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

Adherence to a prescribed plan of care in chronically ill patient populations of all ages is a global challenge. Failure to adhere to prescribed medications, treatments, and recommended self-care behaviors can lead to poor health outcomes and increased health care costs. Pediatric oncology, immunodeficiency, and hematopoietic stem cell transplant (HSCT) patients are at increased risk of developing treatment-related toxicities including infections, oral complications, and deconditioning, especially when they are non-adherent to prescribed self-care behaviors. Evidence indicates the risk for these toxicities can be reduced by participation in key activities of daily living (ADL), including daily bathing with chlorhexidine gluconate (CHG), physical activity and oral hygiene, known as ADL 1-2-3. Despite this evidence, many patients fail to perform these important ADL during their inpatient treatment, when they are most susceptible. Pilot testing of a paper token economy system demonstrated increased engagement in ADL 1-2-3 in a small group of inpatient pediatric HSCT patients who had a history of non-adherence with these self-care behaviors. The results of the pilot study suggested furthering this effort through the design and building of a digital token economy system. The primary DNP scholarly project aim is to improve overall adherence to ADL 1-2-3, as well as compare adherence between one group of patients receiving the current standard of care and a second group of patients receiving a novel digitalized token economy intervention in addition to the current standard of care. The DNP project serves as a feasibility study for a larger scale randomized controlled trial and therefore includes measurement of intervention fidelity in support of this National Institute of Health grant funded research.

Committee: Elizabeth Bragg PhD, RN (Committee Chair); Susan Allen PhD, RN-BC (Committee Member) Subjects: Medicine; Nursing; Psychology

Doctor of Philosophy, Case Western Reserve University, 2018, Psychology

The Health Belief Model (HBM), as proposed by Janz & Becker (1984), is a theory of adherence to medical recommendation. Findings on the association between the HBM and adherence and metabolic control in adolescents with Type 1 diabetes have been inconsistent (e.g. Brownlee-Duffeck et al., 1987; Patino et al., 2005). The current study aimed to investigate the relationship between parent and adolescent health beliefs and adherence/metabolic control. Further, the study aimed to identify variables that may moderate the parent/adolescent health belief and adherence/metabolic control relationship; namely, amount of parent responsibility for diabetes care, parent emotional support, and executive functioning of parent/adolescent. Findings were generally unsupportive of HBM and moderation hypotheses but patterns emerged that may be important in future research and clinical work with this population. These themes include the tendency for Caucasians and younger adolescents to have better metabolic control, and the importance of parent perception of severity and susceptibility of diabetes complications and the significant correlation both parent and adolescent executive functioning abilities have with adherence/metabolic control. Clinically, results speak to the need of further assessment and intervention targeting health beliefs and executive functioning in parents of adolescents with type 1 diabetes. Results further indicate the need for additional and more nuanced research on health beliefs in this population.

Committee: Amy Przeworksi PhD (Committee Chair); Rebecca Hazen PhD (Committee Member); Arin Connell PhD (Committee Member); Sandra Russ PhD (Committee Member); MacLeish Sarah DO (Committee Member) Subjects: Clinical Psychology

PHD, Kent State University, 2016, College of Arts and Sciences / Department of Psychological Sciences

Sickle Cell Disease (SCD) is a genetic, lifelong condition and the symptoms of SCD include pain crises, acute chest syndrome, increased risk of infection, decreased red blood cells, and stroke. Due to the chronic and difficult to manage nature of SCD, non-adherence is a problem and results in greater rates of hospitalization, infection, pain crises, acute chest syndrome, and an increased risk for early death. Disease management in adolescents with chronic illnesses is more complex than for young children or adults. As they are developing, adolescents become more independent, and responsibility for adherence tasks begins to fall more to the adolescent than their parent. Previous research has revealed that many factors contribute to adherence in SCD, and the best model for studying adherence in this population can be informed by models of adherence in diabetes and the Health Belief Model. Research supports the importance of including adolescent psychosocial functioning, parental stress, and parental perceived barriers when examining contributions to adherence in adolescence. The goal of the proposed study is to evaluate the contributions of adolescent psychosocial functioning, parental stress, and parental perceived barriers to adherence in adolescents with SCD. Overall, findings did not support hypotheses, but important relationships were revealed for this understudied population. The main findings from this study relate to adherence in youth with SCD and fall into three main areas: adolescent anxiety, responsibility for adherence, and healthcare barriers. Adolescents high in anxiety self-reported higher mean levels of adherence than non-anxious adolescents, indicating anxiety may be a protective factor for adherence. In this sample, parents took the majority of responsibility for a range of adherence tasks; however, there were some important tasks for which no one took clear responsibility. Responsibility also varied by mother level of education and insurance ty (open full item for complete abstract)

Committee: Beth Wildman Ph.D. (Advisor); Josefina Grau Ph.D. (Committee Member); John Updegraff Ph.D. (Committee Member); Prasad Bodas M.D. (Committee Member); Mark A. James Ph.D. (Committee Member) Subjects: Clinical Psychology

MS, University of Cincinnati, 2013, Medicine: Clinical and Translational Research

Previous studies associating non-adherence with donor specific antibodies (DSA) development in renal transplant recipients have used subjective assessments to classify non-adherence. No studies have examined the association between objective measures of non-adherence – primarily, standard deviation and/or coefficient of variation of immunosuppressive drug levels - and DSA development. We retrospectively analyzed the standard deviation and coefficient of variation in the five most recent tacrolimus or sirolimus trough drug levels at the time of DSA testing in 69 low-to-standard immunologic risk, first-time pediatric renal transplant recipients followed at a single US pediatric nephrology center. DSA prevalence in the population was 38% (n=26). DSA+ patients had significantly higher standard deviation (p=0.014) and coefficient of variation (p=0.024). There was a trend towards increased DSA prevalence in patients taking sirolimus vs. tacrolimus (p=0.14). Multivariate logistic regression demonstrated that coefficient of variation (p = 0.03) and black race (p=0.012) retained statistical significance in DSA development. For each 10% increase in coefficient of variation, the odds of developing a DSA increased by almost 40% (adj OR 1.38, 95% CI 1.09, 1.75). Future studies are needed to understand the extent and length of time variations in immunosuppressant medications that are tolerated prior to DSA formation.

Committee: Paul Succop Ph.D. (Committee Chair); Jens Goebel M.D. (Committee Member); Ahna Pai Ph.D. (Committee Member); Erin Nicole Haynes Dr.P.H. (Committee Member) Subjects: Surgery

Doctor of Philosophy, The Ohio State University, 2003, Psychology

Treatment regimen adherence is a well-documented problem in pediatric psychology. The literature is replete with studies indicating that adherence in pediatric chronic illnesses is significantly correlated with several family- and child-related psychosocial variables. The current work proposed and tested a model of treatment regimen adherence (as defined as prescription refill rate with physiological outcome as a covariate) for children and adolescents with asthma. The results suggest that although none of the proposed model variables (attention deficit-related behavior, secondary gain, family life stress, and child-reported illness attitudes) is a significant predictor of adherence, secondary gain does moderate the relationship between asthma severity and adherence (with peak flow as a covariate). More specifically, a significant positive correlation between severity and adherence exists only when secondary gain is low; otherwise, the correlation is non-significant. The optimal linear combination of participant age, secondary gain, child-reported illness attitudes, family stress, and attention-related behavior problems is not a significant predictor of prescription refill rate when physiological outcome is covaried from refill rate. This finding is consistent with the notion that outcome is in some way related to adherence and should not be considered a nuisance or control variable.

Committee: Thomas Linscheid (Advisor) Subjects: Psychology, Clinical