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The Efficacy of the Psychosocial Risk Factor Survey in Measuring the Progress of Appalachian Cardiovascular Rehabilitation Patie

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The Efficacy of the Psychosocial Risk Factor Survey in Measuring the Progress of Appalachian Cardiovascular Rehabilitation Patie The Efficacy of the Psychosocial Risk Factor Survey in Measuring the Progress of Appalachian Cardiovascular Rehabilitation Patients A dissertation presented to the faculty of The Patton College of Education of Ohio University In partial fulfillment of the requirements for the degree Doctor of Philosophy Bethany L. Fulton December 2017 © 2017 Bethany L. Fulton. All Rights Reserved. 2 This dissertation titled The Efficacy of the Psychosocial Risk Factor Survey in Measuring the Progress of Appalachian Cardiovascular Rehabilitation Patients by BETHANY L. FULTON has been approved for the Department of Counseling and Higher Education and The Patton College of Education by Yegan Pillay Associate Professor of Counseling and Higher Education Renée A. Middleton Dean, The Patton College of Education 3 Abstract FULTON, BETHANY L. Ph.D., December 2017, Counselor Education The Efficacy of the Psychosocial Risk Factor Survey in Measuring the Progress of Appalachian Cardiovascular Rehabilitation Patients Director of Dissertation: Yegan Pillay In an extension of research validating the Psychosocial Risk Factor Survey (PRFS), the present study examines the use of the PRFS as an effective counseling assessment tool for participants in a cardiovascular rehabilitation program located in North Central Appalachia. Participants were administered the tool on site by program staff during orientation prior to beginning the program and at its conclusion on the last day of attendance. Completion of the pre-and post-assessments by participants was voluntary. Permission to use the data was given by all participants in written form. A mixed method design with explanatory focus proved effective in the compilation and analysis of data. The PRFS scores assisted in the determination of behavioral progress through the 12-week cardiovascular rehabilitation program. Specific risk factors measured by the PRFS are: depression, anxiety, anger/hostility, social isolation, and emotional guardedness. Statistically significant differences were found between the pre-and post-assessments overall. Participants with less change in scores continue to have all the specified risk factors present in post -scoring. Participants with more change in scores present less specified risk factors in post scoring. The use of Bronfenbrenner’s bioecological model offers a framework to analyze qualitative archival data. The research used participant files from the program, 4 specifically counseling summaries. Integrating the information given from the scoring with themes that emerge from the archival summaries offers some insight to the patterns that may distinguish progress or regress in participant evaluation. Further research recommendations center on furthering insight into psychosocial risk factors within this specific sample, the impact of CHD on the North Central Appalachian population, and using the PRFS with Appalachian and other rural area client populations. Keywords: Appalachia, Bronfenbrenner, counseling, PRFS, psychosocial risk factors 5 Dedication For my mother, Judith A. Fulton, and in memory of my father, Doyle L. Fulton 6 Acknowledgments Thank you to my advisor, mentor, and committee chair, Dr. Yegan Pillay. Your unfailing support, thoughtful questions, and gentle nudges keep me moving forward and continue to inspire me as a counselor and a person. Thank you to Dr. Gordon Brooks, Dr. Laura Harrison, and Dr. Paul Chase. Your insights, knowledge, and experiences increase the quality of my work and my motivation. Thank you to Dr. Andrew Byrne for assistance in navigating SPSS. Megan Beatty, Kathy Partuch, Erica Baker, Selena Baker, and Levi Funk. The cardiovascular rehabilitation program used for this research provides encouragement, support and hope to many in North Central Appalachia. Many thanks to the administrative staff of the Patton College of Education for their diligence and wonderful support to students. Thank you to my parents, Judie and Doyle Fulton for not questioning my need to keep learning, reminding me why it is important that all people receive education and healthcare without discrimination, that honest work is good work no matter what you do, and kindness to strangers is a way of being that improves life for everyone. Thank you to Jane and Donald Richter, the best in laws, loudest cheerleaders, and most generous providers of Casa Nueva breakfasts and hugs. Thank you, Stephen Richter, my partner in life, and my constant reminder of how love manifests in many ways. Paulo Frere writes, “No one can say a true word alone.” The people mentioned here as well as countless others are a part of my words. To the best of my ability, and with great appreciation, I am blessed to share this with them. 7 Table of Contents Page Abstract ...........................................................................................................................3 Dedication .......................................................................................................................5 Acknowledgments ...........................................................................................................6 List of Tables................................................................................................................. 10 List of Figures. .............................................................................................................. 11 Chapter One: Introduction ............................................................................................. 12 Cardiovascular Heart Disease .................................................................................. 12 Cardiovascular heart disease in North Central Appalachia. ................................. 14 Behavioral Cardiology ............................................................................................. 17 Cardiovascular Rehabilitation Programming ............................................................ 18 The Psychosocial Risk Factor Survey ...................................................................... 19 Risk factors. ....................................................................................................... 20 Theoretical Framework ............................................................................................ 21 Purpose of the Study ................................................................................................ 23 Research Question(s) and Hypothesis ...................................................................... 24 Quantitative. ...................................................................................................... 24 Qualitative. ........................................................................................................ 24 Significance ............................................................................................................. 24 Limitations .............................................................................................................. 26 Delimitations...................................................................................................... 27 Definitions of Key Terms......................................................................................... 27 Behavioral Cardiology. ...................................................................................... 27 Cardiopulmonary Rehabilitation......................................................................... 27 Coronary Heart Disease (CHD). ......................................................................... 27 Emotional Guardedness (EG). ............................................................................ 28 Psychosocial Risk Factors. ................................................................................. 28 Social Isolation (SI). .......................................................................................... 28 Summary ................................................................................................................. 29 Chapter Two: A Review of the Literature ...................................................................... 30 Psychosocial Risk Factors Related to Coronary Heart Disease ................................. 30 Risk Factors and the North Central Appalachian. ............................................... 31 Rethinking culture and health care.. ........................................................ 32 Bronfenbrenner’s Bioecological Theory ................................................................... 34 Current Risk Factors in Appalachia .......................................................................... 38 Perceptions of Appalachian Americans .................................................................... 39 Absence of care in Appalachia. .......................................................................... 40 The Psychosocial Risk Factor Survey ...................................................................... 42 Summary ................................................................................................................. 43 Chapter Three: Methodology ......................................................................................... 45 Research Design ...................................................................................................... 45 8 Ethical Considerations.: ..................................................................................... 47 Research Question(s) and Hypothesis .....................................................................
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