Date of Award

Fall 11-18-2022

Embargo Period

12-1-2032

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Nursing Science

Department

Nursing

College

College of Nursing

First Advisor

Gayenell Magwood

Second Advisor

Shannon Phillips

Third Advisor

Edith Williams

Fourth Advisor

Diane Kamen

Abstract

Purpose: This dissertation aimed to explore continuity in care coordination for Black women with systemic lupus erythematosus (SLE) at the interpersonal, personal, and system levels.

Problem: Care for SLE is multidimensional. It consists of therapeutic and pharmacological interventions, coordinated services, and multidisciplinary involvement. However, because of the multifaceted care process, care fragmentation and poor outcomes are likely to occur. This is immensely true for Black women with SLE, who experience significantly worse organ damage and prognosis outcomes than White women with SLE. Collectively, biological, environmental, and social factors in this population exacerbate disease activity requiring comprehensive coordination for improved outcomes. Nonetheless, care coordination needs for Black women with SLE to ensure and support continuity in care coordination in this population are not fully understood. Thus, to understand this phenomenon, the following aims were developed:

Aim 1:

  1. Identify relationships between concepts and potential care coordination variables for Black women with SLE.

Aim 2:

  1. Determine appropriate methods and strategies to conduct a mixed methods study that examines continuity in care coordination for Black women with SLE.
  2. Identify patient perspectives on factors that enhance or impede continuity in care coordination from data obtained through interviews with Black women with SLE.

Methods: This study was conducted using a convergent parallel mixed methods design. The study was grounded on concepts from Barr et al.’s Expanded Chronic Care Model (ECCM) and supported by concepts of continuity and complimentary behavioral and care coordination models for data collection (Capability-Opportunity-Motivation-Behavioral Model and MacColl’s Care Coordination Model). First, a realist review was conducted to determine approaches that reduce fragmented care and explore the concepts of continuity in care for SLE and other comparable multimorbid conditions (Manuscript 1). Next, a feasibility study was conducted to determine the appropriate methods and resources to successfully conduct a mixed methods study designed to identify barriers and facilitators to continuity in care coordination for Black women with SLE (Manuscript 2). Finally, a convergent parallel mixed methods study was conducted examining continuity in care coordination for Black women with SLE (Manuscript 3).

Findings: Findings from manuscript 1 suggested the use of a multifaceted approach that reflects patient and provider engagement, social factors, and organizational structure. Hence, identified critical gaps supported future examination of SLE as a multimorbid condition, SLE care continuity, and the social and cultural factors that influence SLE care continuity. Manuscript 2 results demonstrated acceptability of study procedures, relevancy of study content, and adequacy of resources to successfully complete the associated pilot study. Finally, manuscript 3 study findings illustrated the role of continuity in SLE care coordination and considerations for designing and employing a care coordination model for Black women with SLE.

Conclusion: Collectively, the manuscripts provide a chronological framework for determining the need for a model of care for Black women with SLE. Additionally, knowledge gained can support testing in a larger sample and highlight additional areas to explore for developing the proposed care model.

Rights

Copyright is held by the author. All rights reserved.

Download

Available for download on Wednesday, December 01, 2032

Share

COinS