Doctoral Dissertations

Nolan, Kayleigh. (2023). The Lived Experiences of Postpartum Mothers and Their Emotional Well-Being: A Work of Art (Assisted Reproductive Technology).
Dissertation chair: Kate Eglseder

Existing literature has not adequately addressed the concern for the well-being of mothers who utilize ART, nor has there been much focus on emotional health and well-being outcomes once ART treatments conclude (Melville et al., 2021). This qualitative study used a descriptive transcendental phenomenological design to capture the essence of 10 mothers’ lived experiences who were post-birth of their first child conceived with ART. The researcher sought to answer: What are the lived experiences/perceptions of well-being in the postpartum period for mothers who utilized ART? How do the emotions experienced in new motherhood influence one’s occupational engagement and participation after conceiving with ART? Five overarching themes emerged from the data provided through a pre-interview descriptive survey, self-report of the Edinburgh Postnatal Depression Scale (EPDS), and in-depth, one-on-one reflective interviews with each participant. Themes included: (1) Postpartum Relics: An Emerging Occupational Identity; (2) Emotional Imprints of the ART Journey; (3) Supports and Constraints of Relational Intimacy; (4) Mind Over Matter: Retuning as a Mechanism of Hope, Joy, and Survival; and (5) Shaping the Future of Motherhood After ART. The major findings of the study suggest mothers who conceive with ART engage in a pre-motherhood lifestyle of occupational imbalance and disruption, which brings about intense emotional experiences and changes in how they perform occupations. ART mothers’ experiences are not only characterized by intense physical/bodily changes, financial stressors, and relational adjustments, but also by overt and ongoing emotional experiences and decision-making that come with a degree of intense difference, separating their experiences from mothers who conceive naturally. Despite the intensity of their journeys, ART mothers are found to adapt well to motherhood, are empowered in using the mind to exercise resilience, vulnerability, and gratitude, experience a deep sense of appreciation for their children, have greater/deeper emotional intimacy with their spouses, and perceive themselves as more deliberate parents compared to mothers who conceive naturally. 

Alexander-Greene, Christine. (2022). A Case Study of Key Program Elements Supporting the Occupational Participation of Foster Youth in the Student Role.
Dissertation chair: Lisa Crabtree

The barriers to educational attainment for children in foster care have been well documented. According to recent literature, issues of abuse, neglect, overuse of psychotropic medications, and a lack of social capital are rampant within the foster care population. As a result, children in foster care are often characterized with decreased participation in classroom or school activities and experience poor outcomes such as low graduation rates and homelessness. Although programs exist to target at-risk youth, the mental health needs of very young children in foster care can still go undetected and therefore, unmet for years. Moreover, the empirical research identifying any program as part of a complex system that can either impede or enhance program effectiveness and participation in the student role is very sparse. The aim of this mixed methods study was to examine from an occupational science (OS) perspective a single case, a Treatment Foster Care (TFC) Program implemented by a private, large, non-profit agency targeting youth in foster care, to elucidate key program elements that support the occupational participation of foster youth in the student role and their mental health. With TFC as the unit of analysis, data was collected through semi-structured interviews, archived data, and surveys. Results revealed the following key program elements, which were suggested as ideas for best practice: 1) strong therapeutic relationships 2) effective collaborative relationships 3) a trauma-informed approach to intervention 4) a focus on contextual factors, and 5) the re-education of key players and community. Implications of these findings for OS include future research on the many different influences on the occupational performance of foster youth in the student role, which are outlined in this study.

Lankford, Ashley. (2022). The Experience of School-Age Assistive Technology Users and Their Families During Emergency Remote Instruction and the Impact on Classroom Engagement.
Dissertation chair: Amanda Jozkowski

Student engagement in the classroom is important for academic and future success. Many students with disabilities rely on classroom supports, such as assistive technology, to access the curriculum and demonstrate their understanding. Recently the COVID-19 pandemic forced many school districts to abruptly shift to emergency remote instruction. Numerous factors, including those in the home environment, impacted the individual student experience and their classroom engagement. As engagement is vital for student success and well-being, this study aimed to gain a rich understanding of the student and caregiver experience during emergency remote instruction. Nine dyad pairs of AT student users with disabilities and their caregivers participated in semi structured interviews and described their experiences. Using their own words, four superordinate themes emerged. Results support the Morris and Cox (2017) model of engagement but expanded the understanding of meaning associated with classroom participation, aligning with concepts from Wilcock’s Occupational Perspective of Health model (2007, 1998). Engagement is complex; students were found to need both intrinsic and extrinsic motivations, to give meaning to daily occupational participation and to support their overall well-being. During emergency remote instruction, students’ doing, or the daily occupations they participated in, changed. Students reported feeling socially isolated, confused by the added school demands from the home environment and their caregivers, negatively impacted, and the work was less meaningful. Students were forced to redefine what it meant to be a student. Ultimately, the long-term impact of emergency remote instruction, specifically students’ sense of belonging and who they will become, will not be fully realized for years to come. Future research should continue to utilize the Morris and Cox (2017) model with Wilcock’s OPH (2007, 1998) model to continue to gain a greater understanding of student engagement and continue to follow the future implications of students experience during emergency remote instruction. Further, future researchers should use Interpretive Phenomenological Analysis (IPA) methodology with students with disabilities and their caregivers together to generate a richer understanding of the student experience.

Pugh, Heather. (2022). Occupations and the More-Than-Human World: An Ethnographic Exploration of Multi-Species Occupations Involving Horses and Humans.
Dissertation chair: Kendra Heatwole Shank

Despite the broad, multi-disciplinary interest in human-animal relationships, research related to human-animal engagement often focuses on the results of their interactions together instead of the action-oriented, mutually shaped features of their engagement . Moving beyond an individualized perspective in the study of occupation requires not only a theoretical paradigm shift towards the Transactional Perspective of Occupation, but also a methodological shift, broadening our focus from the individual experience. The primary goal of this study was to develop a preliminary understanding of the features of multi-species occupations, expanding the focus from the outcomes of the occupation to understand the action-oriented nature and mutually-shaped features of multi-species occupations. The inquiry followed a multi-modal qualitative design involving six horse-human dyads that had known each other for greater than one year. Dyads were observed and videotaped in their natural environment engaging in non-riding activities. Video data were analyzed through a qualitative coding process using a fifteen-second interval recording system. Qualitative interviews incorporating video and photo elicitation were also conducted and coded for comparison with visual data. Visual data of the dyads demonstrated a variety of observable features, including movement and mutual touch patterns and the presence of behavioral synchrony. Based on visual and interview data, embodied communication and co-regulation were characteristics of the dyads’ engagement, with most participants noting perceptions of attunement with their equine partner and all participants indicating that improved well-being was an outcome of regular interactions with their equine partners. Generating evidence that moves beyond viewing human-animal relationships through the limited perspective of therapeutic outcomes may deepen our understanding of multi-species occupations and explore the mechanism of action or change when animals such as equines are incorporated into therapeutic interventions.

Weatherly, Matthew. (2022). Adolescents with Cancer: A Phenomenological Examination of Parents' Occupational Experience.
Disseration chair: Barbara Demchick

Approximately 40,000 children and adolescents are diagnosed with cancer each year. Research has suggested that the parents that care for adolescents diagnosed with cancer are underrepresented in the literature. Additionally, this parental population has rarely been examined from an occupational perspective. The current study examined the phenomenological experience of parents that cared for an adolescent diagnosed with cancer. The aim of the current research was to explore how the parents’ occupational experiences were affected by caring for their adolescent. Each parent cared for an adolescent that was diagnosed at 13 – 16 years of age, is now cancer free, and has been in remission for an average of 4.83 years. Six parents, five mothers and one father, were interviewed twice via WebEx format. Four themes emerged during the interviews: (a) a search for answers, (b) adapting and prioritizing the occupational life, (c) intrinsic and extrinsic resources, and (d) long term effects on families.

King, Terris. (2018). Occupational Engagement: African American Culinary Ministers' Perceptions and Beliefs about Meal Preparation and Eating Practices.
Dissertation chair: Janet DeLany

The purpose of this study was to understand the perceptions about the food, food preparation practices, and eating practices of African American culinary ministers who participate in a faith-based action research project to promote health within the church community. Eating and food challenges exist within many African American communities that contribute to the disproportionate numbers who are affected by chronic diseases. Food deserts which limit food choices contribute to disproportionate spread of chronic disease among African Americans (Donkin et al., 1998). Health illiteracy about healthy eating practices combined with low income and poor education also contribute to health disparities within the African American community (Ownby et al., 2012). Current health care services and nutritional improvements efforts in the African American community are insufficient to address this epidemic. 

The African American church through its ministries, may be able to provide faith-based community health initiatives to improve the health of the community. The culinary ministry may be one of the ministries able to provide such an initiative because they are the trusted source responsible for meal preparation within the African American church. However, no studies could be found about the beliefs and perception of culinary ministers related nutritional meal preparation and eating practices. Thus, the current study was launched. Of the 9 culinary ministers who volunteered to participate in the research project, 8 completed the entire process. The data collection process included 2 focus groups, 7 learning sessions and a meal preparation session. The culinary ministers prepared a healthy meal for 30 members of the Seniors Ministry. During the initial focus group, a Food Diary (FD) produced by the University of Western Ontario (Appendix D) was distributed to the culinary ministers. 

Participants were asked to include the food, beverages and portion sizes of meals over a 5-day sequence. The FD was collected from the culinary ministers during the final focus group. The transformative mixed research method was utilized to collect and analyze the findings. The Person-Environment-Occupational Performance Model (PEOP) and the Health Belief Model served as the theoretical lenses for this study. Occupational science, with its focus on the intersectionality of people, their environments, and their daily life occupations, provided the disciplinary lens for interpreting historical and current factors influencing the perceptions about the food, food preparation practices, and eating practices of African American culinary ministers. The five themes that emerged from the data analysis were: authority and voice; holiday and everyday foods; food, health, and faith; trust and distrust of the health care system; and group supports. 

These themes revealed the interplay of person, environmental, and occupation factors on the occupational performance of the culinary ministers and their perceptions about their occupational roles for influencing the health of the church members. Some of the factors were assets and contributed to the occupational performance and positive perceptions; other factors created barriers to achievement and fulfillment of occupational roles.

Wrightsman, William. (2018). Gay Mens’ Experience of Same-Sex Marriage and its Relation to Well-being: An Interpretative Phenomenological Analysis.
Dissertation chair: Jenna Yeager

Same-sex marriage is a recent and growing societal phenomenon, which has garnered little attention from researchers. Currently, most of what is known regarding the experience of marriage comes from research using opposite-sex couples. The study of same-sex marriage provides an opportunity to explore how gay men experience marriage in relation to societal norms. This qualitative study illuminated the lived experience of three gay men who have participated in the phenomenon of same sex marriage. Interpretative phenomenological analysis (IPA) was the primary methodology used to guide this study. IPA combines various phenomenological elements, such as phenomenology, hermeneutics, and idiography, to understand how research participants perceive a particular life experience; interpretation is central to IPA methodology. Data collection included three extensive interviews with each of the participants, which resulted in rich descriptions of their marriage experience. Data analysis revealed four superordinate themes associated with the participants’ experience of marriage: (a) acceptance, (b) the long shadow of stigmatization, (c) critical crossroads, and (d) the meaning of marriage. An important finding in this study was the impact that sexual prejudice and stigmatization had on the participants’ gay identity, occupational experience, and well-being, which ultimately influenced their experience of marriage. The knowledge gained from this study on same-sex marriage will be used to expand current literature, and inform social scientists regarding the impact that sexual prejudice and heteronormativity have on the occupational experience and health outcomes of this understudied population.

Greenbaum, Ann (2017). Activity Patterns and Well-being in Commuters: An Occupational Perspective. Dissertation chair: Beth Merryman

This study explored the predictors of commuter well-being in college students using an occupational framework. While past studies focused more on the physical impact of commuting on health, there was a gap in the scholarly literature regarding the occupational aspects (the doing) of commuting on well-being, especially using different modes of transportation, such as by car, bike, walking, or campus shuttle. Using a mixed methods sequential design, this research examined occupational science concepts such as enjoyment, routine, control, choice, and meaningfulness experienced during commuting by various modes. The study includes surveys of over 500 students as well as focus groups of commuters. Findings indicate that several occupational aspects accounted for 59% of the variance in a model of satisfaction with commuting, suggesting occupational aspects are significant predictors of commuter satisfaction. Further, the doing of commuting (activity patterns and dimensions of experience in a Do-Live-Well framework) resulted in greater satisfaction when active modes (walking or cycling) of commuting were used, compared to passive modes (car and campus shuttle). Future studies can address how attention to occupational aspects can enhance commuting experiences and promote participation in healthier and more sustainable modes.

Voss, Maren (2017). Understanding Well-being Among Retirees Experiencing Late-life Unemployment. Dissertation chair: Beth Merryman

This study examines the role of paid work as a form of occupational engagement, with consequent impacts on health, particularly as activity patterns shift during the transition to retirement. Occupational engagement is viewed here as a necessary element of health and wellness generally, but the impact of lost work opportunity and the occupational deprivations it incurs are likely to have individual level influences. A phenomenological theoretical approach was taken in the analysis of work transitions during the pre- and post- retirement years to gain an individual level perspective on the challenges of occupational deprivation that might compromise health. Occupational theory posits that episodes of occupational deprivation will result in negative effects on well-being. 

The latent benefits of work theory describes mechanisms by which lost work opportunity can have detrimental effects, as changes in time-use and lost opportunities for meaningful engagement result in a loss of socially endorsed identity. Lost work opportunity has been demonstrated to have a negative impact on physical and mental health. Similarly, early and involuntary retirement have been linked to poorer physical and mental health outcomes. It can be difficult to define either involuntary retirement or unemployment late in life, particularly when retirement benefits are procured after a job has been involuntarily terminated. Existing literature does not adequately capture the occupational deprivation of late-life job loss on the health and wellness of individuals approaching the retirement years. 

A mixed methods analysis was conducted using an explanatory sequential model in appreciation of the complexity of the question of how unemployment impacts the health and well-being of older adults. Quantitative analysis was conducted using the Health and Retirement Study. The total number of months of unemployment experienced between 2000-2012 were calculated for each individual. Unemployment months were regressed with demographic and baseline health measures to assess the relationship with health during retirement. Qualitative interviewing was conducted to assess the sociological factors that influence the relationship between lost work opportunity and retirement health, including information about retirement timing, time-use in retirement, and personal sense of control in life course events. Qualitative interviews were analyzed for relevant themes and interpretations were integrated with the quantitative findings. 

A total of 529 (6.5%) of individuals in the HRS sample (N=8,099) had experienced late-life unemployment after the age of 50, with an average of 17.5 months (SD=15.76). Late-life unemployment had no significant effect on self-reported physical health (ß=.0015, p=0.376) but was significantly associated with lower levels of mental health (ß=.0091; p<.01). Qualitative interviewing revealed high levels of reported stress during the episode of unemployment, followed by resiliency and a return to prior happiness levels. Individuals with late-life unemployment had much higher levels of involuntary retirement timing (between 47-57% compared to 15-28% for those with stable employment). Concepts of productivity and meaningful engagement shift during the retirement years. 

In quantitative analysis of the HRS I found a direct negative effect of late-life unemployment on mental health (CES-D scores) in retirement, but no significant effect on self-reported physical health or number of chronic health conditions. Qualitative interviews revealed that 1/6 of individuals experiencing a forced removal from their employment just prior to retirement did not classify this work displacement as unemployment. This suggests there is likely error in the measurement of unemployment that is available in the quantitative public dataset. Qualitative interviews identified strong themes of resilience in the face of unemployment challenges as well as a preference for choice in time-use over money during the retirement years. It may be necessary to redefine productive or meaningful engagement in the occupational balance models when they are applied to the retirement years.

Roman, Cynthia (2016). Occupational Time: A Case Study of the Experiences of Time in a Sample of American and Filipino Healthcare Practitioners.
Dissertation chair: Regena Stevens-Ratchford

The purpose of this qualitative study was to describe occupational time in a sample of American and Filipino healthcare practitioners. Through a collective case study, the researcher collected and analyzed data from twelve healthcare participants. The Model of Human Occupation was the theoretical framework that guided this study. The instruments used for data collection included: questionnaires, time perception inventory, time diaries, observations, and semi-structured interviews. The researcher analyzed the data on a case by case and cross case basis. The cross-case analysis emerged four themes: time creates a sense of order, time: a valuable entity, personal and professional time is not exclusive from one another, and cultural dimensions of occupational time. The participants’ occupational time overlapped within their personal and professional contexts. When participants were able to complete occupations within their personal and professional time, this influenced their well-being and sense of being productive.

Eglseder, Kate (2015). The Lived Experiences and Occupations of Intimate Partners of Individuals with Spinal Cord Injury Related to Sexual Well-Being.
Dissertation chair: Maggie Reitz

The onset of spinal cord injury (SCI) results in physical and psychological changes which impact participation in occupations related to sexual well-being. Although education and resources are often provided to the individual, frequently the intimate partners of individuals with SCI are not included in this training. The purpose of the research for this dissertation was twofold. One purpose was to describe the lived experience of intimate partners of individuals with SCI related to sexuality. The second was to identify education and resource needs related to sexuality for these individuals.  It is believed that information gained from this study can be utilized to inform future development of educational resources for this population.  A collective case study design was chosen for this project.  For the purpose of this project, four participants were selected utilizing purposive sampling and participated in in-depth interviews relating to the lived experiences and perceived educational needs of the participants.

Batarseh, Haifa (2015).  A Mixed Methods Study of Mood Disorder in Mothers of Children with Autism Spectrum Disorder and Mothers of Typically Developing Children. Dissertation chair: Janet DeLany

This mixed method study examined mood disorders in mothers who were rearing a child with ASD.. The objective of the quantitative section of the study was to examine the occurrence of maternal depression and bipolar disorders in mothers of children with ASD compared to mothers of typically developing (TD) children. The Depression History Questionnaire that was adapted from Interactive Autism Network (IAN) at Kennedy Krieger Institute (KKI) database was used for this comparison. The qualitative section of the study explored the meaning of the lived experience of mothers who concurrently were depressed and rearing a children with ASD using a phenomenological approach. Results of the quantitative inquiry indicated that mothers of children with ASD report a history of: (a) depression and bipolar disorder; (b) treatment for depression or bipolar disorder; (c) suicidal ideation or suicidal attempts; and (d) depression, bipolar disorder, and suicide among the participants’ first and second-degree relatives more frequently than mothers of TD children. The following five emerged themes emerged from the qualitative exploration: a) Regardless of when I was first diagnosed, having a child with ASD contributed to and intensified my depression; b) I feel a lack of support and understanding either from my husband, the extended family, or the community; c) Challenges and stressors of rearing a child with ASD are ongoing; what I do is never enough and is physically and mentally exhausting; d) It is difficult to balance all aspects of my life; it may be less demanding if I sacrifice one of my roles; and finally, e) There is a history of mental health challenges in my family. These findings provide valuable insight about concurrently coping with depression and rearing a child with ASD and propose interventions to address the challenge.

Natasi, Julie (2014). Occupational Lives of Individuals with Visual Impairment.
Dissertation chair: Regena Stevens-Ratchford

The occupational lives of individuals with visual impairment reveal adaptation to a world clearly processed through vision. Through a collective case study, the researcher collected and analyzed data on the occupational lives of three individuals with visual impairment. Occupational adaptation served as the theory underpinning the study. Instruments to collect data included a demographic questionnaire, visual assessments, the Self-report Assessment of Functional Visual Performance, the MOS Social Support Survey, semi-structured interviews, and observations. The researcher analyzed the data by case study and across the case studies. Three themes emerged from the cross-case analysis: an occupational life of doing, an occupational life rich with well-being, and an occupational life filled with motivation for independence. The participants were highly motivated to complete their occupations and activities independently. Participation in activities in the home and community environments provided participants with life satisfaction and happiness. Problem solving skills, adaptations, and support of family and friends allowed the participants to achieve relative mastery of their occupations.

Leimbach, Linda (2013). Men as Quiltmakers: Crafting the Intersection Between Gender and Creative Occupation. Dissertation chair: Janet DeLany.

This qualitative study used an ethnographic research method to explore the occupational engagement of seven American male quiltmakers. The study investigated the occupational products, occupational processes and occupational experiences of the male quilters, as well as the meaning and impact of quiltmaking in their lives. The findings were interpreted from a postmodern perspective that integrated a transactional view of occupation and social construction feminism. The results indicated that meaning, identity, context, and gender intersected to influence the quilters' occupational products, occupational processes, and occupational experiences. Quiltmaking was meaningful in that it promoted self-expression and self-development, allowed for opportunities to educate others about quiltmaking, and provided financial support. Sources of meaning influenced the types of quilts made by the quilters, and intersected with their identities as quilting artists, artisans, crafters, educators, and business owners to enhance their overall sense of health and well-being. Their occupational experiences varied as a function of their quiltmaking identities and the contexts in which they shared their work. Though the male quilters possessed physical and temporal resources that exceeded those of many women quilters, they were less socially connected to other quilters in comparison to women quilters. In addition, though the male quilters felt that they were socially supported by people in their micro-environments, they discerned that their quiltmaking was devalued within the larger social context due to its association with the work of women. While the work they produced appeared to be similar to that of women quilters, the quiltmaking experiences of the male quilters were influenced by a number of gender-related issues, including their minority status, stereotypical assumptions about male quilters, and differential treatment from others as a result of their gender. This study informed quilt studies and occupational science about the work and experiences of a group of male quilters, and demonstrated the complexity of quiltmaking as an occupation; further research about this population and occupation is indicated. By studying men who engage in an occupation typically associated with women, this study also explicated the gendered attributes of occupation as being distinct from the gendered identity of an individual. As such, this study informed occupational science that gender is more than a personal factor in its influence upon occupational engagement. Further research is indicated to identify the sociocultural and gendered attributes of occupation to promote occupational justice so that all people may engage in the occupations of their choice to the benefit of their health and well-being.

Flanagan, Joanne (2012). Movement and Play in Infants at Risk for Autism.
Dissertation chair: Janet DeLany.

Few prospective studies on early detection of autism have found early markers during infancy associated with later diagnosis. The objective of this current study was to examine the relationship between movement and play at 6 months of age and later outcome classification in infants at high and low risk for autism. The study was part of a larger observational cohort (longitudinal) design and employed retrospective double blind video analysis. The TIME Clinical Subtest was used to measure movement maturity and atypical positions, and the Revised Knox Preschool Play Scale (RKPPS) was used to examine the play skills of infants on archived videotapes. Later social and communication behaviors for ASD were determined by outcome diagnostic grouping assigned at 36 months of age by expert clinical researchers. Results suggest that early atypical positions and play skills may be early indicators of developmental disruption in high-risk infants for autism. These findings may provide valuable information about emerging signs of impairment and problematic occupational behavior in ASD which could assist in not only earlier detection but also earlier intervention to improve participation in early childhood occupations.

Demchick, Barbara (2012). Quality of Life in Families with a Transition-aged Young Adult on the Autism Spectrum. Dissertation chair: Karen Eskow

The purpose of this study was to describe family quality of life (FQOL) from the perspective of families with youth on the autism spectrum at or nearing the age of transition from school to adulthood. A qualitative phenomenology approach was used. Participants included ten families made up of six mothers, two fathers, and two grandmothers. The primary form of data collection was two in-depth interviews. Observations and field notes supplemented interview data, and previously administered Maryland Autism Services Surveys (MASS) were examined to contribute to the triangulation of the data. Trustworthiness of the data was enhanced by the presence of a second researcher during data collection and analysis, peer debriefing, and member checking. Another purpose of this study was to explore sensory processing in these transition aged youth, and to investigate the influence of sensory processing difficulties on family life. This was explored through the interviews, and through administration of the Adolescent/Adult Sensory Profile, which was filled out by the family members. Results of the qualitative study revealed three themes that describe FQOL from the participants' perspectives: changes associated with puberty and associated disorders that manifest or worsen during puberty affect autism and challenge quality of life; occupations are influenced and restricted when there is a family member on the autism spectrum; and the onus of responsibility for transition falls on the family. The investigation into sensory processing in young adults revealed the existence of difficulties in sensory processing, with trends noted in the types of difficulties seen in these young adults. Sensory processing influenced FQOL, with families modifying activities to accommodate their young adult's sensory needs. Implications of these results for the study of occupation and for the practice of occupational therapy are discussed.

Krutis, Susan (2012). Medication Adherence, Social Support and Recovery: Perspectives of Consumers with Schizophrenia Spectrum Disorders and their Families. Dissertation chair: Beth Merryman

Medication non-adherence for individuals with schizophrenia spectrum disorders is a problem with serious consequences to personal health, family relationships, and the community at large. Occupational therapists in mental health facilitate medication management strategies and need to be informed in order to determine best practice approaches. This study utilized a qualitative multiple case-study approach to examine the lived experiences of four consumers and four families relative to psychiatric medication adherence, social support, and recovery. In-depth, semi-structured interviews and brief recovery surveys were completed. Results suggest that consumers in this study incorporated medications as a process that illustrated development of self-awareness. Consumers' desire for greater autonomy in early adulthood emerged as a powerful influence on their sense of liminality. Parents articulated that medications were necessary for their adult children's illnesses, and that decisions about how to support their adult children were complicated. The findings of this study have important implications for occupational therapists in the delivery of client-centered mental health care to support individuals and their families with medication adherence.

Stav, Eli (2012). First Generation College Students: A Mixed Methods Study of Experiences and Academic Success. Dissertation chair: Jenna Yeager

Racial and socioeconomic disparities in higher education have lifelong implications for individuals’ income, career development, and opportunities for success and prosperity in subsequent generations.  A mixed methods study was conducted to examine and compare student academic performance and outcomes while delving into the experiences of first-generation college students.  The results of this study revealed first-generation college students perform at lower academic levels with less outcome achievement compared to their traditional student counterparts.  In addition, support services funded by federal dollars, result in minor enhancements in course performance as measured by grade point average and credit completion, but does not improve academic outcomes.  Some of these results may be explained by the themes that emerged from the perspectives of the students and advisors and included it’s the destination, not the journey, traveling into a new world, and use of travel aids.  The themes suggest that first-generation college student enter college with a different perspective and motivation goals compared to their traditional peers, then encounter a very different culture while enrolled, but make use of resources to support their performance. 

Much of the supportive programming available in institutions of higher education is designed and executed from a social justice perspective aimed at equity of access and affordability rather than an occupational justice perspective which needs to focus on equity of engagement.   The finding of this study suggest a social justice approach which considers the students as occupational beings and targets the students as well as the context could alleviate the occupational marginalization and occupational apartheid experienced by first-generation college students. 

Moghimi, Christine (2012). A Phenomenological Examination of the Caregiving Experience of Elderly Spousal Caregivers.
Dissertation chair: Regena Stevens-Ratchford

Problem: Older adults with chronic illness often require extensive informal care. Informal care generally is provided by family members, and increasingly, elderly spouses. Providing care to a loved one has the potential to last for weeks, months, and in chronic illness management, even decades. The literature has shown that there can be great burden and stress in the occupation of spousal caregiving. The purpose of this study was to examine the caregiving process in a sample of informal elderly spousal caregivers caring for a chronically, medically ill spouse. In order for occupational therapists to assist elderly spouses in their caregiving occupation, they must have an in-depth knowledge and understanding of the caregiving experience. Methodology: A qualitative phenomenological approach was utilized to provide an in-depth look at the elderly spousal caregiving process. Research questions in this study explored the culture, occupation, successful aging and occupational justice in elderly spousal caregiving. Data was collected from a purposive sampling of five elderly spousal caregivers through a series of four long interviews that were audio taped and then transcribed. Statements were transformed into clusters of meanings. The data analysis process transformed these clusters to make a general description of the experience for each participant including a textural description, a structural description and finally a textural-structural synthesis. Conclusion: Four themes emerged from the data: the culture of elderly spousal caregiving is one of forced self-reliance; the occupation of elderly spousal caregiving centers around concern for safety; elderly spousal caregiving challenges one's ability to age successfully and elderly spousal caregiving is an unjust occupation. Elderly spouses committed themselves to caregiving when their loved one needed help in the home. The caregiving occupation involved advocacy, multiple interactions with formal healthcare and challenges to physical and emotional capabilities. Elderly spouses learned through trial and error, were isolated and confined, and were often the sole provider of care. Clinical considerations included a population-based approach for occupational therapists with the intent of a triad approach to care: therapist, patient and caregiver.

Zadnik Newell, Mary (2011). A Two Part Study of Student to Professional Transition: Analysis of Objective Factors Related to a Successful Outcome on the NBCOT Exam and a Qualitative Exploration of Student Transition into Practice.
Dissertation chair: Sonia Lawson

The purpose of the research performed for this dissertation was twofold. One purpose was to identify academic and demographic variables related to a successful outcome on the NBCOT exam. The second was to examine the processes involved in preparing for the NBCOT exam and for transition into practice and to identify, in a small cohort, whether there are similarities in these processes. A mixed methods approach was chosen for this project to address its complex design. Two sets of data were collected in pilot fashion and two sets of data collected to expand upon pilot results. Quantitative methods were used to analyze objective academic and demographic variables to determine whether or not they relate to a successful outcome on the NBCOT exam. Qualitative data from focus groups were used to inform the selection of some academic variables in the quantitative analysis. Results demonstrated that there were specific academic variables related to student outcome on the NBCOT exam. In addition, qualitative data identified learning strategies and adaptive processes that students and practitioners used in their preparation for and through their transition from student role to professional role.

Kyler, Penalpha (2009). Contributory Phenomena of Family-Centered Care Leading to Effective Partnerships. Dissertation chair: Marcie Weinstein

An abundance of literature describes occupational therapy's relationship with family-centered care (FCC); however, little information discusses concurrent parallel attitudes and behaviors of parents, children, and occupational therapists involved in pediatric occupational therapy practices, particularly from a family-centered perspective. Using phenomenological methods, the objective of the study was to identify the patterns and behaviors illustrating the triads' interactions, in an effort to understand how the triads' bond or form partnerships during occupational therapy service delivery. The study also sought to answer whether these bonds were family-centered, and if so, whether they contributed to satisfaction with occupational therapy services. Four triads of child, mother and occupational therapist were each interviewed and observed several times, and also participated in a narrative writing task. Using the elements of FCC outlined in the American Academy of Pediatrics' definition (2003) as the framework, the results were transcribed, analyzed and theme coded. The emergent themes were markedly similar across all triads, reflecting their values, beliefs, and behaviors. The themes identified areas of importance for the participants, and included: ongoing communication; active listening; validation; respect; mutual problem-solving; acknowledgement of child; and family empowerment and support. The results clearly indicated that these occupational therapists and mothers, and to a lesser extent, their children receiving services, demonstrated very positive attitudes towards family centered care, and beyond that, were actively and mutually engaged in behaviors that furthered their attainment of family-centered care in practice. Ongoing analysis and reflection suggested that family-centered care can be thought of as evolving relationships and dynamic process, and those behaviors comprising a family-centered approach may be viewed on a continuum. Most significantly, trust was identified as the key component for the successful development of FCC. Trust is discussed based on its essential components of communication, time and reflection, and validation. Satisfaction regarding the quality of the partnerships with occupational therapy was intertwined, as each participant realized that an FCC approach held something positive for them.

Wingrat, Jennifer (2007). The Impact of Classroom Furniture on Third Grade Childrens' Occupational Performance. Dissertation chair: Charlotte Exner

Being a student is a primary occupation for children. Theoretical principles of the Person-Environment-Occupation Model suggest that interactions between people, environments, and the occupations they perform affect occupational performance. Studies show that classroom furniture is often too large for schoolchildren; there is little study of the impact on classroom occupational performance. This study used a repeated measure correlated groups design to assess relationships among furniture fit, sitting behaviors, on-task behaviors, math scores, and comfort in 31 third grade children, and handwriting legibility in a subset of 15 children while sitting in large standard classroom furniture and smaller standard and ergonomic furniture. The students demonstrated significantly better sitting and on-task behaviors and higher math test scores in the smaller, better fitting furniture. Students sat significantly better in the ergonomic chairs; better sitting behaviors were correlated with better handwriting legibility. The study supports the significance of environmental features for children's occupational performance.