College of Science and Health Theses and Dissertations

Date of Award

Fall 11-22-2016

Degree Type

Thesis

Degree Name

Master of Arts (MA)

Department

Psychology

First Advisor

Anne Saw, PhD

Second Advisor

Megan Greeson, PhD

Abstract

Individuals with serious mental illness (SMI) on average die 25 years sooner than individuals in the general population. The elevated mortality is mainly due to preventable medical conditions and barriers to care. Primary care-behavioral health integration and wellness interventions have shown to be effective in addressing the disparities. However, racial and ethnic minorities are underrepresented in the literature. In particular, the disparities in health conditions and access to care among Asian American immigrants with SMI are exacerbated by unique cultural and linguistic barriers in healthcare service delivery. The current thesis examined a multi-year multi-faceted wellness intervention designed for Asian American immigrant adults with SMI in a primary care behavioral health integrated care setting.

The first study used a longitudinal dataset on daily overall functioning, psychological distress, waist circumference, systolic and diastolic blood pressure from 220 Asian American adults with SMI to test our hypotheses: (1) participants in wellness groups had greater improvements in physical and psychological health outcomes than their counterparts who did not join wellness groups (ie. comparison group); (2) social connectedness moderated the relationship between wellness interventions and health outcome changes. Path analyses using structural equation modeling were conducted in Amos version 23.0. Results showed that participants with higher psychological distress, systolic and diastolic blood pressure at baseline had a greater decrease in distress and blood pressure respectively over time. Greater improvements in social connectedness were found to be associated with greater increase in daily overall functioning. By contrast, smaller improvements in social connectedness were linked with smaller reductions in distress. We did not find significant group differences in health outcome changes between wellness and comparison groups. There were also no statistically significant moderation effects of social connectedness. Important insights and lessons were offered in this study to direct future research on effectiveness of wellness interventions for Asian Americans with SMI.

The second study explored the possible mechanisms in wellness interventions that were associated with observed changes in health behaviors and outcomes among Asian Americans with SMI. We conducted 5 individual interviews with providers and 7 focus group discussions with 41 consumers. We employed constant comparative method deriving from modified grounded theory approach to analyze the data. Seven themes were generated: client empowerment, information sharing across providers, cross-organization dynamics and building a cohesive team, organizational and systems change, organizational leadership, building capacity, and sustainability and implementation of individual behaviors. Findings were situated in the Health Behavior Framework as barriers and supports at individual, organizational/system and societal levels that influence health behaviors (Bastani et al., 2010). The importance of multi-level wellness interventions that take individual and social-ecological determinants of health into consideration is underscored. The longitudinal and qualitative findings of the current thesis helped to inform decisions in designing research and intervention for improving wellness among Asian Americans with SMI.

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