Transportability of an empirically supported dissonance-based prevention program for eating disorders

This study sought to evaluate the degree to which positive effects remained when a well studied cognitive dissonance eating disorder prevention program was disseminated through a large national sorority under naturalistic conditions. All participants underwent a 2-session program run by peer facilitators. The sample included 182 undergraduate women from a local chapter of a national sorority at a large public university. Analyses revealed that the program significantly reduced body dissatisfaction, thin ideal internalization, dietary restraint, and the use of the media as a source of information about beauty, and restrained eating. Importantly, effect sizes were maintained at 5-months and 1-year follow-up. These findings demonstrate that empirically supported programs can remain effective when disseminated with careful training in large social systems.     

Multilevel factor analysis and structural equation modeling of daily diary coping data: Modeling trait and state variation

The current study used multilevel modeling of daily diary data to model within-person (state) and between-person (trait) components of coping variables. This application included the introduction of multilevel factor analysis (MFA) and a comparison of the predictive ability of these trait/state factors. Daily diary data was collected on a large (n = 366) multiethnic sample over the course of five days. Intraclass correlation coefficient for the derived factors suggested approximately equal amounts of variability in coping usage at the state and trait levels. MFAs showed that Problem-Focused Coping and Social Support emerged as stable factors at both the within-person and between-person levels. Other factors (Minimization, Emotional Rumination, Avoidance, Distraction) were specific to the within-person or between-person levels, but not both. Multilevel structural equation modeling (MSEM) showed that the prediction of daily positive and negative affect differed as a function of outcome and level of coping factor. The Discussion section focuses primarily on a conceptual and methodological understanding of modeling state and trait coping using daily diary data with MFA and MSEM to examine covariation among coping variables and predicting outcomes of interest.     

Aging,Spirituality, and Time: A Qualitative Study

We examined the concepts of aging, time, spirituality, and future care needs in four randomly selected informants from a group of 54 never-married childless older women. Using data from the Generativity and Lifestyles of Older Women (GLOW) study, we questioned how women’s perceptions of these concepts came together in current older age. We employed cultural theory, (our theoretical framework), ethnography, (our methodological framework), and phenomenology, (our philosophical foundation) to produce a portrait of each woman interviewed. Through a three-session interview process, we elicited the women’s life stories, reasons for childlessness, and topics that emerged as significant to the women, including aging, a sense of time remaining, and spirituality. A key finding was that the context of each woman’s life, both biographical and historical, transpired as a foundation for these concepts. That is, a woman’s “place in time” shaped their experiences of aging, as well as her reasons for childlessness and perceptions of finitude.     

Deciding in the best interest of clients with dementia: the experience of public guardians

We conducted an in-depth interview study of public guardians in three local jurisdictions in the state of Maryland to explore the decision-making process utilized by court-appointed public guardians making medical and EOL care decisions on behalf of their clients with dementia. Overall, public guardians appeared to make their decisions in the context of relevant ethical principles and relevant case law and state statute, and the basis upon which they made informed decisions was dependent on their training and experience. The stated goal of public guardians is to make decisions that they believe are in the best interest of their clients. In the case of a healthcare decision, their goal is to maximize quality of life; and in the case of an EOL care decision, their goal is to minimize pain and suffering. In general, public guardians gathered information in order to identify previous preferences of their now-incapacitated clients, so that they could develop a preference profile to assist both an initial decision on whether an individual ought to have a court-appointed public guardian, and with healthcare and EOL decisions once an appointment was made. When guardians were unable to develop a preference profile for a particular client, they relied on past decisions in similar situations. Healthcare and EOL decisions were most often triggered by a recommendation by the client's healthcare provider. Once a decision-point was identified, the public guardian considered the risks and benefits of the proposed intervention in light of the client's current condition. At times the guardians reviewed informational resources such as textbooks and the Internet. In addition, most guardians sought advice from a medical consultant who is available to all public guardians in Maryland. Some guardians sought the advice of this medical consultant only when faced with more complex decisions. Guardians challenged physicians' recommendations when they believed the physicians were recommending an intervention that was not in the best interest of the client--that is, they advocated against either overtreatment or undertreatment. Ultimately, guardians took particularly difficult issues to the court and obtained a judge's opinion.