The Impact of Social Determinants on Healthcare Transition Readiness and Posttraumatic Growth Among Adolescent and Young Adult Childhood Cancer Survivors Restricted; Files Only
Kim, Gayeong (Fall 2024)
Abstract
Adolescent and young adult childhood cancer survivors (AYA CCS) experience various types of post-cancer resilience, including behavioral and emotional resilience. Social determinants of health (SDoH) (e.g., neighborhood deprivation) may influence post-cancer behavioral resilience (i.e., healthcare transition readiness) and emotional resilience (i.e., posttraumatic growth) in AYA CCS.
Manuscript I was a mixed-methods systematic review examining the impact of SDoH on healthcare transition readiness among AYA CCS. The review identified factors such as primary caregiver and AYA education levels, relationships with healthcare providers, access to health insurance and services, economic stability, neighborhood income, and parental/peer support as key contributors to healthcare transition readiness.
Manuscript II was a secondary data analysis investigating the impact of neighborhood-level SDoH on healthcare transition readiness among AYA CCS. Potential mediating and moderating effects of neuropsychological factors (e.g., posttraumatic stress and neurocognitive function) on the association between SDoH and healthcare transition readiness were also explored. The Readiness for Transition Questionnaire was used to assess the readiness with three domains: “adolescent responsibility”, “parent involvement”, and “overall readiness.” Neighborhood-level SDoH were measured by the Area Deprivation Index (ADI) and Environmental Justice Index (EJI). More deprived neighborhoods (higher ADI and EJI) were associated with greater “adolescent responsibility” and increased “parent involvement.” Posttraumatic stress mediated the relationship between ADI and adolescent responsibility, with neurocognitive function moderating the effect of ADI on posttraumatic stress.
Manuscript III was a secondary data analysis assessing the impact of neighborhood-level SDoH on posttraumatic growth in AYA CCS. Potential mediating effects of posttraumatic stress on the relationship between SDoH and growth were also explored. Higher neighborhood deprivation was associated with increased growth. A curvilinear relationship between posttraumatic stress and growth was identified, where moderate stress is linked to increased growth, but excessive stress was associated with diminished growth. Posttraumatic stress curvilinearly mediated the relationship between neighborhood deprivation and growth, with the mediation effect varying by posttraumatic stress levels in AYA CCS.
These findings uncovered the significant impact of neighborhood-level SDoH on post-cancer resilience outcomes in AYA CCS, along with the complex influence of neuropsychological factors during the process.
Table of Contents
INTRODUCTION
Problem Statement……………………………………………………………….….……….1
Aims of Study………………………………………………………………....……………….1
Background and Significance……………………………………………….….….……….2
Theoretical Framework………………………………………………………….….……….8
Reference………………………………………………………….….………………………...11
PAPER 1: The Impact of Social Determinants on Healthcare Transition Readiness Among Adolescent and Young Adult Childhood Cancer Survivors: A Mixed Methods Systematic Review
Abstract…………………………………………………….….….……….…….….….………22
Introduction……………………………………………….….….……….…….….….……...24
Methods……………………………………………….….….……….…….….….…….........25
Results……………………………………………….….….……….…….….….……...........28
Discussion……………………………………………….….….……….…….….….……......35
Conclusios……………………………………………….….….……….…….….….……......41
Reference……………………………………………….….….……….…….….….…….......43
PAPER 2: The Impact of Social Determinants and Neuropsychological Factors on Healthcare Transition Readiness Among Childhood Cancer Survivors
Abstract…………………………………………………….….….……….…….….….………68
Introduction……………………………………………….….….……….…….….….……...70
Research Design and Methods……………………………………………….….….………72
Results……………………………………………….….….……….…….….….……...........78
Discussion……………………………………………….….….……….…….….….……......81
Conclusion……………………………………………….….….……….…….….….…….....87
Reference……………………………………………….….….……….…….….….…….......89
PAPER 3: The Impact of Social Determinants on Posttraumatic Growth Among Adolescent and Young Adult Childhood Cancer Survivors
Abstract…………………………………………………….….….……….…….….….………108
Introduction……………………………………………….….….……….…….….….……...110
Research Design and Methods……………………………………………….….….………111
Results……………………………………………….….….……….…….….….……...........117
Discussion……………………………………………….….….……….…….….….……......119
Conclusion……………………………………………….….….……….…….….….……......124
Reference……………………………………………….….….……….…….….….……........125
CONCLUSION
Clinical Implications……………………………………………….….….……….…….…...142
Research Implications……………………………………………….….….……….…….….142
Limitations……………………………………………….….….……….…….….….……......142
Conclusion……………………………………………….….….……….…….….….…….......142
About this Dissertation
| School | |
|---|---|
| Department | |
| Degree | |
| Submission | |
| Language |
|
| Research Field | |
| 关键词 | |
| Committee Chair / Thesis Advisor | |
| Committee Members |
Primary PDF
| Thumbnail | Title | Date Uploaded | Actions |
|---|---|---|---|
|
|
File download under embargo until 09 January 2026 | 2024-11-09 17:42:18 -0500 | File download under embargo until 09 January 2026 |
Supplemental Files
| Thumbnail | Title | Date Uploaded | Actions |
|---|