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.

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.

Job burnout, a prolonged reaction to job stress, includes mental and physical aspects of exhaustion related to professional work life. Linked to individual health-related problems, decreased job satisfaction, poor organizational commitment, and higher turnover, burnout poses a problem for both employees and organizations. The nursing profession identifies the prevalence of burnout and the resulting harmful effects in many settings, yet until now, rural critical access hospital settings have not been considered. To build and maintain a competent, healthy rural nursing workforce that responds innovatively to growing healthcare needs, it is important to examine burnout levels in rural nurses and to identify factors that might be associated with mitigating burnout.

This study focuses on how psychological capital, socio-demographic and organizational work-related factors are associated with burnout in this population. This cross-sectional, descriptive correlational study employed the Maslach Burnout Inventory for Health Professionals, the Psychological Capital Questionnaire, and a sociodemographic questionnaire assessing individual and organizational work-related factors as self-report tools. Descriptive statistics, correlations, and regression analyses were performed to assess aspects of the nurses’ work environment, while describing the relationships among the variables.Means and standard deviations were examined across key variables and compared to reports from other studies. Hypotheses predicted psychological capital would be associated with burnout (negatively associated with emotional exhaustion and depersonalization, positively associated with personal accomplishment), and that individual sociodemographic and organizational work-related factors would also be associated with BO. It was further hypothesized that PsyCap would moderate the relationship between work-related factors and BO.

Maslach Burnout Inventory results reveal similar findings to those in the global sample. However, levels of emotional exhaustion and professional accomplishment were greater in our rural nurse sample compared to published values. Higher levels of psychological capital were found to be related to decreases in depersonalization and correlated to greater professional accomplishment. Psychological capital was not found to moderate associations within this study. Intent to stay more than one year had a strong, negative correlation with emotional exhaustion. The findings suggest burnout in this sample resembles that of the global problem and sets a baseline from which psychological capital trainings may be built.

The purpose of the study was to explore students' writing abilities throughout the online RN-BSN program at a large urban university in the Southwest. The aims of the study were: 1) explore how students' writing abilities, confidence in writing, and ability to locate resources change throughout the online RN-BSN program, 2) identify which aspects of writing students consider to be their strengths and/or challenges, and 3) explore which factors predict how well students write, their confidence in writing, and their ability to locate resources. After obtaining IRB approval, an invitation to participate in the study was sent to students enrolled in four different courses within the RN-BSN program. Students who chose to participate completed a 16-item questionnaire in which they rated their writing abilities, confidences, and skills, indicated strengths and challenges in their writing, and skills in locating evidence-based resources. An improvement was noted in students' self-rated academic writing confidence, professional writing confidence, internet reference skills, and library reference skills. The number of years as a registered nurse predicted overall writing ability and academic writing confidence.

Physician's cultural competence is important in healthcare because it helps improve quality of care as well as address healthcare disparities among minorities. Additionally, it positively correlates with patient satisfaction, which has been shown to increase treatment adherence and improve medical outcomes. This study investigated the effect of physician's cultural competence on patient satisfaction in a Latino population and how these compared to a European-American population. Physician's Cultural Competence for Patient Satisfaction (PCCPS) scale developed by Dr. Ahmed was utilized in this study. The PCCPS scale deconstructed physician's cultural competence into five subcategories: Macro-cultural, Proxemics/Chronemics, Language, Patient-centered Cultural Competence, and Patient Satisfaction. This scale and various demographic questions were incorporated into a survey that was distributed amongst participating patients. Gathered data was analyzed to determine which demographic factors and subcategories of physician's cultural competence were more relevant or important when interacting with patients that have distinct cultural backgrounds, such as Latino and European-American. Findings from this study will add to building a foundation of evidence in health care that advocates for a more holistic approach to medicine and incorporates cultural competence as an important determinant to predicting health care outcomes.

Almost sixty percent of adults within the United States are in a married or committed, cohabiting relationship. This study sought to examine the trajectory of relationship satisfaction over 14 consecutive days employing an ecological momentary assessment (EMA) method. Daily reports of relationship satisfaction were collected via a smartphone application developed from the LifeData platform. Phone-based interview questions posed one week after the 14-day EMA period afforded evaluation of usability and acceptability, in preparation for a much larger study of couples coping with cancer. Twenty-seven adults in a married or committed, cohabitating relationship served as participants, recruited from researchmatch.org. (These individuals were not coping with cancer.) Participants received a smartphone notification between 7:30pm and 8:30pm each day, with 45 minutes to begin recording their responses. A single item from the Dyadic Adjustment Scale (item #31) was used to assess relationship satisfaction. Findings revealed a marginally significant increase in satisfaction over the course of 14 days (b = 0.04, t = 1.85, p = .077). In addition, an intraclass correlation (ICC) value of 0.59 indicated larger between-person variability than within-person variability, suggesting that satisfaction varies more from one individual to another than it does within individuals over time. Finally, plots of mean relationship satisfaction by the standard deviation of relationship satisfaction showed lower variability in day-to-day satisfaction among those who were on average more satisfied with their relationship compared to those who were on average less satisfied. Feedback regarding convenience and ease of the application indicated favorable attitudes towards smartphone-based data collection.

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.

Purpose: The purpose of this study is to examine perceptions of medical-surgical nurses of alcohol-abusing patients admitted to an acute care facility Background: Studies report that many nurses have negative feelings about substance-abusing patients (Neville & Roan, 2014). It has been found nurses report a lack of knowledge about substance abuse disorders, as well as a view that substance abusing patients are more emotionally challenging and dangerous, often leading to decreased motivation and lower levels of job satisfaction (van Boekel, Brouwers, van Weeghel & Garrestsen, 2013). However, studies have found that additional education can positively impact nurses' perceptions (Arthur, 2001). Methods/Approach: This study is a descriptive design using a 17-question 2-part survey. The first part of the survey includes seven demographic questions pertaining to the participants' characteristics and experiences. The second part of the survey is adapted from the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), a valid and reliable instrument used to assess healthcare providers' attitudes toward working with alcohol-abusing patients. Results: Eighty four medical-surgical nurses participated in the study. Over half reported having four hours or less of continuing education on alcohol abuse disorder. Regression analyses identified positive relationships between factors, particularly continuing education, on perceptions of alcohol-abusing patients. Conclusions/Implications: Results of this study can be used to determine what factors contribute to nurses' perceptions of alcohol-abusing patients in the medical-surgical unit, therefore aiding in identifying and developing effective policies, protocols, and interventions aimed at improving quality of patient care in this specific patient population.

Although many studies have looked into the relationship between depression and eating behaviors, most have not looked into the interaction between depressive mood, weight status, and eating behaviors; specifically the consumption of added sugars. This longitudinal study examined the relationship between depressive mood and added sugar consumption among college freshmen, and how weight status play a role in this relationship. A web-based survey assessing depressive mood score and added-sugar foods consumption, and height and weight measurements were obtained. A total of 511 participants (aged 18.5±0.4 years; 70.5% females) were recruited at Arizona State University from August 2015 through January 2016. The main outcomes measured were the relationship between depressive mood score and added sugar consumption (tsp/d) within each participants and between mean weight status groups (underweight & “healthy” weight, overweight, and obese). In the study, the mean added sugar consumption was 19.1±11.87 tsp/d. There were no significant association between depressive mood and added sugar consumption within or between freshman students over time. But overall, there was a slightly positive relationship between depressive mood and added sugar consumption across four time points. No significant interaction was found between BMI, depressive mood, and added sugar consumption within each student, but significant differences in the relationship of depressive mood and added sugar between mean weight status groups (p=0.025). Each individual’s BMI in the previous time points was significantly negatively associated with added sugar consumption in the current time points (beta = -0.70; p=0.010). The results from this study indicates that depressive mood may not affect added sugar intake in this sample. BMI did not have an impact on the relationship within each student, but have an impact between mean weight status groups, so further studies are needed to continue look at how BMI influences the relationship between depressive mood and added sugar consumption.

Background: Emerging interventions that rely on and harness variability in behavior to adapt to individual performance over time may outperform interventions that prescribe static goals (e.g., 10,000 steps/day). The purpose of this factorial trial was to compare adaptive vs. static goal setting and immediate vs. delayed, non-contingent financial rewards for increasing free-living physical activity (PA).

Methods: A 4-month 2 × 2 factorial randomized controlled trial tested main effects for goal setting (adaptive vs. static goals) and rewards (immediate vs. delayed) and interactions between factors to increase steps/day as measured by a Fitbit Zip. Moderate-to-vigorous PA (MVPA) minutes/day was examined as a secondary outcome.

Results: Participants (N = 96) were mainly female (77%), aged 41 ± 9.5 years, and all were insufficiently active and overweight/obese (mean BMI = 34.1 ± 6.2). Participants across all groups increased by 2389 steps/day on average from baseline to intervention phase (p < .001). Participants receiving static goals showed a stronger increase in steps per day from baseline phase to intervention phase (2630 steps/day) than those receiving adaptive goals (2149 steps/day; difference = 482 steps/day, p = .095). Participants receiving immediate rewards showed stronger improvement (2762 step/day increase) from baseline to intervention phase than those receiving delayed rewards (2016 steps/day increase; difference = 746 steps/day, p = .009). However, the adaptive goals group showed a slower decrease in steps/day from the beginning of the intervention phase to the end of the intervention phase (i.e. less than half the rate) compared to the static goals group (−7.7 steps vs. -18.3 steps each day; difference = 10.7 steps/day, p < .001) resulting in better improvements for the adaptive goals group by study end. Rate of change over the intervention phase did not differ between reward groups. Significant goal phase x goal setting x reward interactions were observed.

Conclusions: Adaptive goals outperformed static goals (i.e., 10,000 steps) over a 4-month period. Small immediate rewards outperformed larger, delayed rewards. Adaptive goals with either immediate or delayed rewards should be preferred for promoting PA.