatalism, familism, and mistrust. Providers rated their engagement of patients in decision-making, the patients’ interpersonal style, and working alliance immediately after the consultation. Measures of CD4 count and viral load were obtained from patients’ medical records. Cultural characteristics were not related to patient desire for engagement in decision-making. Patient perceptions of being highly informed and involved in decision-making were not related to satisfaction or immune functioning. Patient perceptions of provider affiliation and control, and the complementarity between these two, were also not found to have any significant relation to satisfaction or immune functioning. Though working alliance was not found to have a significant relation to any outcome, the relation between patient perception of a stronger working alliance and higher satisfaction was marginally significant. A match between patient and provider on the bond subscale of working alliance was found to correspond to IMI affiliation complementarity. Though the hypotheses were not supported, certain demographic variables were significantly associated with outcomes. For example, use of antiretroviral medications was associated with lower viral load and gender (i.e., being male) was related to lower CD4. The limitations of this study and directions for future research are discussed.

Over the past few years, the rate of elective interventions in pregnancy in the United States, including elective inductions of labor and elective cesarean deliveries, has increased dramatically. While scholars attribute some of the increase in elective interventions to the female patients who request elective procedures from obstetricians, some literature contradicts that notion and suggests physicians are actually the primary perpetuators of the growth in elective procedures. Although pregnant women may seek elective interventions because of desired convenience, physicians can also claim the benefit of convenience in scheduling deliveries. In addition, elective procedures provide physicians greater monetary compensation than labor and deliveries which evolve without intervention. The current dissertation investigates the communicative role of obstetricians in women’s delivery decisions through in-depth interviews with obstetricians practicing in the state of Kentucky (N=28). Guided by the framework of Message Convergence, the study assesses how obstetricians manage uncertainty surrounding patient care and make clinical decisions in the midst of either unclear evidence or competing messages. The study also reveals the ways that physicians utilize their medical expertise to engage in decision-making with patients. In addition, specific scenarios of decision-making regarding delivery are discussed, including patients’ requests and physicians’ provisions of requests; patients’ requests and physicians’ refusals of requests; and physicians’ recommendations for treatment and patients’ refusals of recommendations for treatment. Finally, the internal tensions and conflicts experienced by physicians in the decision-making process with patients are also examined.

The goals of this project are twofold. The first goal is to articulate my sense making of reproductive health for Women of color in the United States as a postcolonial condition; one that I trace back to the logics of elimination of settler colonialism (Wolfe, 2006) and frame as maintained through the colonial institutions, or racial projects (Omi & Winant, 2015), of the Prison Industrial Complex, the welfare system, and the health care system which create and perpetuate dominant cultural narratives of “the welfare queen”, “the negligent Black mother”, and “the wily patient”. I show how these narratives colonize the minds of health care providers and contribute to the current stratification of health care. My second goal with this project is to show how postcolonial interpretive ethnography can be used as a narrative medicine educational intervention for providers. Currently, Narrative Medicine asks providers to read themselves, their patients, and their interactions as literature to emphasize the personal and interpersonal tensions that are often lost in the fast paced biomedical world (Charon, 2001). With this project I aim to expand the field of Narrative Medicine to consider the ways patient-provider interactions are postcolonial, and how analyses of these interactions can be a method of decolonization. I do so by analyzing three interpretive ethnographic narratives that I have created which story my interactions with three Women of color: Tiffany, Rose, and Jane. I then analyze each of these interactions for colonizing and decolonizing sense making.

No description available.

Type 2 diabetes is epidemic in the American Indian population. One problem health care providers face when working with the American Indian population is communicating about secondary complications, such as periodontal disease. From a public health standpoint, periodontal disease prevention is important not only to prevent unnecessary oral pain and tooth loss, but also to prevent other more serious systemic problems from occurring such as cardiovascular disease, strokes, and bacterial pneumonia. The purpose of this qualitative study was to examine the communication efforts of health care providers and understand if and how they discuss periodontal disease with their American Indian patients with type 2 diabetes. Structured interviews were conducted with health care providers at an American Indian community clinic using questions based on the model of communication competence. Data analysis consisted of an analysis of the interview transcripts looking for concepts, themes, and events to see if discussion of periodontal disease is occurring at diabetic visits. Results of the study showed that although all the providers knew about the link between diabetes and periodontal disease risk, not all the providers were discussing the risk with their patients, and time, perceived health literacy, and other priorities all played a role in the lack of communication. This finding has the potential to influence positive social change by being an impetus for change in current diabetic patient care policies in the areas of communication and education regarding American Indian patients with diabetes about periodontal disease risk.