Matching Items (5)
Filtering by
- All Subjects: Health Sciences
Description
This body of research sought to explore relationships between parenting practices, physical activity resources, and Hispanic children’s physical activity. Guided by the Family Ecological Model (FEM) and the Ecological Model of Physical Activity (EMPA) this study examined the influence of parents on children’s physical activity through an integrative review. A cross sectional study was conducted to investigate potential relationships between parental perception safety at school, gender, and children’s physical activity. A cross sectional study was also utilized to examine potential correlations between parenting practices, physical activity resources, and children’s physical activity. Parental role modeling of physical activity and parental support for physical activity emerged as parenting practices that have considerable potential to impact children’s physical activity. Gender differences among children’s physical activity were also a key finding of this study with boys participating in more physical activity than boys. While quality of physical activity resources did not have significant associations with parenting practices or children’s physical activity, more research is needed to determine how resources for physical activity may impact parenting practices, and children’s physical activity.
ContributorsHutchens, Amy (Author) / Lee, Rebecca E (Thesis advisor) / Todd, Michael (Committee member) / Lyles, Ann Marie (Committee member) / Holtzclaw, Barbara (Committee member) / Arizona State University (Publisher)
Created2017
Conceptualizing social capital and active transportation to school through a social-ecological model
Description
Active transportation to school (ATS) has received an increasing amount of attention over the past decade due to its promising health contributions. Most of the existing research that surrounds ATS investigates factors from the physical environment as well as factors from the individual perspective that influence walking and biking to school. This research attempts to add to the existing knowledge by exploring the impact that social relationships within the neighborhood have on ATS.
A model, based on social ecological theory, was presented and tested to examine elements thought to influence ATS. A logistic regression analysis was run to determine the odds of students walking or biking based on the influence of each construct within the model. Results indicated that the physical and socio-cultural constructs were directly and significantly related to ATS behavior while the construct of safety had an indirect effect. These findings support the idea that there are several factors that operate within and across different ecological levels to influence the mode of transportation to school. Therefore, programs to promote ATS should involve multi-level strategies. In addition to the physical environment, interventions should address interpersonal relationships within the family, school, and neighborhood.
A model, based on social ecological theory, was presented and tested to examine elements thought to influence ATS. A logistic regression analysis was run to determine the odds of students walking or biking based on the influence of each construct within the model. Results indicated that the physical and socio-cultural constructs were directly and significantly related to ATS behavior while the construct of safety had an indirect effect. These findings support the idea that there are several factors that operate within and across different ecological levels to influence the mode of transportation to school. Therefore, programs to promote ATS should involve multi-level strategies. In addition to the physical environment, interventions should address interpersonal relationships within the family, school, and neighborhood.
ContributorsRoss, Allison (Author) / Searle, Mark (Thesis advisor) / Knopf, Richard (Committee member) / Kulinna, Pamela (Committee member) / Rodriguez, Ariel (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2015
Description
This dissertation was guided by the Ecological Model of Physical Activity and Ecological Model of Obesity and sought to determine the relationship between active transportation (AT), physical activity, and cardiometabolic health among adults and ethnic minority women. Chapter 2 presents an investigation into the relationship between walking for AT and cardiometabolic health among adults through systematic review. Chapter 3 presents an exploration of the cross-sectional relationships of AT and moderate-to-vigorous physical activity (MVPA) with cardiometabolic health among African American (AA) and Hispanic/Latina (HL) women from Texas. Chapter 4 presents an investigation into the cross-sectional relationship of AT on cardiometabolic health and physical activity among primarily HL women.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
In Chapter 2, walking for AT was found to be related to smaller waist circumference, lower blood pressure, and lower prevalence of abdominal obesity and hypertension, and that differences may exist based on sex. Walking for AT was not clearly defined, and criteria used to determine the presence of cardiometabolic outcomes were inconsistent. No significant relationships between AT and cardiometabolic health were found in Chapter 3 or 4; however, AT users had slightly better cardiometabolic health. AT users had significantly higher levels of self-reported total physical activity compared to those who did not use AT in Chapter 3. Furthermore, a significant relationship was found between MVPA and diastolic blood pressure. Associations differed by ethnicity, with MVPA being inversely related to body fat in both AA and HL women, but to body mass index only in AA women. AT users were found to be seven times more likely to meet 2018 national MVPA recommendations than non-AT users in Chapter 4. Across all studies, measures of AT were subjective and of low quality, potentially limiting the ability to detect significant findings.
High quality randomized controlled studies should be conducted using clearly defined, objective measures of AT, and analyzed based on sex and race/ethnicity. Clinicians should recommend AT use to promote meeting MVPA recommendations where appropriate, potentially resulting in improved cardiometabolic health. Policymakers should advocate for changes to the built environment to encourage AT use and MVPA to improve public health.
ContributorsLorenzo, Elizabeth (Author) / Lee, Rebecca E (Thesis advisor) / Todd, Michael (Committee member) / Shin, Cha-Nam (Committee member) / Arizona State University (Publisher)
Created2019
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
Description
Team-based care has been linked to key outcomes associated with the Quadruple Aim including improving the health of populations, patient and provider experience and lowering healthcare costs. Less is understood about the connection between team-based care and the patient experience. Emerging evidence connects team-based care with patient activation, a component of the patient experience. Use of the Electronic Health Record (EHR) and machine learning have significant potential to overcome previous barriers in how teams are studied to better understand their impact on critical care delivery outcomes, such as patient activation. This research program included a systematic review of the literature to analyze the relationship between team-based care and patient satisfaction, a proxy for the patient experience. Overall, this review found a positive relationship between team-based care and patient satisfaction, including 57% of studies with improved patient satisfaction with team-based care implementation. Secondary findings included a relationship between team composition and patient satisfaction, with larger teams (three or more disciplines) associated with improved patient satisfaction.
A methodological paper was then prepared to describe the process in which primary care teams were identified within EHR data utilizing a common definition for team-based care supported by prominent team theorists. This novel approach provides a roadmap for the health services researcher to leverage EHR data to study the impact teams may have on critical patient outcomes in the real-world practice environment.
The final study in this work utilized a large EHR data set (n = 316,542) from an urban health system to examine the relationship between team composition and patient activation. Patient Activation was measured using the Patient Activation Measure (PAM). Results from mixed-level model analysis were compared to machine learning analysis using multinomial logistic regression to calculate propensity scores for the multiple effect of team composition. After controlling for confounding variables in both analyses, more diverse, multidisciplinary teams were associated with improved patient activation scores.
Implications for this research program include the feasibility of identifying teams within the EHR and utilize big data analytics with machine learning to measure the impact of teams and real-world patient related outcomes.
ContributorsWill, Kristen Kaye (Author) / Lamb, Gerri (Thesis advisor) / Delaney, Connie (Committee member) / Todd, Michael (Committee member) / Arizona State University (Publisher)
Created2021