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Couples Coping with Cancer: A Hold Me Tight Pilot Intervention Study
Full text linkCancer is an illness that affects not only patients but also their partners/spouses. Thus, there is a need for more couple-based psychosocial interventions designed to help couples patients and their partners with the diagnosis and treatment of cancer. Emotionally Focused Therapy for couples (EFT) is an attachment evidenced based model that has some support for use with couples coping with chronic illness. Prior researchers who evaluated couple-based psychosocial cancer interventions have included primarily white middle class samples and most focused on cognitive behavioral and psycho-educational approaches. Using attachment theory (Bowlby, 1980) and the biopsychoscial approach (Engel, 1977), this one-arm program evaluation study (pre-post test) was designed to examine if an adapted version of a couple’s group therapy treatment, Hold Me Tight (HMT: Johnson, 2009) can help a racially diverse low to middle income sample of couples cope with the diagnosis and treatment of cancer in a spouse or in a committed partner. A total of seven couples, six African American and one White/Asian couple (total of n=14 participants) completed this study. The couple support group intervention (HMT) was evaluated at baseline and post-intervention. The following two specific aims were examined: 1) Assess intervention acceptability and feasibility using recruitment and retention rates, participants’ reasons for refusal or dropout, and level of post-intervention participant satisfaction; and 2). Pilot test treatment efficacy by comparing the pre-test and post-test measures for couples who completed the study. A comparison of baseline and post-intervention psychological (BDI II), relationship satisfaction (RDAS), attachment (ECR-S, BARE), and impact of the cancer (IES and FACT-G, version 4.0 for patients only) measures were conducted. Descriptive statistics, paired samples t-tests, and repeated measure ANOVAs were conducted to describe pre-post differences. Despite the slower than anticipated rate of recruitment at the one referring northeastern urban oncology clinic (25 couples were referred over a 13-month recruitment period; 12 volunteered and 7 couples completed the study), findings suggest the intervention is acceptable, although more feasible for patients post-cancer treatment (survivors). According to the repeated measures ANOVA results, there were significant medium to large effects for improved relationship satisfaction (RDAS total) and a decreased traumatic impact of the cancer diagnosis (IES total) for both patients and partners from pre-intervention to post-intervention. The outcome of this one-year pilot feasibility study was evidence of a promising theoretically-based (Attachment in Couples: Hazan & Shaver, 1987) brief couple support intervention for diverse samples of couples coping with cancer, acceptability, feasibility, and pilot data.Ph.D., Couple and Family Therapy -- Drexel University, 201
Health Literacy and Self-Efficacy in the Adult Tobacco Cigarette Smoker and Reformed Smoker with Vascular Disease
No full textINTRODUCTION: Smoking is the leading preventable cause of morbidity and mortality in the United States with cardiovascular disease accounting for one third of smoking related deaths in adults 35 years and older. Identifying factors attributing to successful cessation can positively influence smoking cessation policy and direct future tobacco cessation treatment plans. The purpose of this study was to examine differences in health literacy and self-efficacy between adult tobacco cigarette smokers and reformed smokers with vascular disease. METHODS: This study employed a cross‐sectional, comparative descriptive design. A convenience sample of 200 participants evenly divided between tobacco cigarette smokers and reformed smokers was recruited from the Geisinger Medical Center Vascular Surgery Clinic in Danville, PA. Participants filled out the Short Version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and the Generalized Self-Efficacy Scale (GSE) to determine their level of generalized self-efficacy and health literacy. RESULTS: The mean age of the two hundred study participants was 68.17 with the majority being male (72.5%). One hundred percent of the participants described themselves as Caucasian and were either married (61.5%) or living with someone (71%). The majority of the study participants obtained a minimum of a high school diploma or (76.5%) and reported an annual income less than fifty thousand dollars (84.5%). No significant differences were found between the two groups for health literacy (p = 0.215) or self-efficacy (p = 0.154). CONCLUSION: No significant differences in health literacy and self-efficacy were identified in adult tobacco cigarette smokers and reformed smokers with vascular disease. Several demographic factors were found to have a significant difference in the two study groups to include age, gender, marital status, and living arrangements. In addition, there was a statistically significant increase in the use of alcohol, caffeine and/or medication for anxiety and/or pain within the last year in the adult tobacco cigarette smokers compared to the reformed smokers. This study adds to the growing body of knowledge regarding variables that have a relationship to smoking cessation. In doing so, better interventions and policies regarding smoking cessation can be formulated in the future improving health and lower health care costs.Dr.N.P., Nursing Practice -- Drexel University, 201
Chronic HBV Infection and Community‐Based Services for High‐Risk Asians and Pacific Islanders
Full text linkChronic hepatitis B (HBV) infection is a significant cause of morbidity and mortality in the U.S., and results in considerable health disparities for Asians and Pacific Islander Americans (APIs). There are still multiple knowledge gaps regarding HBV in APIs, including information on factors associated with HBV infection and immunity in foreign‐born APIs. Particularly in Philadelphia, the epidemiological landscape of chronic HBV infection in high‐risk API communities remains largely unknown, making it difficult to develop appropriately targeted interventions. Community‐based screening and linkage to care can play an important role in improving low HBV diagnosis rates and generating a more complete understanding of HBV infection in high‐risk ethnic communities. However, there are no recommended strategies for addressing HBV infection at the community level, which has limited the success of community‐based programs throughout the U.S. This project used a mixed‐methods approach to: determine the factors associated with HBV infection and protection (immunity) among APIs in Philadelphia who participated in community‐based screening; and to understand the processes, challenges and strategies for conducting enhanced community‐based screening and linkage to care. The study included quantitative analysis of survey and seroprevalence data from 2,047 foreign‐born and 2nd generation APIs residing in Philadelphia; and qualitative analysis of narratives, focus groups and interviews from two sites that conducted enhanced community‐based HBV programming. Controlling for all other variables (at p<0.5), infected individuals in the sample tended to be male, between the ages of 18‐29, disclosed that they had been previously tested for HBV, had a high school diploma or less, and had either a family member with HBV or HCC, or lived with an infected person; protected individuals in the sample tended to be between the ages of 18‐29 and born in Korea; susceptible individuals tended to be over age 55, with no family history of HBV, no previous HBV test, and born in a country with no (or a limited) national HBV vaccine program. Not controlling for other variables, being born in China was significantly associated with being linked to care. Results of the qualitative analysis revealed that having a diverse community stakeholder committee was important to the success of enhanced community‐based HBV programming. Including stakeholders in all planning stages, and offering ongoing opportunities for training and relationship development helped maintain stakeholder engagement. Limited time, funding, HBV knowledge, bi‐lingual resources, and a lack of language capable free health clinics served as challenges to HBV screening, vaccination and linkage to care. Service integration, advanced planning, and having an understanding of community needs were identified strategies to improve programmatic outcomes. Identified challenges with data collection included length of the survey instrument, as well as limited staff time and training needs. The results of this project can be used to guide future community‐based interventions in Philadelphia and around the U.S., to successfully improve HBV‐related screening, vaccination and linkage to care for high‐risk and infected API communities.Dr.P.H., Community Health and Prevention -- Drexel University, 201
What is the "Western Pattern?": Refining Factor-Derived Dietary Patterns from the NHANES Food Frequency Questionnaire Using 24-hour Dietary Recall Data
Full text linkMeal pattern analysis is an emerging technique in nutritional epidemiology useful for identifying eating patterns associated with disease. Two meal patterns commonly found in large epidemiologic studies are the "Western" pattern, characterized by high intakes of red meat, eggs, refined grains, fried foods and added sugars, and the "prudent" or "healthy" pattern, consisting of fruits, vegetables, whole grains, and low fat food items. The Western pattern has become more common worldwide along with the chronic diseases associated with this eating pattern, including obesity, heart disease, type II diabetes mellitus and some diet-related cancers. Factor analysis was used to determine major dietary patterns from 2005- 06 National Health and Nutrition Examination Survey (NHANES) Food Frequency Questionnaire (FFQ) data. Variables were entered into factor analysis with three different grouping schemes. Individuals in the top quintile of each factor were considered to have the greatest adherence to a given pattern. The 39 category analysis provided a balance between simplifying output and retaining predictive value of different food types. Multiple logistic regression models were constructed to determine predictors from demographic and 24-hour dietary recall data, including total energy, food source, food groups represented, number of eating occasions, and breakfast skipping. Men were more likely to follow the Western pattern, and women as well as older Americans were more likely to follow the healthy diet pattern. Mexican Americans and other Hispanics were much less likely, and black Americans much more likely than other ethnicities to follow the Western diet pattern. There was a clear linear relationship showing increased likelihood of following the healthy pattern with each increasing level of education. High income groups were both less likely to follow the healthy diet pattern and less likely to follow the Western pattern when compared to all other income groups. Increasing daily energy had a strong positive association with the Western pattern, and increasing dietary diversity was inversely associated with the Western pattern. Eating out at a restaurant or bar was associated with a lower likelihood of following the healthy pattern. A greater number of eating occasions was generally associated with a lower likelihood of following the Western pattern with the exception of the highest frequency snacking group (9-21 snack items per day). Individuals reporting only 1-2 snack items per day were about half as likely to follow the healthy pattern. Skipping breakfast was associated with an almost 1.5 times greater likelihood of following the healthy diet pattern. These findings are potentially useful for identifying individuals at risk for disease, or targeting health promotion efforts to specific population subgroups. A short form scale based on these results may help to identify strong adherents of the Western dietary pattern in resource-limited settings.Dr.P.H., Community Health and Prevention -- Drexel University, 201
The Effects of Self-Book© Art Therapy on Emotional Distress in Female Cancer Patients: A Randomized Controlled Trial
Full text linkThe purpose of this study was to evaluate the effects of the Self-Book© art therapy intervention on emotional distress and psychological well-being in female cancer patients. Assessing and treating patients’ unmet emotional needs is a national focus in oncology care today. The intervention provided patients with an opportunity to portray their feelings and identify coping skills artistically through a creative process. Art therapy is based on the theory that the human mind tends to experience intrusive and avoidant stress response symptoms when faced with adverse events, such as a life-threatening illness. Creative expression can help patients reintegrate their sense of self and strengthen personal attributes. To evaluate the intervention, a repeated measures randomized controlled trial design was employed. Sixty consenting women were enrolled and randomly assigned to either the six-session Self-Book© art therapy intervention group or the standard care control group. Results suggest that Self-Book© art therapy may help decrease emotional distress and enhance spiritual well-being in female cancer patients during active oncology treatment. Positive trends in the data were present, but there were no statistically significant differences between the groups for the two main variables. Small treatment effects were found for Self-Book© art therapy on participants’ psychological well-being. However, one subscale measure revealed statistically significant greater improvements in Self-Book© art therapy participants’ spiritual wellbeing compared to the standard care control participants. Additionally, 30% of art therapy participants reported post-intervention emotional distress scores that were below the clinical range for emotional distress, compared with only 5% of standard care control participants, suggesting that Self-Book© art therapy has clinical significance. Analysis of limited narrative data from exit interviews contributed to positive trends in emotional distress, suggesting that emotional needs were met for the majority of Self-Book© art therapy participants.Ph.D., Creative Arts Therapies -- Drexel University, 201
Does Distraction During Bottle Feeding Promote Over-Feeding?
Full text linkIndividuals who are distracted by surrounding stimuli (e.g., watching television, using a tablet and/or computer, etc.) during meals tend to consume more food and energy than those who are not distracted. This is because distraction during meals decreases individuals’ awareness of their internal states of hunger and satiation. It is unclear whether this phenomenon carries over to maternal distraction during infant feeding. While there is existing literature on responsive infant feeding, and its beneficial impacts on infant feeding outcomes, the present study is the first to assess maternal distraction during the mother-infant feeding interaction and its impact on responsive feeding and infant formula/milk consumption.
This secondary analysis of a bottle-feeding study had three specific aims: 1) to compare amounts of formula/milk consumed between infants of distracted mothers vs. infants of non-distracted mothers with the hypothesis being that the former would consume more than the latter; 2) to compare the degree of maternal responsiveness to infant cues between distracted mothers versus non-distracted mothers with the hypothesis being that the former would score lower on the sensitivity to cues and responsiveness to infant distress than the latter; 3) To explore predictors of distraction during the feeding interaction.
Mothers and their 0 to 24-week-old bottle-feeding infants (N=28) visited the laboratory for feeding observations. Mothers were video-recorded while feeding their infants as they normally would at home. Infant intakes were assessed by weighing the bottles before and after the feedings. Maternal distraction was defined as: 1) looking somewhere other than at the infant for more than 75% of the feeding; 2) using a cell-phone; 3) conversing with someone other than their infant; or 4) falling asleep. To explore predictors of maternal distraction, mother and infant anthropometrics were measured, and mothers completed questionnaires about their feeding styles, infants’ temperaments, and own eating habits. Finally, video records were scored using the Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Feeding Scale, which provided measures of mothers’ sensitivity to infant cues and responsiveness to infant distress.
The difference in intakes for infants of distracted (n=8) vs. not distracted (n=20) mothers did not reach significance (p=0.24). There was, however, a trend towards a significant interaction between maternal distraction and infant age (p=0.06): the association between maternal distractedness and intake for infants over 10.9 weeks of age approached significance (distracted: 174.4 ± 23.0 ml vs. non-distracted: 126.7 ± 14.5 ml; p = 0.09), whereas there was no association between maternal distraction and intake for infants younger than 11 weeks of age (p=0.99). Maternal distraction and infant intake was also modified by two dimensions of infant temperament: orienting/regulation capacity (p=0.03) and surgency (p=0.04). When infants had low levels of orienting/regulation capacity, those whose mothers were not distracted consumed significantly less than those whose mothers were distracted (92.4 ml ± 13.8 ml vs. 177.1 ± 33.8 ml, p=0.03). When infants had high levels of orienting/regulation capacity, there was no difference in intake between infants with distracted mothers vs. those with non-distracted mothers. Infants with low levels of surgency who had non-distracted mothers consumed significantly less than those whose mothers were distracted (78.4 ml ± 14.3 ml vs. 140.6 ml ± 22.5 ml, p=0.03). For infants with high levels of surgency, there was no effect of maternal distraction on infant intake.
A higher proportion of distracted mothers scored lower on the sensitivity to cues subscale of NCAST feeding scale than non-distracted mothers (p=0.04, Fisher’s Exact Test). Additionally, a significantly greater proportion of distracted mothers were single (p=0.05), and there was a trend towards a significantly higher proportion of distracted women classified as low-income compared to non-distracted mothers (p=0.07). Furthermore, distracted mothers tended to have higher levels of pressuring (p=0.09) and lower levels of responsive feeding styles compared to non-distracted mothers (p=0.07).
In conclusion, maternal distraction during bottle-feeding may increase the risk of overfeeding infants who are older, who have poor self-regulatory capacity, and who are low in surgency/extraversion. The findings of this study also highlighted certain maternal characteristics associated with maternal distraction. Further research with experimental designs and larger samples is needed to fully understand the predictors and effects of maternal distraction on infant feeding.M.S., Human Nutrition -- Drexel University, 201
Transformation in the Emerging Professional Identity While Working with Adults Who Have Chronic Mental Illness: An Art-based Heuristic Inquiry
Full text linkThe purpose of this arts-based heuristic inquiry was to explore the transformational process in an art therapy intern's emerging professional identity while working with adults diagnosed with chronic mental illness. Incorporating Moustakas' systematic process of heuristic inquiry with the use of art making and journal writing as methods of gathering data, the researcher sought to comprehend her experience and its influence on her professional identity in this arts-based heuristic research. Due to the nature of the study, the researcher was the only subject in this research. Data collection for this research lasted for the 29 weeks that the researcher interned at a long term, intensive outpatient setting.
Upon thorough reflection, examination and analysis, the researcher uncovered themes pertaining to her experience from visual and written data collections. Themes that emerged from the artworks were containment, nature and organic forms, relational movement, and brightness of color. Themes that emerged from the journal entries were relational process, self confidence, developing self-awareness, validation of professional self, expectation of self, and positivity. Results demonstrated that while the themes from both data collection were similar, the content that each data focused on were subtly different and allowed for a broader perspective on the researcher's experience.M.A., Art Therapy and Counseling -- Drexel University, 201
Latino Skin Color: The Role of Discrimination, Racial identity, and Parental racial Socialization on Self Esteem and Depression
Full text linkUsing the Cross Racial Identity Model (Cross, 1991), Multidimensional Model of Racial Identity (Sellers, et al. 1998), and Helm's White Racial Identity Model (Helms, 1995), this web-based quantitative cross-sectional survey study was designed to examine the associations between selfreported skin color, racial discrimination, racial identity, parental racial socialization, selfesteem, and depressive symptoms in a convenience sample of 205 United States of America (USA) born Latinos (ages 18-25). Most participants were between 18 and 21 years old (64%) and were women (78.5%). Participants were asked to self-identify their race and approximately one-third [27% (n=56)] reported their race as White, and only 10.2% (n=21) reported their race as Black. Most self-reported their skin color as a lighter shade (89% rated their skin color between 1 and 4) and 31.2% (n=64) reported their skin color as "2=very light". Only 10.8% (n=22) reported their skin color as 5 and above (darker skin color). Approximately one-quarter reported their parent's country of origin is Mexico 24.9% (n=51) and others reported their parent's country of origin is the United States of America (15.1% n=31), or various countries in Latin America (e.g., Puerto Rico, Guatemala, Honduras, Cuba) and European Countries (e.g., Scotland, Spain, Ireland, Hungary). More than half were single when they completed the survey (58.5%), 39% were in a relationship, and 2.9% were married. Approximately, 70% reported they spoke another language while growing up; 64.9% reported speaking Spanish. Most were in college when they completed the survey (68.8% n=141). More than half reported their annual income as less than $10,000 (n=138; 67.3%) and approximately half reported their family's social economic status as working class (43.9%). Participants first completed a demographic questionnaire and then 5 valid and reliable self-report surveys to examine their skin color, racial identity, perceived racial discrimination, parental racial socialization, self-esteem, and depressive symptoms. Results suggest that racial identity, specifically the self-hatred and anti-dominant stages of the cross identity stages of development, and not skin color or parental racial socialization is a significant mediator between perceived racial discrimination and self-esteem and depressive symptoms. Participants who perceived more racial discrimination and who were in the self-hatred stage tended to report more depressive symptoms (partial mediation). Results of the second mediation analysis suggest that the self-hatred and anti-dominant scales are significantly associated with lower self-esteem and is a fully mediated model because the racial discrimination path was not significant. Thus, for USA born Latinos who report experiencing racial discrimination, the more grounded in self-hatred or anti-dominant identities, the lower their self-esteem and the more depressive symptoms they tend to experience. This is a noteworthy finding which supports Cross's (1991) racial identity development. Results also suggest that parental socialization towards equality despite racial differences is a significant predictor of higher self-esteem and less depressive symptoms. This dissertation study has important implications for family therapists who are working with young adult USA born Latinos. First, more comprehensive clinical assessments should be done to better understand Latinos' experiences of racial discrimination, racial identity, self-esteem, and depressive symptoms. Clinicians should focus on the importance of parental socialization toward equality, in particular when Latino youth report experiencing discrimination, depressive symptoms, and lower self-esteem. In future research studies, two or more racial identity models should be used to capture the diverse ways Latinos tend to racially identify in the USA. Studies should also be designed to prospectively evaluate the importance of racial identity development over time from childhood to young adulthood to better understand Latino mental health and well-being in order to develop culturally sensitive family prevention programs for parents and youth.Ph.D., Couple and Family Therapy -- Drexel University, 201
Art Therapists' Assessment Practices in the Inpatient Psychiatric Facility: A Descriptive Survey
No full textThis study explores the assessment practice of art therapists working in inpatient psychiatric facilities. This investigation is significant because while inpatient psychiatry emphasizes assessment, and continues to be a common employment setting for art therapists, little is known about their current assessment practice in this setting. State-of-the-field information is necessary if professions are to support clinicians, adapt to the changing role of treatment settings, and thereby uphold their responsibility to clients. A descriptive survey in the form of an interview was created. Five art therapists, all credentialed professionals representing a range of 13 to 40 years of practice were interviewed. Interviews were coded then synthesized into themes. Participants’ assessment practices were found to be influenced by both changes in the treatment setting, and the values of their profession. Participants described clinical evaluation as one of their primary responsibilities. While this makes their self-perceived role consistent with the function of the treatment setting, conflict was noted between the impositions of the setting and participants’ professional identities. Participants use multiple assessment formats with separate goals and purposes, and consider their use of art-based assessment to be more genuine than other assessments required by the facility. Participants described using primarily informal assessments. This was found to be the case despite knowledge of available standardized tools, and the emphasis of current mental health care on evidence-based practice. The need for a structured, if not standardized tool/process was suggested by participants’ current assessment practice, which must meet the documentation requirements of the setting while upholding the values of clinicians. The findings of this study, though not generalizable, suggest a number of questions for future research including: What qualities would be most valued in an art-based assessment tool designed for use in inpatient psychiatry? What type of clinical information would be most relevant to art therapists’ practice in this specific setting? How can the profession of art therapy support practitioners in developing and adapting their practice to specific settings? Answering these questions may support the profession of art therapy, and its practitioners, by developing processes that broaden the field’s relevance and efficacy across mental health contexts, thereby improving client care.M.A., Art Therapy and Counseling -- Drexel University, 201
Prediction of Independent Walking in Young Children with Cerebral Palsy
Full text linkIndependent walking for even short distances is an important goal for families and focus of physical therapy intervention in young children with cerebral palsy (CP) classified Gross Motor Function Classification System (GMFCS) levels II-III. The aims of this research were to: 1) identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that indicate readiness for independent walking; and 2) examine whether a parent reported focus and amount of physical therapy (PT) predicted usual methods of walking in daily settings. Participants in the first study were 80 children with CP, 2-6 years of age. Backward stepwise logistic regression was used to analyze a person-environment model of child and family factors that predicted children’s ability to take steps independently. Functional strength measured in a dynamic sit to stand task that incorporates components of postural control and coordinated body movements was the only variable that predicted taking 3 or more steps independently after one year. The model had a 79% probability of predicting not walking and a 54% probability of predicting walking. Participants in the second study were 84 children with CP, 2-6 years of age, also classified GMFCS levels II-III. For each of four settings, (home, preschool, community, outdoors), multiple linear regression was used to analyze a model of the parent reported focus of PT services on balance activities for postural control, strengthening exercises, transfer training, and mobility training and the amount of PT received. A focus on strengthening exercises was the only significant predictor of walking performance at preschool only, (P<.05), explaining 17% of variance in children’s usual method of walking. The regression model was not predictive of walking at home, inside community buildings, or in outdoors settings. These studies add to previous research supporting strengthening activities for children with CP, indicating that a child who is able to stand from a bench may be ready for a focus on walking, and a focus on strengthening exercises in physical therapy may optimize walking independence in preschool. Future studies measuring child and family factors at frequent intervals are needed to determine precise indicators of readiness for independent walking. Prospective studies are recommended to examine the relationship between strengthening in closed chain functional activities in therapy and during daily activities and children’s usual method of walking in everyday settings. Physical therapists, parents, and other providers are encouraged to provide frequent opportunities for practice of functional strengthening, i.e., sitting to standing from a bench or climbing the ladder on the slide, and other components of walking to promote more independence in walking in young children with CP. Task-specific practice of walking throughout the child’s day may be influenced by the people and settings providing opportunities for practice. Effective collaboration, consultation, and coordination between therapists and others may be indicated to maximize opportunities for walking practice.Ph.D., Rehabilitation Sciences -- Drexel University, 201