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I INSOMNIA and SOCIAL SUPPORT AMONG THAI WOMEN WHO HAVE

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I INSOMNIA and SOCIAL SUPPORT AMONG THAI WOMEN WHO HAVE INSOMNIA AND SOCIAL SUPPORT AMONG THAI WOMEN WHO HAVE EXPERIENCED INTIMATE PARTNER VIOLENCE A dissertation submitted to Kent State University College of Nursing in partial fulfillment of the requirements for the degree of Doctor of Philosophy By: Muntaha M. Alibrahim July 2018 i Dissertation written by Muntaha Alibrahim BSN, Jordan University of Science and Technology, 2002 M.S.N, Jordan University of Science and Technology, 2005 Ph.D., Kent State University, 2018 Approved by _______________________________, Chair, Doctoral Dissertation Committee Patricia Vermeersch _______________________________, Co-Chair, Doctoral Dissertation Committee Ya-Fen Wang _______________________________, Member, Doctoral Dissertation Committee Ratchneewan Ross ______________________________, Member, Doctoral Dissertation Committee Marlene Huff _____________________________, Member, Doctoral Dissertation Committee Donna Bernert Accepted by _______________________________, Director, Joint Ph.D. in Nursing Program Patricia Vermeersch ______________________________, Associate Dean for Graduate Programs Wendy Umberger ii ALIBRAHIM, MUNTAHA, Ph.D., August 2018 Nursing INSOMNIA AND SOCIAL SUPPORT AMONG THAI WOMEN WHO HAVE EXPERIENCED INTIMATE PARTNER VIOLENCE (131 pp.) Director of Dissertation: Patricia Vermeersch Yafen Wang Insomnia is the most common of all sleep problems. Long-term insomnia affects an individual’s overall quality of life. Insomnia can arise from physiological, psychological, or environmental factors. Exposure to stressors such as Intimate Partner Violence (IPV) could lead to insomnia, which eventually affects physical and mental health. Social support is one strategy that alleviates and improves health outcomes. Limited studies in Thailand have addressed insomnia in women and its relationship with IPV and social support. This study aimed: 1) to examine the relationships between number of IPV types experienced, severity of physical abuse, perceived severity of sexual abuse, perceived severity of psychological abuse, social support, and insomnia; 2) to examine the moderating effect of social support on the relationships between number of IPV types experienced, perceived severity of IPV types (physical, sexual, and psychological abuse), and insomnia after controlling for age, education level, and income; and 3) to determine which social support form proved more effective: family support or friends support. The transactional model of stress and coping guided this study (Lazarus & Folkman, 1984). This study used secondary data analysis with a correlational but non-experimental design. Two-hundred and eighty four Thai women aged 18 years and older receiving care in the obstetrics and gynecology unit, and read and write in Thai comprised the subjects of this study. iii Pearson r test and hierarchical multiple regression analysis were used to analyze the data. The results reported significant relationships between the study variables, except that the relationship between perceived severity of sexual abuse and social support did not appear as significant. The results of hierarchical multiple regression indicated that social support was not a moderator between independents variable and insomnia. R2 change in insomnia variance was not significant when adding the interaction terms of social support with other variables to the regression model. Neither friend nor family support were significant as moderators between study variables. Still, friends support was significant as a predictor of reduced insomnia whereas family support was not. This study findings can contribute to the existing Thai literature by providing new information about insomnia and associated factors. In practice, nurses can use the study findings in determining the underlying factors that might be associated with insomnia, such as IPV. Nursing intervention can then be provided based on underlying factors. Where insomnia does not relate to IPV, available friends support can be provided to a woman to decrease insomnia and simultaneously improve her sleep quality. iv ACKNOWLEDGMENTS I would offer my sincere and deepest appreciation and special thanks to Dr. Ratchneewan Ross, who let me using her data to conduct this study. This study would not have been possible without her support and continous guidance. Many grateful thanks are likewise due to my advisor Dr. Patricia Vermeersch for her support and her willingness to provide her ideas and direction to help me in achieving my goals during my Ph.D. journey. I am also indebted to my co-advisor, Dr. Ya-fen Wang, who was with me step-by-step while writing this dissertation, and who was also willing to provide her excellent advice at any time. She remained a source of support by encouraging whenever I lost confidence and motivation. These three indeed served as remarkable inspirations during the writing of this dissertation. A mere “thank you” remains wholly inadequate for your real aid and comfort. Many thanks are due to other committee members, Dr. Marlene Huff and Dr. Donna Bernert, who played a remarkable role in developing my dissertation by rendering valuable comments and suggestions. Special thank goes to my loving and supportive husband, Shadi, who has always been my source of strength. Many thanks are also to my children, Roa`a, Abdullah, and Zain, who provide endless inspiration. Most importantly, I would thank my dear mother, for her support by continuous prayers on my behalf. Special thanks go to my sisters, Amneh and Amal, as well as my brother, Khalid. Finally, I could not forget the support from my friends Ghada and Aseel. I am most thankful for each of you. v TABLE OF CONTENTS Chapter Page 1-Introduction ................................................................................................................................. 1 Background and Significance...................................................................................................... 4 Worldwide Prevalence and Significance of Insomnia ............................................................. 4 Worldwide Prevalence IPV ..................................................................................................... 5 Significance of Social Support ................................................................................................ 6 Prevalence of Insomnia in Thailand ........................................................................................ 6 Prevalence of IPV in Thailand ................................................................................................. 7 Problem Statement ...................................................................................................................... 8 Theoretical Framework ............................................................................................................. 10 Constructs Definitions and Theoretical Correlations ................................................................ 10 Substruction Framework ........................................................................................................ 13 Relationships between Constructs and Study Variables ........................................................ 14 Study Model .............................................................................................................................. 16 Assumptions .............................................................................................................................. 17 Study Aims ................................................................................................................................ 18 Research Questions ................................................................................................................... 18 Study Hypotheses ...................................................................................................................... 18 2- Review of the Literature ........................................................................................................... 20 Insomnia .................................................................................................................................... 21 Causes of Insomnia ................................................................................................................ 24 Risk Factors of Insomnia ....................................................................................................... 25 Consequences Of Insomnia ................................................................................................... 26 Stressors and Insomnia .......................................................................................................... 28 Insomnia and IPV ...................................................................................................................... 29 Intimate Partner Violence (IPV) ................................................................................................ 30 What is IPV? ........................................................................................................................... 30 Types of IPV ........................................................................................................................... 31 Severity of IPV ....................................................................................................................... 32 Multiple IPV Experience ........................................................................................................ 34 Risk Factors
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