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dc.contributor.advisorLewis, Frances M
dc.contributor.authorAl Mulla, Hebah Ahmed
dc.date.accessioned2019-10-15T22:53:45Z
dc.date.submitted2019
dc.identifier.otherAlMulla_washington_0250E_20575.pdf
dc.identifier.urihttp://hdl.handle.net/1773/44666
dc.descriptionThesis (Ph.D.)--University of Washington, 2019
dc.description.abstractBackground: Maternal cancer is a substantial source of stress for children. Children of diagnosed mothers are at heightened risk for depression, anxiety, withdrawal, and worrying. To best support these children, it is essential to identify, understand, and be able to measure the children’s illness-related concerns. However, to date, very little is known about what concerns children and how those concerns might exacerbate adjustment problems. Furthermore, the field lacks a valid measurement of the child’s reported concerns about the mother’s cancer. In the absence of such understanding, it becomes difficult to design and deliver programs for children. Purpose: The overall purpose of the dissertation was to address the gap in the literature about illness-related concerns from the perspective of school-age children experiencing maternal cancer. This dissertation comprises three studies, all of which include a sample of children (7–12 years) of mothers diagnosed with early stage breast cancer. Study 1 described the experienced illness-related concerns reported by children in the first six months of their mother’s diagnosis and identified differences by age and gender of the child. Study 2 evaluated the content and construct validity of illness-related concerns children attribute to their mother’s breast cancer and derived a brief version of a standardized scale to measure these illness-related concerns. Study 3 tested a theoretical model examining the process through which the children’s concerns about the mother’s breast cancer influenced their anxiety three months later. Methods: These studies are based on secondary analysis of data from a longitudinal randomized control trial of a cancer parenting program, the Enhancing Connections Program. Baseline data prior to randomization were used in all three studies; in addition Study 3 used data from participants 3 months later. Study 1 utilized inductive content analysis to analyze 140 children’s written responses to an open-ended question asking the child, “Think about a situation that has bothered you during the last month that had to do with your mom’s breast cancer”. Study 2 utilized confirmatory factor analyses to test and compare three hypothesized factor models of illness-related concerns in children of mothers with cancer guided by a preliminary literature analysis. Models were specified using data from 203 children who completed a 93-item self-report previously untested questionnaire (About My Mother’s Illness Scale, AMMI). Based on conceptually informed decision rules, 18 items from the AMMI were selected as indicators to the factors for the three tested models. Study 3 utilized structural equation modeling and bootstrapping to test the model. Mothers (N= 176) completed a standardized measure of depressed mood and children (N= 176) were assessed on their illness-related concerns, desire for psychological proximity, and anxiety after three months. Results: Study 1: Losing Her, the core construct, was identified and organized the children’s concerns in seven domains: (a) knowing about the cancer, (b) her being away from me, (c) worrying about her, (d) being unable to do things together, (e) seeing my mother be different, (f) losing her ability to do what she usually does, and (g) wishing she did not have cancer. Study 2: the multidimensional five-factor model revealed the best fit to the data. The five-factor model included five related yet distinct dimensions of illness-related concerns that the child attributed to the mother’s cancer: (a) changes in family routines and resources, (b) uncertainty, (c) illness contagion, (d) mother’s death, and (e) mother’s well-being. Study 3: children’s concerns were significantly associated with maternal depressed mood and the child’s desire for psychological proximity. However, as the mother’s depressed mood increased, the child’s desire for psychological proximity decreased toward the ill mother. Children’s unmet desire for psychological proximity significantly mediated the relationship between their reported concerns and their anxiety three months later. Conclusions: This dissertation adds to our understating of illness-related concerns in school-age children of mothers with breast cancer and addresses the conceptual and operational limitations in the literature. The derived 18-item Child’s Illness-Related Concerns Scale can benefit services and programs and assist in assessing and targeting specific dimensions of children’s concerns. Consistent with attachment theory, findings revealed crucial pathways to be targeted by clinicians and future interventions for the adjustment of children experiencing maternal cancer. Alleviating the child illness-related concerns, minimizing the mother’s depressed mood, and attaining the children’s desire for proximity can prevent or reduce the risk of anxiety in children
dc.format.mimetypeapplication/pdf
dc.language.isoen_US
dc.rightsnone
dc.subjectAttachment
dc.subjectCancer
dc.subjectChildren
dc.subjectConcerns
dc.subjectMothers
dc.subjectSchool-age
dc.subjectOncology
dc.subject.otherNursing
dc.titleDescribing, Measuring, and Testing a Model of Illness-Related Concerns among Children Experiencing Maternal Breast Cancer
dc.typeThesis
dc.embargo.termsRestrict to UW for 5 years -- then make Open Access
dc.embargo.lift2024-09-18T22:53:45Z


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