Theses and Dissertations
This collection includes both ASU Theses and Dissertations, submitted by graduate students, and the Barrett, Honors College theses submitted by undergraduate students.
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Description
A core principle in multiple national quality improvement strategies is the engagement of chronically ill patients in the creation and execution of their treatment plans. Numerous initiatives are underway to use health information technology (HIT) to support patient engagement however the use of HIT and other factors such as health literacy may be significant barriers to engagement for older adults. This qualitative descriptive study sought to explore the ways that older adults with multi-morbidities engaged with their plan of care. Forty participants were recruited through multiple case sampling from two ambulatory cardiology practices. Participants were English-speaking, without a dementia-related diagnosis, and between the ages of 65 and 86. The older adults in this study performed many behaviors to engage in the plan of care, including acting in ways to support health, managing health-related information, attending routine visits with their doctors, and participating in treatment planning. A subset of patients engaged in active decision-making because of the point they were at in their chronic disease. At that cross roads, they expressed uncertainly over which road to travel. Two factors influenced the engagement of older adults: a relationship with the provider that met the patient's needs, and the distribution of a Meaningful Use clinical summary at the conclusion of the provider visit. Participants described the ways in which the clinical summary helped and hindered their understanding of the care plan.
Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist.
Insights gained as a result of this study include an understanding of the discrepancies between what the healthcare system expects of patients and their actual behavior when it comes to the creation of a care plan and the ways in which they take care of their health. Further research should examine the ability of various factors to enhance patient engagement. For example, it may be useful to focus on ways to improve the clinical summary to enhance engagement with the care plan and meet standards for a health literate document. Recommendations for the improvement of the clinical summary are provided. Finally, this study explored potential reasons for the infrequent use of online health information by older adults including the trusting relationship they enjoyed with their cardiologist.
ContributorsJiggins Colorafi, Karen (Author) / Lamb, Gerri (Thesis advisor) / Marek, Karen (Committee member) / Greenes, Robert (Committee member) / Evans, Bronwynne (Committee member) / Arizona State University (Publisher)
Created2015
Description
More underrepresented minority (URM) healthcare professionals are needed to improve health equity. Although holistic review in admissions has the potential to increase URM participation in health professions, recent data suggest that its impact varies substantially. The purpose of the dissertation research described here was to identify interventions to increase diversity among healthcare professionals and explore holistic review use in physician assistant (PA) program admissions to advance understanding of effective practices. PA programs were selected as an important prototype for exploratory studies since the extent of holistic review use in PA programs was unknown; at the same time, URM representation among PA students has decreased over the last 15 years.
A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes.
Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students.
Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs.
A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes.
Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students.
Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs.
ContributorsCoplan, Bettie (Author) / Lamb, Gerri (Thesis advisor) / Evans, Bronwynne (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2019