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A Constructivist Grounded Theory Exploration of Wellbeing in Female

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A Constructivist Grounded Theory Exploration of Wellbeing in Female A Constructivist Grounded Theory Exploration of Wellbeing in Female Adult Sexual Assault Victims/Survivors by Pamela Wadsworth A Dissertation Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy Approved July 2015 by the Graduate Supervisory Committee: Elizabeth Reifsnider, Chair Bronwynne Evans Angela Moe Jane Champion ARIZONA STATE UNIVERSITY August 2015 ABSTRACT The purpose of this constructivist grounded theory study was to explore the perceptions of adult female sexual assault victims/survivors about their wellbeing: their definitions and descriptions of wellbeing; the impact of the assault on wellbeing; and barriers and facilitators to achieving wellbeing following assault. Feminist theory provided the sensitizing concepts for this research. Data were collected via semistructured interviews with 22 adult women who had experienced at least one episode of sexual assault at or above the age of 18. Data analysis included first, second, and third level coding techniques, memo writing, and data displays. Participants experienced negative effects to their overall wellbeing as well as to the wellbeing domains of physical, mental, career/economic/financial, relational, and spiritual. The findings of this study support wellbeing as a core category encompassing the five domains listed above, also described in the literature. The participants also confirmed and expounded in depth on the dynamic, interactive, and overlapping nature of each of the domains of wellbeing and their ability to enhance, maintain, or worsen health status and overall wellbeing. In addition, a new construct emerged that cut across all domains, that of safety, and the overarching significance of culture was recognized. Additional research should continue to explore wellbeing in diverse populations of sexual assault victims/survivors. Additional research should also explore the significance and function of safety in sexual assault victims/survivors. Formal and informal supporters of sexual assault victims/survivors should be aware of the complex ways that sexual assault affects i women. In addition, they should be aware of helpful resources for sexual assault victims/survivors. ii DEDICATION I dedicate this dissertation work to my loving and patient husband, Rosario Curcuru. I could not have done this without your words of encouragement and all of the extra duties you have taken on during the last four years. I also dedicate this work to my three rock star daughters, Wen, Alice, and Téa. You offered inspiration to me every day. I dedicate this dissertation to my friends, who struck a perfect balance between compassion and tough love. Finally, I dedicate this dissertation to the amazing, resilient women who took the time to share the most intimate details of your lives, receiving only my gratitude and chocolate as a thanks. iii ACKNOWLEDGEMENTS I would like to acknowledge the many individuals who have helped me complete this dissertation. Without the support of my family and friends, I would not have had the sanity to complete my first semester. You helped sustain me all of the way through. Thank you. Dr. Eve Krahe, you have been an amazing friend and mentor. I hope that we can continue to work and spar together. I would like to acknowledge the amazing individuals and organizations who went above and beyond in helping me to recruit sexual assault victims/survivors for this study. You did this because you care about helping to improve their wellbeing. Thank you for all that you do. I would also like to express my deepest gratitude and heartfelt thanks to each of my committee members. I knew that I could always count on Dr. Elizabeth Reifsnider to give me the cold hard truth. I also knew that I could count on her warmth and sense of humor. I would like to thank Dr. Jane Champion, whose work inspired me to some of my questions. I also benefited from her kindness and wisdom. I would like to thank Dr. Angie Moe. I am so glad that I have had the fortune to know you as a friend, scholar, and activist. I hope that we can continue to collaborate on research and life. I would like to thank Dr. Bronwynne Evans for being my inspiration in so many areas of life. You are an amazing leader, scholar, and mentor. I could not have done any of this without your wry comments, patience and faith in me. I hope that someday, I will be able to offer someone else all of the care you have given to me. iv TABLE OF CONTENTS Page LIST OF TABLES ........................................................................................................... xvi LIST OF FIGURES ........................................................................................................ xvii DEFINITIONS ............................................................................................................... xviii CHAPTER 1 INTRODUCTION ............................................................................................... 1 Background and Context ....................................................................................... 1 Wellbeing. ................................................................................................... 3 Problem Statement ................................................................................................ 5 Statement of Purpose and Research Question ....................................................... 5 Research Approach ................................................................................................ 5 Assumptions .......................................................................................................... 7 The Researcher ...................................................................................................... 7 Rationale and Significance .................................................................................... 9 2 PROBLEM ......................................................................................................... 11 Background and Significance .............................................................................. 14 General Physical Health. ........................................................................... 14 Chronic Pain.............................................................................................. 16 Sleep Disturbance. .................................................................................... 17 Reproductive Health. ................................................................................ 19 v CHAPTER Page Intersection of Reproductive Health, Health Seeking Behaviors, and Relational Health. ..................................................................................... 20 Psychological Health ........................................................................................... 22 Depression................................................................................................. 23 Suicidal Ideation and Attempts. ................................................................ 24 PTSD. ........................................................................................................ 24 Connections between Mental Health and Formal Health Care System. ... 26 Mental Health and Time Interaction. ........................................................ 27 Behavioral Health. .................................................................................... 28 Connections between Health and Social Support ................................................ 31 Intimacy/Sexual Health. ............................................................................ 31 Spiritual Coping and Health...................................................................... 32 Sexual Assault and Socioeconomic Status and Achievement ............................. 33 Lack of Information of Health Outcomes in Diverse Socio-Cultural Contexts. ................................................................................................... 35 Lack of Knowledge about Long Term Health Outcomes. ........................ 36 Physical, Psychological, and Social Health Interconnected. .................... 37 Lack of Information on Wellbeing. .......................................................... 37 Subjective Wellbeing Congruent with Objective Health Measures .................... 38 Necessity of Wellbeing Research with Sexual Assault Victims and Survivors .. 39 vi CHAPTER Page 3 METHODOLOGY ............................................................................................ 41 Introduction ......................................................................................................... 41 Sensitizing Concepts ........................................................................................... 42 Methodology ....................................................................................................... 45 Classical Grounded Theory. ...................................................................... 45 Constructivist Grounded Theory............................................................... 47 Research Design .................................................................................................. 51 Sample and Sampling. .............................................................................. 51 Inclusion and Exclusion Criteria. .............................................................. 51 Theoretical Sampling. ............................................................................... 53 Setting .................................................................................................................
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