Human Development and Family Science

Permanent URI for this collectionhttp://hdl.handle.net/10342/35

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FROM SCARS TO STRENGTH: UNVEILING THE INTERSECTION OF ACES, SOCIAL DETERMINANTS, AND RESILIENCE IN ADULT INPATIENT REHABILITATION
(East Carolina University, December 2024) Kucukardali Cansever, Betul
This dissertation explores the complex relationship between adverse childhood experiences (ACEs), protective and compensatory experiences (PACEs), and their influence on resilience in primary care contexts and among adult inpatient rehabilitation patients. While ACEs are known to be linked with negative health outcomes, little attention has been given to the care for patients following a screening of ACEs in primary care, and protective factors are rarely if ever, considered in healthcare contexts. Furthermore, the role of ACEs, PACEs, social determinants of health (SDoH), and resilience in adult inpatient rehabilitation contexts are relatively unknown. The primary objective of this research is to deepen the scientific understanding of how ACEs, PACEs, and SDoH interact to shape resilience when individuals face medical conditions requiring inpatient rehabilitation. By examining this dynamic, this dissertation investigates clinical practices, research methodologies, and health equity policies, ultimately enhancing strategies for screening, triage, and intervention in rehabilitation units. The dissertation employs a dual approach, combining systematic reviews with original quantitative empirical analysis. It is organized into six chapters: the first chapter introduces the concept of resilience in rehabilitation and its relationship to ACEs and PACEs. The second chapter provides a systematic review of ACE screening practices in adult primary care settings, focusing on the types of clinical responses (e.g., resources, referrals, interventions) that follow positive ACE screenings. The third chapter systematically investigates additional psychosocial factors, both protective and adverse, that are assessed alongside ACE screenings in primary care, framed through a socio-ecological resilience model. The fourth chapter details the methodology of the original quantitative research. The fifth chapter presents the results of the empirical study, which examines the interaction between SDoH, protective factors, resilience, and behavioral health in adult inpatient rehabilitation patients with a history of ACEs; and the sixth chapter synthesizes the key findings and their contributions to the field, focusing on the integration of protective experiences in ACE screening interventions. It employs data visualization techniques to analyze health disparities across North Carolina counties based on the study participants' sample, offering recommendations for improving patient care and health equity. The research ultimately advances an understanding of the interplay between childhood adversity, protective factors, and health outcomes, offering strategies for improving resilience and health equity in diverse inpatient rehabilitation populations.
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Exploring Systemic Medical Traumatic Stress In Historically Marginalized Patients
(East Carolina University, December 2024) Brown, Frandrea Latrice
Historically marginalized patients are at an increased risk for healthcare experiences that increase their risk for adverse health events, adverse health outcomes, and psychological distress related to medical trauma. These factors are exacerbated by experiences of structural violence through discrimination and microaggressions. However, research that describes the unique distress historically marginalized patients’ experience related to medical trauma, adverse health events, adverse health outcomes, and structural violence is sparse in healthcare literature. This study seeks to bridge this gap by exploring the interplay between factors and how they each contribute to patients’ experiences. This research is informed by the biopsychosocial-spiritual framework (BPSS) and historical trauma theory, which considers how collective trauma shared by historically marginalized patients spans multiple generations, affects the biopsychosocial-spiritual health of the group, and may result in trauma-related symptoms. Medical trauma, resulting from adverse health events and adverse health outcomes, is a critical yet understudied aspect of healthcare experiences, particularly among historically marginalized populations. This quantitative research, with a national sample, sheds light on the complexities of the relationship between the psychological distress resulting from medical trauma among such groups while recognizing the profound implications in shaping their healthcare. Through a comprehensive examination of the interplay between adverse health events, adverse health outcomes, social determinants of health, structural violence, internal stress, health care policies, practices and procedures, and medical trauma this study elucidates the mechanisms underlying a new concept explored within this dissertation described as systemic medical traumatic stress and its role within historically marginalized communities.
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EXAMINING THE LIVED EXPERIENCES OF AFRICAN AMERICAN AND SOUTH ASIAN PARENTS OF CHILDREN WITH DISABILITIES
(East Carolina University, December 2024) Pearce, Chrishay Yanise
This study aimed to understand the lived experiences of African American and Asian Indian parents of children with disabilities in North Carolina. Using qualitative research, interviews were conducted online via Zoom to understand their experiences taking care of their children with disabilities. Parents had to be either African American or Asian Indian living in North Carolina with a child between the ages of 5-8 with a diagnosed disability to participate in the study. All participants were African American parents from eight North Carolina counties. Eight participants were female, and four were male. Their ages ranged between 25-33 years. The data were analyzed using content analysis, which revealed four major themes with subthemes. The four themes were (1) Lived Experiences as an African American Parent, (2) The Frustrations of Barriers, and (3) Much Needed Familial and Systematic Support. Implications and directions for future research are provided at the end.
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Exploring Black Women's Experiences with Perinatal Loss, Grief, and Coping
(East Carolina University, July 2024) Saufley, Annagrace
This study's purpose is to better understand the lived experiences of Black women who have experienced perinatal loss using Stroebe and Schut’s (1999) Dual Process Model of Coping with Bereavement as a guiding framework. A descriptive phenomenological design was used to conduct semi-structured one-on-one interviews with a purposive recruited sample. The sample consisted of five Black mothers who had experienced a perinatal loss between 20 and 36 weeks gestation within the past five years. Colaizzi’s (1978) framework was used to conduct data analysis. Each woman’s unique story is detailed, following a description of the three emergent themes and seven theme clusters. The three emergent themes found were medical negligence, social relationships, and transformation. These findings build upon existing literature and offer implications for healthcare and research professionals. Future research directions are also explored.
Open Access
UNVEILING MICROAGGRESSIONS ON CAMPUS: LGBTQ COLLEGE STUDENTS' PERSPECTIVES AND RESPONSES
(East Carolina University, July 2024) Hice, Haiden
Previous research has emphasized how addressing microaggressions on college campuses significantly impacts individuals' collegiate experiences, highlighting the negative effects these microaggressions have on mental health. There is a notable gap in understanding how these factors intersect specifically for LGBTQ college students. This study seeks to bridge this gap, guided by Minority Stress Theory (Meyer, 2003) and the Students with Minority Identities in Campus Contexts Model (Vaccaro, 2015), by exploring LGBTQ microaggressions and campus climate perception, investigating their influence on stress, depression, and anxiety levels among LGBTQ students. The findings suggest there is a relationship between negative campus climate perceptions and mental health issues, in addition to experiencing harmful microaggressions, which is indicative of a persistent challenge for LGBTQ students within collegiate environments. Our study aligns with existing literature, emphasizing the need for college officials to prioritize measures aimed at mitigating microaggressions to foster inclusive and supportive campus environments.
Open Access
Relational Biofeedback: Exploring the Role of Social Support in the Practice of Biofeedback
(East Carolina University, July 2024) Knauss, Adrian Weldon
Biofeedback is a health intervention that trains people to exert control over physiological processes through real-time monitoring and feedback mechanisms (Schwartz et al., 2016). The practice promotes self-regulation and can be used to improve physical and mental health (Tan et al., 2016). However, biofeedback interventions are often conducted individually and practitioners rarely utilize the patient’s social network to assist in the development of self-regulation skills (Frank et al., 2010; Schwartz et al., 2016). This is a notable omission since research has established that social systems impact patients’ psychophysiology (Kleinbub, 2017). Therefore, the purpose of this dissertation is to explore how social support persons can be utilized in biofeedback. This concept, which the authors refer to as relational biofeedback, is an underdeveloped, but promising future direction in biofeedback. The dissertation is comprised of six chapters: (a) an introduction to the dissertation, (b) a literature review on the practice and psychophysiological underpinnings of relational biofeedback, with a special emphasis on heart rate variability biofeedback, (c) a systematic review of the literature to identify attempts to use relational biofeedback interventions to date, (d) proposed methodology for an original research study, (e) the results of the mixed-methods research study comparing individual to relational approaches to heart rate variability biofeedback with romantic partners (N = 12), and (f) a series of recommendations for clinicians and researchers, with an focus on the role medical family therapists can play in the advocacy and advancement of relational biofeedback.
Open Access
IMPACTS OF PARENTAL INSECURE ATTACHMENT AND WEIGHT TALK ON CHILD INSECURE ATTACHMENT AND BODY WEIGHT PERCEPTION
(East Carolina University, 2023-05-04) Osterbauer, Monica
The impact of obesity is studied amongst health professionals and researchers over the past few decades. Mitigating the negative health effects of obesity is explored in a variety of populations. Conversations about weight has emerged within society as a prevalent topic between social influencers, professionals, and families. Researchers have identified a connection between parental insecure attachment behaviors and emotional feeding and overeating with their children has been identified. Some parents experience pressure to control their children's weight due to the influence of societal messages and health professionals. Due to this pressure, parents who exhibit attachment anxiety or avoidant behaviors may engage in increased or decreased weight talk through the forms of encouragement to diet, teasing their child about their weight, or dieting to lose weight. This study explored the connections between parents' insecure attachment behaviors and weight talk and whether this impacts their child's attachment style and body weight perception.
Open Access
EXAMINING LINKS AMONG ATTACHMENT, COMMITMENT, RELATIONSHIP WORK, AND SATISFACTION IN YOUNG ADULT COUPLES
(East Carolina University, 2023-05-01) Hampton, Taylor
Using dyadic data, this study explored the relationships between attachment, commitment, relationship work (RW) and satisfaction within young adult couples (n=71). RW is operationalized as discussing romantic challenges with partners and friends (Jensen & Rauer, 2014). Research suggests that an individual's attachment is one of the most fundamental ways people form secure bonds with others (Bello et al., 2008). Attachment has been linked to several relationship outcomes (Feeney, 2016). While many studies have found individual links between attachment and our variables of interest, few have examined them simultaneously using dyadic data. Given the nature of these variables, and the connections between them, we expected that considering them simultaneously would deepen our understanding of these relational interactions. Our Actor-partner interdependence model (APIM) considered actor and partner effects of attachment on commitment, RW, and relationship satisfaction. Findings suggested important gender differences for both partners. These findings not only provide recommendations that will be beneficial for future research, but also provide clinicians important insights when working with couples.
Open Access
Attachment styles of emerging adults and parents, BMI, encouragement to diet, and emerging adults emotional over-eating or emotional-undereating response
(East Carolina University, 2023-05-04) Koppelmann, Caleigh
The purpose of this study is to determine the impact of attachment on parents' and students' BMI, encouragement to diet on their emerging adult children and if this relationship impacts the emotional over-eating or under-eating response. Existing literature indicates that secure attachment styles foster a strong sense of individual self that can serve as protective factors against external stimuli. Insecure attachment styles (anxious and avoidant) require individuals to rely on external regulation strategies due to negative views of self. Not studied is how parents' attachment style impacts their BMI and conversations surrounding weight related topics such as encouragement to diet as well as the impact this conversation has on emotional over-eating or under-eating behaviors employed by their children past childhood into adolescence. To address this gap in the literature, the researcher used a path analysis of regressions to determine the interaction between secure attachment styles of the mother and father on their BMI and dieting behaviors individually, and the impact of this relationship on each parents' encouragement to diet. From here, the impact this relationship had on emerging adults when looking at the emotional over-eating or emotional-undereating outcomes.
Open Access
Utilization of EHR to Improve Support Person Engagement in Health Care for Patients With Chronic Conditions
(2022) Hodgson, Jennifer; Tucker, Emily; Forbes, Thompson; Welch, Melissa; Pye, Joseph
Open Access
Family‑Centered Primary Care for Older Adults with Cognitive Impairment
(2022) Welch, Melissa L.; Hodgson, Jennifer L.; Didericksen, Katharine W.; Lamson, Angela L.; Forbes, Thompson
Open Access
MedFTs’ Role in the Recruitment and Retention of a Diverse Physician Population: A Conceptual Model
(2022-01-06) Davis, Corin E.; Lamson, Angela L.; Black, Kristin Z.
Open Access
Medical Family Therapy in Rural Community Health: A Longitudinal “Peek” into Integrated Care Successes
(2022-01-09) Lamson, Angela L.; Hodgson, Jennifer L.; Limon, Francisco; Feng, Cheng
Open Access
Together We Can: Increase Couple Functioning for Low-SES Families
(2021-04) Baugh, Eboni; Mallette, Jacquelyn; Harcourt-Medina, Kate Taylor; Almond, Lindsey
Open Access
Non-parental Adults and Sexual Health Behaviors Among Young Minority Men: A Qualitative Examination
(2021-12-02) Roberts, Erin; Sterrett-Hong, Emma M.; DeBow, Joseph; Caton, Erica; Harris, Matthew; Brewer, Russell; Marchal, Madeline; Tauzer, Marjorie; Arnold, Emily A.
Open Access
RECRUITMENT, RETENTION, AND INTERSECTIONALITY: RECOGNIZING THE VOICES OF HISTORICALLY MARGINALIZED AND SYSTEMICALLY OPPRESSED MEDICAL RESIDENTS
(East Carolina University, 2022-04-21) Davis, Corin E
The health and wellbeing of healthcare professionals has become a significant concern for the function of the healthcare system in the United States (U.S.). With a catastrophic physician shortage in healthcare and cumulative social injustices across the nation, medical schools and residency programs must prioritize the recruitment, wellbeing, diversification, and retention of physicians. The purpose of this dissertation is to increase the body of literature related to burnout and compassion fatigue related to historically marginalized and systemically oppressed residents. The six chapters in this dissertation, include a/an: (a) conceptual model of how MedFTs can influence the recruitment and retention of diverse physicians, (b) scoping review of LGBTQ+ patient and provider experiences in primary care, (c) systematic review of intersectional data related to burnout and compassion fatigue in residency, (d) methodology chapter describing the original study, (e) original research study that reports the results from a quantitative survey and phenomenological interview guide with historically marginalized/systemically oppressed residents related to burnout, compassion fatigue, discrimination, and harassment throughout their residency experience, and (f) conclusion chapter that offers a review of the previous chapters and recommendations for residency programs in the form of a fact sheet.
Open Access
Exploring the Experiences and Attitudes of Healthcare Professionals Caring for People with Intellectual Disability
(East Carolina University, 2022-04-20) Tucker, Emily C
People with intellectual disability experience profound health disparities and care inequities. A systematic review focusing on the implementation of community-based mental health interventions for adults with intellectual disability highlighted a dearth of research. However, disparities exist across every area of health, and are not exclusive to mental health services. Previous researchers identified two major contributing factors to the gap in healthcare (a) provider attitudes toward intellectual disability, and (b) inadequate provider training. Therefore, a transformative convergent parallel mixed methods design was conducted to expand and enhance what is available in the literature with two guiding parts to the study. Part one of the study was designed to understand the attitudes of healthcare professionals toward intellectual disability. Part two was designed to explore the experiences of primary care providers caring for adults with intellectual disability. The research question for part one was, what are the attitudes of healthcare professionals toward intellectual disability, with hypotheses that attitudes will be overall positive and may be different based on participant gender and age. Preliminary analysis of data collected from 81 healthcare professionals to date, confirms that healthcare professionals have relatively positive attitudes toward people with intellectual disability. More data is being collected to determine if differences in attitudes based on age and gender are significant. Part two of the mixed-methods study utilized focus groups to answer the following research question, what are the personal and professional experiences of primary care providers that influence how they care for adult patients with intellectual disability? A total of seven focus groups were conducted, across three different clinic locations throughout the United States. Each clinic site hosted a family medicine residency program. There were a total of 46 focus groups participants who consisted of faculty, residents, and clinic staff. Analysis yielded two thematic clusters (a) themes regarding experiences caring for patients with intellectual disability, and (b) themes regarding training needs and recommendations. Focus group data from cluster one, regarding the experiences caring for patients with intellectual disability, yielded six salient themes: (a) patient agency, (b) communication strategies, (c) systemic barriers to care, (d) deficit view of disability, (e) equitable healthcare and (f) communication of intellectual disability. Focus group data regarding the second cluster yielded one training salient theme with five subthemes: (a) guardianship processes and consent for treatment procedures (b) mental health assessment delivery and follow-up, (c) knowledge of community resources, (d) communication barriers, and (e) identifying and communicating a diagnosis of intellectual disability. Participants shared that the training sub thematic areas were largely absent in residency education curricular experiences. Results confirmed that improvements in training are needed that incorporate a contextual understanding of disability and empower providers to move past a deficit-based perspective of disability. This dissertation advances the knowledge of clinical care for adults with intellectual disability and training needs for primary care providers working with this patient population. It also serves to advance the field of medical family therapy by highlighting the important role agency, communion, and promoting equitable healthcare play in improving health outcomes for people with intellectual disability.
Open Access
From Treatment to Recovery: Family, Health, and Sociocultural Implications of Anorexia Nervosa
(East Carolina University, 2022-04-21) DavyRomano, Evie
Anorexia nervosa (AN) is a life-threatening biopsychosocial-spiritual illness that crosses all social locations (i.e., ages, gender identities, sexual orientation, races, ethnicities, socioeconomic status, and body sizes), negatively impacting couple/family systems. While family-based treatments have a well-established evidence base in treating AN, it is unknown how relationally-oriented treatments (i.e., couple and family-based) address the whole person with AN (i.e., biopsychosocial-spiritual) from a dyadic/family systems lens. Recovery is a process fraught with obstacles such as persistent mental health challenges and societal ideals/standards. Sociocultural risk factors such as diet culture (i.e., a system that elevates physical health and perpetuates myths and lies about food choices, eating behaviors, and body types) is an understudied phenomenon which may also complicate recovery. Since risk of relapse is highest following treatment, it is important to understand the biopsychosocial-spiritual health experiences of diet culture for individuals in recovery from AN. The purpose of this dissertation is to address gaps in relationally-oriented treatment and recovery research. This dissertation contains six chapters, including: (1) an introduction chapter to the history of AN diagnosis, treatments, and social location factors, (2) a literature review of biopsychosocial-spiritual health risks and symptoms associated with AN, (3) a systematic review of relationally-oriented treatment studies for AN and how they are addressing biopsychosocial-spiritual health and social location from a dyadic/family systems perspective, (4) a methodological chapter describing the mixed methods approach to the original qualitative study, (5) an original research study demonstrating the lived experience of diet culture for individuals in recovery from AN, and (6) a discussion chapter that pulls together the major findings to provide clinical resources for healthcare providers.
Open Access
LATINO WOMEN’S EXPERIENCE OF SEXUAL VIOLENCE: A PHENOMENOLOGICAL STUDY
(East Carolina University, 2021-12-03) Crespo, Julian
Sexual violence is a public health problem worldwide that disproportionately impacts women. The consequences for survivors are multiple in terms of their overall health (i.e., reproductive health effects, psychological health, interpersonal unsafety, personal sense of worthlessness). Latino women, in particular, have reported higher rates of sexual violence than other populations in the United States. The aim of this study was to explore the experiences of Latino women who were sexually victimized as children and/or adolescents. In order to develop a better understanding of their lived experiences two research articles were completed: (a) a conceptual paper designed to explore socio-cultural and historical factors that are associated with the prevalence and perpetuation of sexual violence against Latino women, and (b) a descriptive phenomenological study to explore the experiences of 14 Latino women who were sexually victimized in their countries of origin. The conceptual paper revealed how religious symbols and cultural narratives grounded in patriarchal values influence the prevalence of sexual violence among Latino women. The phenomenological research study revealed four emergent themes that portrayed the participants' experience: (a) gender expectations made it difficult for participants to cope with sexual violence, (b) deficient family support and boundaries made participants vulnerable to sexual violence, (c) experiencing sexual violence had long-lasting consequences for participants, and (d) multiple factors facilitated healthy coping with sexual violence. Participants acknowledged the need for this phenomenon to be addressed systemically, and the need for survivors to receive as much social support as possible. Researchers, healthcare providers, therapists, and church leaders with the knowledge about sexual violence and its prevalence among Latino women will improve the effectiveness of their participation in prevention and addressing the needs of the survivors.
Open Access
Females Appraisal Distortions in Intimate Partner Relationships
(2020-07) Lee, Frandrea
Intimate partner violence (IPV) initiated by women is vastly under researched compared to violence initiated by men. Socially, the quest to understand IPV has almost exclusively focused on violence perpetrated by men and the bulk of research on the topic has followed suite (Heise et al., 1999; Williams, 2004) Data indicates that most violence occurring within heterosexual relationships is bidirectional. (Hines, 2007; Hamby, 2009). The aim of this thesis is to examine the common themes and distortions that occur as women engage in violence within their relationships. Building on the existing work, this work specifically looks at appraisal distortions of women during IPV. Researchers recruited participants for this study using snowball sampling. The participants for this study consisted of 13 African American women (n=13) using a semi-structured interview procedure to examine their cognitive processes while using violence. Interviews of participants were conducted by phone and the interviews were recorded and coded for themes. The analysis of the results revealed that the most common appraisal distortions were rationalization and blaming. Implications for further research with diverse populations, interventions that promote empathy and increasing skills in recognizing the influence of emotional processing and cognitive distortions are discussed.