Matching Items (36)
Description
Obesity in Hispanic youth has reached alarmingly high levels, increasing the risk of type 2 diabetes, hyperlipidemia, hypertension, and cardiovascular disease. In Mexican American children ages 6-11 years, 41.7% are overweight and obese, 24.7% are obese and 19.6% have a Body Mass Index (BMI) greater than the 97th percentile. While personal, behavioral, and environmental factors contribute to these high rates, emerging literature suggests acculturation, self-efficacy and social support are key influences. The one-group, pre- and post-test, quasi-experimental design used a community-based participatory research (CBPR) method to test the feasibility, acceptability, and preliminary efficacy of the 8-week intervention. Social Cognitive Theory (SCT) was used to guide the design. Measurements included an analysis of recruitment, retention, participant satisfaction, observation of intervention sessions, paired t-tests, effect sizes, and bivariate correlations between study variables (acculturation, nutrition and physical activity [PA] knowledge, attitude and behaviors, perceived confidence and social support) and outcome variables (BMI z-score, waist circumference and BP percentile) Findings showed the SSLN program was feasible and acceptable. Participants (n = 16) reported that the curriculum was fun and they learned about nutrition and PA. The retention rate was 94%. The preliminary effects on adolescent nutrition and PA behaviors showed mixed results with small-to-medium effect sizes for nutrition knowledge and attitude, PA and sedentary behavior. Correlation analysis among acculturation and study variables was not significant. Positive associations were found between perceived confidence in eating and nutrition attitude (r = .61, p < .05) and nutrition behavior (r = .62, p < .05), perceived confidence in exercise and nutrition behavior (r = .66, p < .05), social support from family for exercise and PA behavior (r = .67, p < .01) and social support from friends for exercise and PA behavior (r = .56, p < .05). These findings suggest a culturally specific healthy eating and activity program for adolescents was feasible and acceptable and warrants further investigation, since it may fill a gap in existing obesity programs designed for Hispanic youth. The positive correlations suggest further testing of the theoretical model.
ContributorsStevens, Carol (Author) / Gance-Cleveland, Bonnie (Thesis advisor) / Komnenich, Pauline (Committee member) / Shaibi, Gabriel (Committee member) / Arcoleo, Kimberly (Committee member) / Arizona State University (Publisher)
Created2011
Description
The health enhancing effects of physical activity are well documented in the literature. However, women continue to report lower participation in exercise and physical activity (PA) compared to men. As women age an overall trend in decreased activity is observed. The primary place of activity reported in women is the home and one of the most commonly reported reasons for lack of physical activity is the lack of time. Few instruments have been developed that focus on the activity patterns of women. The Cross Cultural Physical Activity Study that this study was based on targeted women of color to assess the types of activity and constraints to activity experienced by African American and Native American women over 40 years old. This secondary data analysis focused on the psychometric properties of two scales used in the above study, The Physical Recreation Questionnaire (PRQ) and The Typical Week Physical Activity Survey (TWPAS). An exploratory factor analysis (EFA) was conducted on the 18 items from the Physical Recreation Questionnaire (PRQ) which focused on constraints to PA. The results of the EFA were a poor fit of a two factor model. The three factor model had a favorable fit in the EFA. Confirmatory factor analysis (CFA) was then conducted on the 18 items in the PRQ. Results of the CFA supported the presence of three latent variables: enjoyment of PA, constraints to PA, and negotiation of constraints to PA. The Typical Week Physical Activity Survey (TWPAS) is a 35 item measure of moderate PA that includes the activities most often reported by women. The purpose of the TWPAS was to capture habitual PA that might not be recorded in other PA questionnaires. The TWPAS was correlated with criterion measures of PA records, treadmill, accelerometer, and BMI. Although correlations were small, they were in the expected direction with the criterion measures. The evaluation of the instruments supported the presence of the construct of constraints to PA in the PRQ and the measurement of moderate intensity PA in the TWPAS.
ContributorsBishop, Jewel (Author) / Ainsworth, Barbara (Thesis advisor) / Komnenich, Pauline (Committee member) / Arizona State University (Publisher)
Created2012
Description
Though the likelihood is a useful tool for obtaining estimates of regression parameters, it is not readily available in the fit of hierarchical binary data models. The correlated observations negate the opportunity to have a joint likelihood when fitting hierarchical logistic regression models. Through conditional likelihood, inferences for the regression and covariance parameters as well as the intraclass correlation coefficients are usually obtained. In those cases, I have resorted to use of Laplace approximation and large sample theory approach for point and interval estimates such as Wald-type confidence intervals and profile likelihood confidence intervals. These methods rely on distributional assumptions and large sample theory. However, when dealing with small hierarchical datasets they often result in severe bias or non-convergence. I present a generalized quasi-likelihood approach and a generalized method of moments approach; both do not rely on any distributional assumptions but only moments of response. As an alternative to the typical large sample theory approach, I present bootstrapping hierarchical logistic regression models which provides more accurate interval estimates for small binary hierarchical data. These models substitute computations as an alternative to the traditional Wald-type and profile likelihood confidence intervals. I use a latent variable approach with a new split bootstrap method for estimating intraclass correlation coefficients when analyzing binary data obtained from a three-level hierarchical structure. It is especially useful with small sample size and easily expanded to multilevel. Comparisons are made to existing approaches through both theoretical justification and simulation studies. Further, I demonstrate my findings through an analysis of three numerical examples, one based on cancer in remission data, one related to the China’s antibiotic abuse study, and a third related to teacher effectiveness in schools from a state of southwest US.
ContributorsWang, Bei (Author) / Wilson, Jeffrey R (Thesis advisor) / Kamarianakis, Ioannis (Committee member) / Reiser, Mark R. (Committee member) / St Louis, Robert (Committee member) / Zheng, Yi (Committee member) / Arizona State University (Publisher)
Created2017
Description
Generalized Linear Models (GLMs) are widely used for modeling responses with non-normal error distributions. When the values of the covariates in such models are controllable, finding an optimal (or at least efficient) design could greatly facilitate the work of collecting and analyzing data. In fact, many theoretical results are obtained on a case-by-case basis, while in other situations, researchers also rely heavily on computational tools for design selection.
Three topics are investigated in this dissertation with each one focusing on one type of GLMs. Topic I considers GLMs with factorial effects and one continuous covariate. Factors can have interactions among each other and there is no restriction on the possible values of the continuous covariate. The locally D-optimal design structures for such models are identified and results for obtaining smaller optimal designs using orthogonal arrays (OAs) are presented. Topic II considers GLMs with multiple covariates under the assumptions that all but one covariate are bounded within specified intervals and interaction effects among those bounded covariates may also exist. An explicit formula for D-optimal designs is derived and OA-based smaller D-optimal designs for models with one or two two-factor interactions are also constructed. Topic III considers multiple-covariate logistic models. All covariates are nonnegative and there is no interaction among them. Two types of D-optimal design structures are identified and their global D-optimality is proved using the celebrated equivalence theorem.
Three topics are investigated in this dissertation with each one focusing on one type of GLMs. Topic I considers GLMs with factorial effects and one continuous covariate. Factors can have interactions among each other and there is no restriction on the possible values of the continuous covariate. The locally D-optimal design structures for such models are identified and results for obtaining smaller optimal designs using orthogonal arrays (OAs) are presented. Topic II considers GLMs with multiple covariates under the assumptions that all but one covariate are bounded within specified intervals and interaction effects among those bounded covariates may also exist. An explicit formula for D-optimal designs is derived and OA-based smaller D-optimal designs for models with one or two two-factor interactions are also constructed. Topic III considers multiple-covariate logistic models. All covariates are nonnegative and there is no interaction among them. Two types of D-optimal design structures are identified and their global D-optimality is proved using the celebrated equivalence theorem.
ContributorsWang, Zhongsheng (Author) / Stufken, John (Thesis advisor) / Kamarianakis, Ioannis (Committee member) / Kao, Ming-Hung (Committee member) / Reiser, Mark R. (Committee member) / Zheng, Yi (Committee member) / Arizona State University (Publisher)
Created2018
Description
Cardiovascular disease (CVD) is the leading cause of mortality in the U.S. While physical activity can reduce CVD risk, most adults do not engage in adequate physical activity to maintain or improve health. Older adults are less likely to participate in physical activity and experience a greater burden of CVD compared to younger adults. Despite knowledge of motivators and barriers to physical activity, the challenge to reduce cardiovascular risk in the older adult population remains unmet. Older adults face unique and complex barriers to physical activity, including limited social contextual resources and behavioral change processes. Interventions to enhance wellness motivation have demonstrated potential in promoting health behavior change among older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
The purpose of this study was to examine the feasibility of the Yoga for HEART (Health Empowerment and Realizing Transformation) Intervention to increase motivation for physical activity and improve cardiovascular health in older adults. A pilot randomized controlled trial design was used. The Intervention group received Yoga for HEART, a 12-week program to foster motivation for health behavior change. The Control group received a 12-week group yoga program that did not contain theory-based components. The intervention was based on Wellness Motivation Theory, conceptualizing health behavior change as dynamic process of intention formation and goal-directed behavior leading to the development of new and positive health patterns. Critical inputs (i.e., empowering education, motivational support, social network support) were designed to promote social contextual resources and behavioral change processes to increase motivation for physical activity and improve cardiovascular health.
Specific Aims were to: (a) examine intervention acceptability, demand, and fidelity, and (b) evaluate intervention efficacy in promoting physical activity and improving cardiovascular health through increased social contextual resources and behavioral change processes. Participants in the Intervention group realized a significant reduction in body mass index (BMI) from baseline to 12 weeks when compared to participants in the Control group. Intervention group participants demonstrated improvement in theoretical mechanisms (i.e., self-knowledge, motivation appraisal, self-regulation, environmental resources) and intended outcomes (i.e., body composition) when compared to Control group participants. Findings from this study support the feasibility of the Yoga for HEART Intervention in older adults.
ContributorsBarrows, Jennifer Leigh (Author) / Fleury, Julie (Thesis advisor) / Komnenich, Pauline (Committee member) / Belyea, Michael (Committee member) / Arizona State University (Publisher)
Created2018
Description
The goal of diagnostic assessment is to discriminate between groups. In many cases, a binary decision is made conditional on a cut score from a continuous scale. Psychometric methods can improve assessment by modeling a latent variable using item response theory (IRT), and IRT scores can subsequently be used to determine a cut score using receiver operating characteristic (ROC) curves. Psychometric methods provide reliable and interpretable scores, but the prediction of the diagnosis is not the primary product of the measurement process. In contrast, machine learning methods, such as regularization or binary recursive partitioning, can build a model from the assessment items to predict the probability of diagnosis. Machine learning predicts the diagnosis directly, but does not provide an inferential framework to explain why item responses are related to the diagnosis. It remains unclear whether psychometric and machine learning methods have comparable accuracy or if one method is preferable in some situations. In this study, Monte Carlo simulation methods were used to compare psychometric and machine learning methods on diagnostic classification accuracy. Results suggest that classification accuracy of psychometric models depends on the diagnostic-test correlation and prevalence of diagnosis. Also, machine learning methods that reduce prediction error have inflated specificity and very low sensitivity compared to the data-generating model, especially when prevalence is low. Finally, machine learning methods that use ROC curves to determine probability thresholds have comparable classification accuracy to the psychometric models as sample size, number of items, and number of item categories increase. Therefore, results suggest that machine learning models could provide a viable alternative for classification in diagnostic assessments. Strengths and limitations for each of the methods are discussed, and future directions are considered.
ContributorsGonzález, Oscar (Author) / Mackinnon, David P (Thesis advisor) / Edwards, Michael C (Thesis advisor) / Grimm, Kevin J. (Committee member) / Zheng, Yi (Committee member) / Arizona State University (Publisher)
Created2018
Description
Guided by Tinto’s Theory of College Student Departure, I conducted a set of five studies to identify factors that influence students’ social integration in college science active learning classes. These studies were conducted in large-enrollment college science courses and some were specifically conducted in undergraduate active learning biology courses. Using qualitative and quantitative methodologies, I identified how students’ identities, such as their gender and LGBTQIA identity, and students’ perceptions of their own intelligence influence their experience in active learning science classes and consequently their social integration in college. I also determined factors of active learning classrooms and instructor behaviors that can affect whether students experience positive or negative social integration in the context of active learning. I found that students’ hidden identities, such as the LGBTQIA identity, are more relevant in active learning classes where students work together and that the increased relevance of one’s identity can have a positive and negative impact on their social integration. I also found that students’ identities can predict their academic self-concept, or their perception of their intelligence as it compares to others’ intelligence in biology, which in turn predicts their participation in small group-discussion. While many students express a fear of negative evaluation, or dread being evaluated negatively by others when speaking out in active learning classes, I identified that how instructors structure group work can cause students to feel more or less integrated into the college science classroom. Lastly, I identified tools that instructors can use, such as name tents and humor, which can positive affect students’ social integration into the college science classroom. In sum, I highlight inequities in students’ experiences in active learning science classrooms and the mechanisms that underlie some of these inequities. I hope this work can be used to create more inclusive undergraduate active learning science courses.
ContributorsCooper, Katelyn M (Author) / Brownell, Sara E (Thesis advisor) / Stout, Valerie (Committee member) / Collins, James (Committee member) / Orchinik, Miles (Committee member) / Zheng, Yi (Committee member) / Arizona State University (Publisher)
Created2018
Description
Nurses are ideally positioned to lead the transformation of healthcare delivery in the United States, however they must be prepared to do so. The Institute of Medicine has called for nurses to become change agents and assume leadership positions across all levels in order to become full partners with physicians and other health care providers. While clinical leadership is a responsibility for all nurses, expectations for new nurse clinical leadership have not been well studied.
This study sought to determine the nursing leadership competencies clinical managers expect of new nurses in an acute care setting and to identify gaps between end-of-program nursing leadership competencies, as outlined in The Essentials of Baccalaureate Education for Professional Nursing Practice, with leadership competencies identified by clinical managers in an acute-care setting.
A single, bounded case study approach was used to collect data from nurse managers and assistant nurse managers at one acute care hospital. Data from intensive interviews, focus groups, and archival records were analyzed. Seven major themes related to clinical leadership emerged, including intentional learning, communication, professional practice, advocacy, teamwork, influencing practice, and systems thinking. Traits, mentoring, and generational differences emerged as secondary themes.
Data from this study revealed a developmental sequence for clinical leadership. Certain expectations identified as antecedent to clinical leadership emerged initially, whereas other aspects of clinical leadership, developed later in the career trajectory. It was clear that accomplishing nursing care tasks was a fundamental expectation for professional nursing practice. Communication, teamwork and advocacy are crucial leadership competencies which help the new nurse to effectively manage time and provide safe, high-quality nursing care. As the new nurse continues to develop, systems thinking and influencing nursing practice emerge as significant expectations. Nurse managers have clear expectations for how new nurses should be prepared for clinical leadership. The degree to which clinical practice partners employing new nurses and academic nursing programs educating future nurses collaborate to establish expected outcomes is variable; however, academic-practice collaborations are crucial in developing educational standards for entry to practice in complex healthcare delivery systems.
This study sought to determine the nursing leadership competencies clinical managers expect of new nurses in an acute care setting and to identify gaps between end-of-program nursing leadership competencies, as outlined in The Essentials of Baccalaureate Education for Professional Nursing Practice, with leadership competencies identified by clinical managers in an acute-care setting.
A single, bounded case study approach was used to collect data from nurse managers and assistant nurse managers at one acute care hospital. Data from intensive interviews, focus groups, and archival records were analyzed. Seven major themes related to clinical leadership emerged, including intentional learning, communication, professional practice, advocacy, teamwork, influencing practice, and systems thinking. Traits, mentoring, and generational differences emerged as secondary themes.
Data from this study revealed a developmental sequence for clinical leadership. Certain expectations identified as antecedent to clinical leadership emerged initially, whereas other aspects of clinical leadership, developed later in the career trajectory. It was clear that accomplishing nursing care tasks was a fundamental expectation for professional nursing practice. Communication, teamwork and advocacy are crucial leadership competencies which help the new nurse to effectively manage time and provide safe, high-quality nursing care. As the new nurse continues to develop, systems thinking and influencing nursing practice emerge as significant expectations. Nurse managers have clear expectations for how new nurses should be prepared for clinical leadership. The degree to which clinical practice partners employing new nurses and academic nursing programs educating future nurses collaborate to establish expected outcomes is variable; however, academic-practice collaborations are crucial in developing educational standards for entry to practice in complex healthcare delivery systems.
ContributorsMiehl, Nickolaus (Author) / Komnenich, Pauline (Thesis advisor) / Hagler, Debra (Thesis advisor) / Lamb, Gerri (Committee member) / Arizona State University (Publisher)
Created2018
Description
Sedentary behavior has recently been recognized as a widespread, independent risk factor for increased morbidity and mortality from chronic conditions including diabetes, cardiovascular disease, and cancer. Midlife women (age 40-64) are known to have high levels of sedentary behavior and corresponding cardiovascular disease risk. Currently, little is known about mechanisms involved in reducing and maintaining reductions to sedentary behavior in midlife women. Theory-based nursing interventions are needed which reflect process, personal meaning, person-environment interaction, and incorporate a strength-based perspective. Wellness Motivation Theory guided the research, conceptualizing behavioral change processes within culturally and environmentally relevant contexts, while recognizing bidirectional influences of personal and environmental factors on behavioral patterns. The Wellness Motivation Theory addresses social support and norms, community and material resources that influence behavioral choices, individual motivation and goals, and the behavioral change processes of self-knowledge, motivational appraisal, and self-regulation. A qualitative descriptive approach was used to explore social contextual resources and behavior change processes leading to action as decreasing sedentary time in midlife women. The maximum variation sample included 31 midlife women, employees of Arizona State University. Participants attended a one-hour focus group to discuss their experiences with sedentary behavior, and their efforts to sit less and move more. Midlife women characterized social support as: Raising Me Up, Timing Time and Walking and Talking. Support from contextual resources reflected themes of Seeking Place, Stepping Up, and Walking the Talk. Women experienced self-knowledge as Envisioning the Future, Taking Inventory, and Considering Possibles. Motivational appraisal was characterized as Reevaluating Priorities, Wayfinding, and Going All In. Self-regulation was reflected as Recounting Benefits, Keeping On Track, and Creating New Ways. A deeper understanding of motivational processes central to reducing sedentary behavior in midlife women fosters identification of leverage points for future theory-based intervention research which provides primary prevention opportunities to lower cardiovascular disease risk, and promote successful aging.
ContributorsSherman, Tanie (Author) / Fleury, Julie (Thesis advisor) / Belyea, Michael (Committee member) / Komnenich, Pauline (Committee member) / Arizona State University (Publisher)
Created2018
Description
Late preterm infants (LPIs), born between 34 and 37 weeks gestation, are at risk for a myriad of health conditions related to neuro-muscular and physiologic immaturity. However, relative stability allow many of these infants to avoid care in specialty nurseries and discharge home with their mothers after birth. Due to underlying immaturity, feeding difficulty is the most common issue LPIs experience, resulting in early breastfeeding cessation, increased risk for secondary diagnoses, and hospital readmission. The purpose of this study was to assess early breastfeeding behavior of LPIs, including testing inter-rater reliability of an assessment tool and the feeding patterns of infants over time. An extensive review of breastfeeding assessment tools resulted in the selection of the Premature Infant Breastfeeding Behavior Scale (PIBBS) based on its reliability and validity in the preterm infant population. A convenience sample of LPI dyads was recruited and used to conduct inter-rater reliability testing of PIBBS. A longitudinal one-group non-experimental study was used for observational follow-up. A strong statistical agreement of PIBBS scores occurred between mothers and a healthcare professional (Cohen’s kappa values of items ranged from .776 to 1.000, p = <.001). Participants continued using the PIBBS tool after hospital discharge until their infants expected due dates (40 weeks adjusted age). T-test analyses were conducted to examine changes in scores over time indicating increase in item scores (p = .003 - .193). PIBBS appears to be a valid and reliable tool to assess breastfeeding among LPI dyads. Incorporation of PIBBS into a comprehensive plan of care could better support and protect breastfeeding among the LPI population.
ContributorsLober, Angela (Author) / Komnenich, Pauline (Thesis advisor) / Kelly, Lesly (Thesis advisor) / Dodgson, Joan (Committee member) / Arizona State University (Publisher)
Created2018