PhD, University of Cincinnati, 2024, Arts and Sciences: Psychology

Background: Readiness for transition to the adult healthcare system is critical for adolescents and young adults (AYAs), and yet most receive limited support for planning this important healthcare step leading to negative health outcomes such as morbidity and mortality. College students in particular are often tasked with healthcare transition, but many do not utilize healthcare services. Identifying factors and mechanisms that can be modified to increase transition readiness could have important treatment and long-term health implications for young people. AYAs with medical conditions often have greater healthcare transition readiness skills than those without medical conditions, but it is unclear why this difference exists. The current study executed a cross-sectional design to elucidate the complex relationships between individual factors (i.e., preventive healthcare behaviors, healthcare knowledge, and self-efficacy) predicting healthcare transition readiness and medical conditions. Specifically, it was hypothesized that presence of a medical condition would moderate the relationship between individual factors and transition readiness. It was also hypothesized that individual factors would mediate the relationship between presence of a medical condition and transition readiness. Method: Participants were 1,437 AYAs (18-24 years old) with or without medical conditions enrolled at a large midwestern U.S. university. Participants were recruited through an online research participation system utilized by undergraduate courses at the university and received course credit for their participation. AYAs completed measures through an online survey assessing demographic information, healthcare transition readiness (Transition Readiness Assessment Questionnaire 5.0), preventive healthcare behaviors (College Student Health Survey Questionnaire), healthcare knowledge, and self-efficacy (General Self-Efficacy Scale). Moderation analyses (N = 3) were computed using P (open full item for complete abstract)

Committee: Cathleen Stough Ph.D. (Committee Chair); Paula Silva Ph.D. (Committee Member); Kristen Jastrowski Mano Ph.D. (Committee Member) Subjects: Clinical Psychology

Master of Science, The Ohio State University, 2024, Genetic Counseling

Background: Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder caused by pathogenic variants in the COL3A1 gene. Patients can experience aortic or arterial dissections and hollow organ rupture. While it is rare, affecting between 1/50,000 and 1/200,000 people, support organizations exist. The goal of this study is to determine what information would be helpful for support organizations of the vEDS community to prioritize programming regarding mental health support and how the social aspect of support organizations impacts mental health. Methods: People with vEDS and their first-degree family members, including spouses/partners, were surveyed about their mental health, traumatic experiences -including vicarious trauma -, and support organization participation. An electronic survey was administered, which included the STOP-D, OSSS-3, demographic questions, and questions regarding support organization participation, priorities, exposure to trauma, what materials they would like a support organization to provide regarding grief/trauma, and preferred ways of receiving information. Results: One hundred forty-three people participated. Statistically significant relationships were found between experiencing trauma and vicarious trauma (p=0.002) and having access to a provider who listens and confidence in a provider's knowledge of vEDS (p=0.001). Ninety five percent of those who reported vicarious trauma also reported experiencing at least one traumatic event. There was no association found between vicarious trauma and subtype of experienced trauma, or between vicarious trauma and support group participation. Although not statistically significant, high stress was reported for both people with vEDS (65%) and their unaffected family members (60%). Participants also wanted a variety of materials or programs from a support organization, including peer support, individual and group therapy, information on advanced directives, and 24/ (open full item for complete abstract)

Committee: Gretchen MacCarrick (Advisor); Kristen Carpenter (Committee Member); Elizabeth Jordan (Committee Chair) Subjects: Genetics; Mental Health

Doctor of Philosophy (PhD), Ohio University, 2024, Higher Education (Education)

There is growing population of college students with chronic illnesses in many higher education institutions in the United States. These students are battling their health conditions as they also maneuver their experiences on campus. Another growing population of students are international students and some of them also have chronic illness, some diagnosed even before they get to the US and others diagnosed during their time in the country. They too face different challenges concerning their health; however, they are saddled with navigating their health in a foreign country where everything is different from what they are used to. This paper discusses the experiences of international students in the US who are navigating their health and their academics. The paper focuses on international students who have studied in a US higher education system, and they share their experiences on how they have navigated their health issues and balancing their program of study. In addition, they also highlight their challenges and how they have overcome them as well as the forms of support they have utilized during their time in the US.

Committee: Peter Mather (Committee Chair); Greg Kessler (Committee Member); Tamarine Foreman (Committee Member); Laura Harrison (Committee Member) Subjects: Education; Health

Master of Science, The Ohio State University, 2022, Genetic Counseling

Anxiety is one of the most common mental health diagnoses in the general population; however, prevalence of anxiety is even greater in a wide range of chronic illness populations, including cystic fibrosis. Cystic fibrosis (CF) is a genetic condition affecting many major body systems with hallmark features including progressive decreases in lung function and pancreatic insufficiency. Studies have reported anxiety prevalence in patients with CF as high as 46%. Factors impacting anxiety in this population are further complicated in young adult (YA) patients due to transition of medical care in addition to typical social, physical, and societal milestones. However, recent medical advancements through modulator therapy (VX-445/TEZ/IVA) have significantly increased lung function and quality of life for almost 90% of patients with CF. Research investigating potential correlation between recent modulator therapies and anxiety symptoms in the CF population is limited to a few case studies. This study aims to investigate changes in anxiety symptoms in YA patients with CF over the first year of modulator therapy, as well as investigate potential correlations between changes in anxiety symptoms and lung function. Data was compiled through data use agreement with Nationwide Children's Hospital. Anxiety symptoms at baseline, six months, and 12 months after initiation of VX-445/TEZ/IVA were investigated through mental health questionnaires, PROMIS and GAD7. Clinical indicators of FEV1 and demographics were also collected via clinical appointments and the CFQ-R respectively. Statistical analysis and was completed using Stata Version 15 (College Station, TX). Linear mixed models were used to estimate average linear trends for anxiety symptom scores. Spearman correlations were used to assess correlation between mental health questionnaires and lung function changes. Clinical significance was determined by clinically-meaningful cut-offs. A total of 29 participants were included (open full item for complete abstract)

Committee: Leigha Senter-Jamieson MS, CGC (Advisor); Kimberly Pasley Psy.D. (Committee Member); Dawn Allain MS, CGC (Committee Member); Matthew Pastore MS, CGC (Committee Member); Sabrina Palacios MD (Committee Member) Subjects: Genetics; Psychology

Master of Arts, Case Western Reserve University, 2021, Religious Studies

This thesis seeks to bring together three separate, yet ever-communicating entities -- the healthcare (HC) patient, the healthcare system (HCS), and the HC chaplain. Utilizing wisdom from feminist, postcolonial, and affect theorists, this thesis seeks to conceptualize and visualize this triad dynamic. The format is non-traditional in that concepts are expressed and developed through both an art installation and in written form. Largely diagnostic, this work highlights what it is like to be “other” concerning something as personal as bodily illness, how the HCS and its' relationship to capitalist society contributes to the “othering” of chronically ill patients, and how the HC chaplain may also be an “other” who can potentially mediate the relationship between the HCS and the patient.

Committee: Timothy Beal PhD (Committee Chair); Brian Clites PhD (Committee Member); William Deal PhD (Committee Member) Subjects: Religion

Doctor of Philosophy, Case Western Reserve University, 2021, Psychology

Muslims living in the United States are a growing racially and ethnically diverse group, and many of them experience chronic health conditions. A biopsychosocial-spiritual conceptualization model of health and disease may be particularly relevant to Muslims, given the holistic view of medicine promoted in Islam. Muslims may turn to positive religious coping and/or experience religious and spiritual (r/s) struggles in responding to their chronic illness. The purpose of the current study was to investigate the links between religiousness, religious coping, views of God and suffering, physical health, and psychological well-being among U.S. Muslim adults with a chronic medical condition. Participants completed a battery of questionnaires. Data were collected from an online sample (N= 162) and were consolidated through a series of correlations, a path model, and a structural equation model. Some key findings were as follows: As expected, results revealed positive associations between religiousness, perceived closeness with God, gratitude, patience, trust in God and positive religious coping. Attributing God's intent as kind predicted participants' engagement in positive religious coping, while attributing God's intent as cruel predicted divine struggles. R/s struggles were positively associated with anxiety but not associated with depression (which had a low alpha), in partial support of predictions. Unexpectedly, r/s struggles also showed small positive associations with well-being (particularly social well-being), although these were reduced when religiousness was controlled. In line with predictions, r/s struggles were related to greater physical health problems and viewing one's medical condition as life-threatening. Finally, as expected, perceived discrimination was associated with negative healthcare experiences. Implications for clinical practice and research are discussed.

Committee: Julie Exline PhD (Committee Chair) Subjects: Psychology

Master of Fine Arts, The Ohio State University, 2020, Art

This work is composed of images and texts that seek to record and examine the ongoing dialogue and relationship I carry with my body. As someone with systemic lupus, my relationship with my body (and immune system) can be contentious and unpredictable. This thesis aims to explore the nature of that connection through a collection of photos, drawings, writings, and experimental gestures. An attempt has been made to make formal sense of their shape and order, but the truth remains (and is likely evident) that I have encountered the same difficulties as my healthcare practitioners in charting and pining down my body's whims and behaviors. As it turns out, both my body and I are elusive and resist clean categorization. Still, it is my hope that a common thread of investments can be traced within this stream of words and images around how to share, endure and live with/in one's body. It must be said that I conclude with no tidy answers but instead with more questions and trails of inquiry around how to co-exist and live with chronic illness.

Committee: Amy Youngs (Advisor); Ann Hamilton (Committee Member); Erica Levin (Committee Member) Subjects: Fine Arts

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2020, Media and Communication

The Centers for Disease Control argues that chronic diseases are on the rise (Butler & Modaff, 2016, p. 77; Goodman, Posner, Huang, Parekh, & Koh, 2013, p. 1). Moreover, the Mayo Clinic (2020) acknowledges there are more than 200,000 cases of Hashimoto's Thyroiditis diagnosed in the United States each year. Although, there has been much scholarship produced surrounding chronic illness as a whole (e.g. Badr, 2004; Badr & Acitelli, 2005, 2017; Badr, Acitelli, & Carmack Taylor, 2007; Butler & Modaff, 2016; Charmaz, 1990, 1991, 2002a, 2002b, 2006; Kuluski et al., 2014; Lyons & Meade, 1995), I build from this scholarship and narrow the scope by focusing specifically on Hashimoto's patients. Therefore, this dissertation examined the stories from those living with the chronic invisible illness, Hashimoto's Thyroiditis, because I believe they have stories to tell. Furthermore, this dissertation explored the experiences of Hashimoto's patients and how they negotiated their identities throughout their diagnosis process to present day. I used Hecht's (1993, 2014) Communication Theory of Identity (CTI) to frame this study, and I utilized qualitative feminist methodology to structure my project. I completed 30 in-depth interviews, and I invited participants to engage in electronic journal entries, if they so desired. Furthermore, I also incorporated my own vignettes throughout my analysis to ensure I was being reflexive in my work. From my analysis, there were five distinct themes that emerged from the data: before the story was a story, the story, after the story, into perspective, and tomorrow. Overall, the Hashimoto's patients expressed the fact that they felt dismissed by their physicians, stigmatized in the workplace, and they shared their struggles within their relationships. These communication hardships are a problem that need to be further addressed. However, the patients did acknowledge their shifting identities from being well to chronically ill. Being diagnosed with (open full item for complete abstract)

Committee: Sandra Faulkner PhD (Advisor); Amelia Carr PhD (Other); John Dowd PhD (Committee Member); Lisa Hanasono PhD (Committee Member) Subjects: Communication; Gender; Gender Studies; Health

Doctor of Philosophy (PhD), Ohio University, 2020, Individual Interdisciplinary Program

Joey Connor Larry Darrell: A Television/Streaming Series a Clef is a semi-autobiographical, limited-run scriptment/teleplay that draws upon the disciplines of Media Arts and Studies, English, and Philosophy, and is an exploration of the themes of mental illness, stigmatization, family dysfunction, psychological manipulation, diabetes, and forgiveness. It is about a man in his late adolescence who has awful family experiences and afterwards follows a path through life that is far from straight and smooth. Besides mental illness stemming from gaslighting, Joey also develops the chronic illnesses of diabetes and renal insufficiency, plus he suffers from various periods of homelessness. Despite these challenges, Joey never stops pursuing higher education, which he finds to be a great source of stability and solace. In this respect, Joey Connor Larry Darrell is an extended encomium to the powerful role higher education can play in helping individuals who face similar, significant personal challenges.

Committee: Jenny Nelson Dr. (Committee Chair); Robert Miklitsch Dr. (Committee Member); James Petrik Dr. (Committee Member) Subjects: African Americans; Aging; Education; Families and Family Life; Film Studies; Health; Health Care; Higher Education; Mass Media; Mental Health; Motion Pictures; Psychology; Psychotherapy; Therapy

Master of Gerontological Studies, Miami University, 2019, Gerontology

The framers of successful aging envisioned long lives that were relatively disease free. This model has been criticized, particularly in its applicability to individuals with disabilities, many of whom have lived with disabilities throughout their lives. Although there have been recent efforts to include a disability framework in the successful aging model, these adaptations do not specifically address how individuals with invisible disability expect to age. Therefore, the purpose of this study is to evaluate how the six elements of the successful aging with a disability framework are associated with feeling prepared to age among individuals with dysautonomia—a chronic, invisible, and disabling condition. Data come from a cross-sectional, pilot survey regarding experiences of living with dysautonomia conducted in 2018. Logistic regression assessed the associations between the six elements and preparedness to age with dysautonomia. It was also used to assess if availability, accessibility, and appropriateness of medical care were individually associated with preparedness to age. Two of the six elements, autonomy and choice and effective compensation, were significantly associated with preparedness to age, while availability, accessibility, and appropriateness of medical care were not significantly associated. Findings suggest that self-efficacy and chronic disease management may be important to this population.

Committee: Robert Applebaum (Committee Chair); Sara McLaughlin (Committee Member); Katherine Abbott (Committee Member) Subjects: Gerontology; Health

PHD, Kent State University, 2019, College of Arts and Sciences / Department of Sociology and Criminology

Invisible chronic illnesses and conditions significantly impair normal activities of daily living. In the United States, 96% of people with chronic medical conditions show no outward signs of their illness, and 10% experience symptoms that are considered disabling (Shapiro, 2012). Invisible illnesses can hinder a person's efforts to go to school, work, socialize, and more. The challenges and impairment associated with invisible chronic illnesses can be difficult for others to recognize or acknowledge. Others may not understand the cause of the problem, since they cannot see evidence of it in a visible way. One such invisible illness, Crohn's Disease, affects as many as 780,000 Americans (Kappelman et al., 2007) but there is relatively little literature examining people's subjective experiences of the disease (Casati et al. 2000a; 200b). Outsiders see people living with Crohn's Disease working, socializing, smiling and laughing, exercising and grocery shopping. In my dissertation, I find what they cannot see is chronic pain, insomnia, and medication side effects, to name just a few symptoms. My findings also show that people may also experience financial burdens from medical costs, extreme fatigue, loneliness and isolation. My dissertation investigates how persons living with Crohn's manage myriad aspects of their illness while pursuing social milestones, such as having a career, getting married or/and becoming a parent. My research question led to the investigation of three aspects of the Crohn's experience: how biographical disruptions affect life chances, loss and normality; how individuals with Crohn's fight for legitimacy in the clinical setting; and, how stigma and labeling shape an individual's choice to disclose illness in the workplace. The present study centers on how Crohn's Disease extends into people's public and personal lives. By understanding how people handle the demands of their illness, it is then possible to better target interventions that can h (open full item for complete abstract)

Committee: Manacy Pai (Committee Co-Chair); Clare Stacey (Committee Co-Chair); Richard Adams (Committee Member); JoAnn Xi (Committee Member) Subjects: Health; Health Care; Mental Health; Sociology

Doctor of Philosophy, Case Western Reserve University, 2019, Nursing

Background: Advancement in technologies has contributed to patients surviving critical illness, but continuing to live with chronically critically ill conditions. A majority of such patients experience transient or persistent states of decisional impairment requiring family members or authorized surrogate decision makers to render treatment decisions. Abrupt transition to the surrogate decision maker role often evokes heightened stress. Research shows that emotion regulation can help manage situational stress. Purpose: To examine the associations among emotion regulation, role stress, and psychological distress in surrogate decision makers of chronically critically ill patients in intensive care units. Methods: A descriptive, secondary analysis of 120 surrogate decision makers of chronically critically ill patients from various intensive care units within an academic medical center in Northeast Ohio. Parent investigation data were used to address the following questions: (1) what are the associations among emotion regulation (cognitive reappraisal & expressive suppression), role stress, psychological distress, and demographic variables of age, gender, ethnicity, kinship, advance directives, and living will of surrogate decision makers of chronically critically ill patients? (2) what is the relationship between emotion regulation and psychological distress while controlling for surrogate decision makers' demographic variables? (3) does role stress mediate the relationship between emotion regulation and psychological distress while controlling for demographic variables of surrogate decision makers of chronically critically ill patients? Pearson r and Spearman rho correlations and Multiple Regression tests were conducted to answer these questions. Findings: Statistically significant associations included: role stress and psychological distress (r = .29, p < .01), gender and role stress ((r = .22, p < .05), gender and psychological distress (r = .27, p < .01), kinship (open full item for complete abstract)

Committee: Ronald Hickman Dr. (Committee Chair); Jaclene Zauszniewski Dr. (Committee Member); Mathew Plow Dr. (Committee Member); Arin Connell Dr. (Committee Member) Subjects: Health Sciences; Nursing

EdD, University of Cincinnati, 2018, Education, Criminal Justice, and Human Services: Special Education

The increase in children and adolescents with chronic health conditions (CHCs) reaching adulthood has prompted researchers and practitioners to shift their focus towards the long-term implications of conditions and treatments on educational and vocational attainment in early adulthood and beyond. As a result, a growing volume of research has indicated that adults with childhood-onset CHCs experience poorer long-term outcomes compared to healthy counterparts. An understanding of the educational and vocational needs of adults with childhood-onset CHCs is necessary to develop proactive supports to improve educational and vocational attainment for these individuals. This paper presents a survey designed to ascertain the self-reported educational and vocational needs of adults with childhood-onset CHCs in the healthcare setting. The content evaluation process used to validate the Post-Secondary Educational and Vocational Needs Survey (Post-Secondary Survey) according to Lawshe (1975) and Davis (1992) is described, as well as the results (descriptive statistics) from the pilot study evaluating the needs of 15 adult pediatric brain tumor survivors. Findings suggest that the Post-Secondary Survey may be a valid and reliable measure for identifying barriers adults with childhood-onset CHCs report related to participating in educational or vocational programs and vocational attainment. Implications for educators, healthcare providers, and future research are considered.

Committee: Anne Bauer Ed.D. (Committee Chair); Megan Elam Ed.D. (Committee Member); Casey Hord Ph.D. (Committee Member); Laura Nabors Ph.D. (Committee Member) Subjects: Special Education

Doctor of Philosophy, The Ohio State University, 2018, Psychology

Leventhal's Self-Regulatory Model of Illness Behavior (1980) proposes that, in response to a health-relevant stimulus such as a physical symptom or disease diagnosis, individuals generate a mental representation of the stimulus, or illness perception, which guides coping behaviors and influences psychological and physical health outcomes. Despite extensive research linking illness perceptions to coping and health in several disease groups, lesser attention has focused on better understanding determinants of illness perceptions themselves. The goal of the current project was to test a fundamental postulate of self-regulatory theory, which suggests that illness perceptions are influenced primarily by somatic characteristics of the illness stimulus (e.g., symptom type and severity), prior experiences with the stimulus (e.g., treatment success or failure), and changes in the stimulus over time. To do so, two studies were conducted, both in samples of patients with chronic lymphocytic leukemia (CLL). Using a cross-sectional design, Study 1 contrasted illness perceptions among CLL patients (N=330) from three groups differing in symptom severity and prior CLL experiences: active surveillance (n=100), initiating a first treatment (n=78), and initiating treatment for relapsed/refractory disease (n=152). Analysis of variance revealed that, while consequences, identity (symptoms), and illness concern were poorer among patients at each successive phase of treatment, perceptions of how well one understands CLL (coherence) and how long CLL will last (timeline) were poorest among those earliest in the trajectory (i.e., active surveillance). Patients initiating a first treatment believed most strongly that they could personally control CLL (personal control) and that treatment would be helpful (treatment control). Study 2, using a longitudinal, single group design, examined specifically the role of somatic stimulus severity among relapsed/refractory CLL patients (N=152) initiating (open full item for complete abstract)

Committee: Barbara Andersen (Advisor); Charles Emery (Committee Member); Baldwin Way (Committee Member) Subjects: Psychology

Master of Arts, Miami University, 2018, English

“cycles for a long now” employs the self as a case study to explore through poetry how neoliberalism and current events impact physical and mental health. Specifically, it examines how neoliberalism comes to be embodied, including, but not limited to, manifestations of chronic illness. With the term neoliberalism, I refer to the hyper-responsibilization effects of economic policies that provide no safety nets or social services in order to generate as much profit as possible, meaning that people must devote their entire lives and selves to accumulating enough resources to survive. The work uses illness, particularly illness living on the threshold between mental and physical, as a launching point to critique “illnesses” inherent to our contemporary society and how the increasing demands of neoliberalism and its dismissal of the disabled, unproductive body sicken its subjects.

Committee: cris cheek (Committee Chair); Cathy Wagner (Committee Member); TaraShea Nesbit (Committee Member) Subjects: Fine Arts

Bachelor of Arts, Wittenberg University, 2018, Education

Approximately 10-15% of students in the United States are diagnosed with a chronic illness that can alter their education both socially and emotionally, in addition to implications the disorder itself brings upon them. The study performed gathered information on these implications from a parental perspective. Additionally, this study provided insight on the accommodations currently provided to chronically ill students and those that parents believe still need to be provided to their chronically ill child. Results from this study concluded the following: 1) students with a chronic illness have altered relationships with peers, friend, and adults, 2) approximately half of students view their chronic illness as a daily struggle, 3) roughly 50% of participants feel unsatisfied with the accommodations provided to their child.

Committee: Brian Yontz Ph.D. (Advisor); Amy McGuffey Ph.D. (Committee Member); Cathy Pederson Ph.D. (Committee Member) Subjects: Education

Doctor of Nursing Practice Degree Program in Population Health Leadership DNP, Xavier University, 2018, Nursing

Children with special health care needs are surviving into adulthood in increasing numbers, as improvements in care and treatments increase the likelihood of survival. A technical brief published by the Agency for Healthcare Research and Quality reports more than 750,000 of children with medical complexity transition to adult care every year. Fewer than half have the resources needed to adequately make the transition successfully (McPheeters et al., 2014). The use of a portable medical summary was recommended in a Consensus Statement by the AAP, AAFP and ACP in 2002 (American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine [AAP, AAFP, ACP-ASIM], 2002) and by Got Transition/Center for Health Care Transition Improvement as part of the “Six Core Elements for Health Care Transition” (National Alliance to Advance Adolescent Health, 2014, p. 2). The purpose of the project was to increase the number of Pediatric Medical Complexity Algorithm (PMCA) Tier 2 and 3 patients, aged 16-24, who were seen each week for well care or chronic care management visits that have a portable medical summary updated in the past six months from zero to 90%. In this scholarly project, PDSA cycles were used to test the feasibility and usefulness of the portable medical summary, an electronic tool developed in the electronic health record, and shared with families. The portable medical summary was evaluated by providers and families and their feedback led to modifications for its improvement. By the conclusion of this DNP project, there was an increase to 100% of youth who had a portable medical summary initiated.

Committee: Susan Allen Ph.D. RN-BC (Committee Chair); Betsy List Ph.D. MPH RN (Committee Member) Subjects: Health Care; Health Care Management; Nursing

Master of Arts (M.A.), University of Dayton, 2017, Psychology, Clinical

Individuals with chronic illness are prone to experiencing stigmatization associated with their illness (Ginsburg & Link, 1993); these individuals often utilize an avoidant coping style (Philips, 1987) and are vulnerable to poor social support. Existing literature describes how the chronically ill encounter these constructs, yet the impact of these factors on college students' health-related quality of life and psychological functioning is not understood. Two studies tested the hypotheses that stigma, avoidant coping, and social functioning are associated with HRQoL and psychological well-being in undergraduate students who have chronic illness. Participants were undergraduates diagnosed with at least one chronic illness. Participants completed self-report measures online. In Study 1 (N = 140), stigma, avoidant coping, and social support significantly predicted diminished HRQoL, depression, and anxiety. Study 2 (N = 193) confirmed the results of Study 1, finding that stigma, avoidant coping, and social support significantly predict diminished HRQoL, depression, and anxiety; findings across both studies supported hypotheses. Findings suggest that college students with chronic illness face significant challenges associated with and during their undergraduate career.

Committee: Jacob Burmeister PhD (Committee Chair); Catherine Lutz-Zois PhD (Committee Member); Lee Dixon PhD (Committee Member) Subjects: Psychology

PHD, Kent State University, 2017, College of Nursing

A PATH ANALYSIS OF TRUST IN NURSES, SOCIAL SUPPORT, PATIENT SELF-ADVOCACY, PSYCHOLOGICAL DISTRESS, AND PHYSICAL SYMPTOMS IN PATIENTS WITH CHRONIC HEART FAILURE (199 pp.) Director of Dissertation: Ratchneewan Ross, Ph.D., RN, FAAN Patients with heart failure participate in care by self-advocating, or speaking up, to their health care providers. By gaining and using health information, assertively communicating, and making decisions, patients are self-advocating. A cross-sectional, path analysis design was used to test two structural models. A convenience sample of 80 HF clinic patients were surveyed using the Adapted Patient Self-Advocacy Scale, Health Care Relational Trust in Clinic Nurses Scale, Medical Outcome Study Social Support Scale, Hospital Anxiety and Depression Scale, and the Symptom Status Questionnaire for Heart Failure. An analysis was conducted to test the direct and indirect effects of trust in nurses, social support, and self-advocacy, on psychological distress and physical symptoms. Two structural models were created; neither model fit the data as hypothesized. A respecified model focusing on the components of self-advocacy was tested, trimmed, and found to fit the data (chi square 9.452, df 6, p .105; RMSEA .085; CFI .877, IFI .892, NFI .752). Trust in nurses directly affected patient self-advocacy knowledge (beta .25, R2 .06, p .05). Social support directly affected patient assertiveness (beta .26, R2 .07, p .05). And social support directly affected depressive symptoms (beta-.40, R2 .16, p .001). Nursing plays a role in patient self-advocacy. Educating and encouraging patients to use acquired knowledge in decision making supports patient participation and self-advocacy. Nursing's encouragement of the supportive role of friends and family members can have a positive influence on patient assertiveness and depressive symptoms.

Committee: Ratchneewan Ross Ph.D., R.N., F.A.A.N. (Committee Chair); Patricia Vermeersch Ph.D., C.N.P., R.N. (Committee Member); Marlene Huff Ph.D., M.S.N., C.N.S. (Committee Member); Joel Hughes Ph.D. (Committee Member); Richard Adams Ph.D. (Committee Member) Subjects: Communication; Nursing

Doctor of Philosophy (PhD), Ohio University, 2017, Communication Studies (Communication)

People with disabilities have long been under-represented and misrepresented in mainstream media, and have sought strategies to contest discourses of difference that frame disability as a pitiable tragedy, a burden, or a source of inspiration used to make non-disabled people feel better about their own lives. With the advent of the internet and the increasingly participatory character of the media landscape, people with disabilities are now more able to generate and circulate a counter-narrative--one which draws on the social model of disability to highlight the ways in which stigmatizing and oppressive responses to different bodies create and perpetuate marginalization. However, the disability community is far from monolithic. In addition, the line between "chronic illness" and "disability" remains blurry. Thus, as individuals engage in self-advocacy and collective/connective action by publicizing their stories, they draw from varied discourses of difference that preserve or resist medicalization. Similarly, advocates organize to pursue potentially conflicting goals. The resulting tensions of representation and organization are particularly apparent in the case of The Mighty, a for-profit media company that publishes stories submitted by people with disabilities, chronic illnesses, and mental health conditions. This site has become an increasingly popular resource for some members of the disability community. At the same time, it has also become a site of contention and has received criticism from disability activists who protested its publishing practices via the hashtag initiative, #crippingthemighty. For this dissertation project, The Mighty served as a context to explore how public performances of self-advocacy in digital spaces link to connective/collective action. Taking a constructivist approach to grounded theory (Charmaz, 2006), I analyzed interviews with Mighty staff members (14 participants), Mighty contributors (29 participants), and #crippingt (open full item for complete abstract)

Committee: Austin Babrow PhD (Advisor); Brittany Peterson PhD (Committee Member); JW Smith PhD (Committee Member); Stephanie Tikkanen PhD (Committee Member); Risa Whitson PhD (Committee Member) Subjects: Communication