Female survivors of intimate partner violence (IPV) are at increased risk for negative sexual health outcomes, such as susceptibility to HIV/AIDS, other sexually transmitted infections, unintended pregnancy, miscarriage, and cervical cancer. Despite this known risk, HIV risk reduction interventions are lacking in IPV content, and little is known about women’s protective sexual health behaviors in this context. The purpose of this dissertation is to gain a deeper understanding of women’s sexual health within the context of a violent intimate relationship. Data were collected through semi-structured, in-person interviews with women who had experienced IPV (N = 28). Service-seeking women were recruited from a domestic violence shelter and a domestic violence counseling program; non-service-seeking women were recruited through a statewide coalition against domestic violence and online advertisements. Interviews were audio-recorded, transcribed, and then analyzed in NVivo Qualitative Software (Version 10). Detailed process notes, analytic memos, peer debriefing, and the use of visual analytic displays were used to increase the trustworthiness of findings. Results are presented in chapters two, three, and four. Chapter two explores women’s experiences of sexual violence in IPV relationships. Women described how their intimate partners used a combination of sexual abuse, sexual coercion, and sexual assault as a unique weapon of power and control. Chapter three examines women’s sexual risks across the levels of their ecological environment using an intersectional feminist framework. Women’s sexual risks went beyond sexual violence and were influenced by subtle yet pervasive cultural gender norms that reduced their power in relation to their male sexual partners. Chapter four focuses on understanding women’s protective sexual health behaviors in order to inform the development of an intervention that follows women’s natural pathway to care as they heal from victimization to surviving to thriving.

The treatment of individuals with multiple chronic conditions represents the single largest driver of Medicare costs. The use of prescription drugs is a major component in the treatment/management of chronic disease in the United States. Medication nonadherence, however, is a common problem among older adults and leads to significant morbidity and mortality. Whereas, the problem of medication nonadherence has been a primary focus of research for the last thirty years, much is still unknown about which older adults are most at risk for medication nonadherence, as well as what are effective theory-based interventions to improve a person's medication self-management.

The purpose of this descriptive explanatory study was to better understand the self-management behavior, medication adherence, in a sample of frail urban older adults. The study used a combination of quantitative and qualitative methods to analyze data from a larger twelve-month study of a nurse care coordination intervention. Ryan and Sawin's (2009) Individual and Family Self-Management Theory served as the study's conceptual framework for identifying the context and processes involved in the older adults' medication self-management. Quantitative results found several individual- as well as family-level predictors for medication nonadherence. Qualitative analyses identified three overarching themes to describe the participants' struggles along the multistep process of medication adherence. Additionally, a cultural domain described the need for more information from participants to understand their nonadherence. Integration of the results further increased our understanding of medication-self management in these frail older adults, and offers direction for clinical practice and future research.

ABSTRACT Caregiving studies generally do not focus on the post-caregiving phase of care, or African Americans post-caregivers (AAPCGs). This mixed-methods study guided by the Transitions Theory, explored the experiences of 40 AAPCGs residing in Los Angeles, California and Phoenix, Arizona, whose loved ones died within the last 10 years. Data collection tools included individual interviews, demographic questionnaire, CES-D, Brief Cope, and Social Support. Findings present the specific aims of the study. Aim 1 dealt with the types, patterns and properties of post-caregiving transitions (PCT). Many AAPCGs experienced multiple, simultaneous transitions that continued to impact their lives many years after caregiving ends. Aim 2 dealt with factors that facilitate or inhibit healthy PCT. Facilitators include: Being satisfied with care provided; fulfilling death-bed promises; living out the legacy of the deceased; deep spiritual beliefs in God and support of family, friends and church. Inhibitors include: Experiencing a deep sense of loss, confusion, depression, loneliness, and guilt; physical challenges such as fatigue and exhaustion, breathing problems, dizziness, fainting, cognitive difficulties, pain, headaches, hypertension and insomnia; family conflicts, job or home loss that linger long after PCT. Aim 3 involves process indicators including: connectedness with family, friends, co-workers, church and God; returning to work or school. Coping strategies that helped AAPCGs include: productive ventures, family mementoes, reminiscing, new baby, or visiting cemetery. Appropriate coping led to outcome indicators of mastery such as new environment; making decisions; taking actions; readying oneself for another caregiving role; preparing for one's own life and death; or caring for self. Fluid integrative identities include: Sense of balance, peacefulness and joy, fulfillment, compassion; remembering without pain; or new identity. Implications for practice, policy, education and research include: Care providers and policy makers must ensure that AA caregivers receive adequate EOL and hospice information and support for adequate preparation of loved one's death. Geriatric educators must design and implement curricular programming that includes the post-caregiving phase as a very important phase of caregiving. Researchers should design culturally-congruent assessment tools or improve the checklist developed in this study to appropriately measure PCT; and also develop culturally-relevant interventions to facilitate healthy PCT.

Obesity is a worldwide epidemic. Countries in the Middle East, Central and Eastern Europe, as well as North America have the highest prevalence of obesity in the world. Perimenopause is a transitional period in the life of a woman, occurring a few years before and a year after menopause or last menses. During this period, a woman may experience several physiological, psychological and socio-economical changes that may affect the health promotion efforts related to weight management. Perimenopausal obesity prevalence is high in Middle-Eastern countries and is a particular problem in Gulf Cooperation Council Countries (GCC). Despite the high prevalence of obesity in GCC countries and its comorbidities among the perimenopausal women, not much attention is given to it. There is lack of understanding regarding the perception of perimenopausal women of midlife weight gain. This study proposed a qualitative descriptive design that used semi-structured interviewing, and conventional content analysis. The purpose of this study was to examine the culturally specific views of perimenopausal GCC women concerning the causes and processes of midlife weight gain. Constructs derived from the health belief and explanatory models to identify and sort themes into conceptual categories were used. The themes and initial interpretations were brought forward into the organizing and explanatory framework of the socioecological model for further exploration and elucidation. The problem of overweight/obesity among the perimenopausal women in GCC countries was found to have many dimensions. These dimensions interacted at multiple levels (individual, interpersonal, organizational and community) and encompassed factors salient in both the HBM and Kleinman's model of disease and risk behaviors. The findings of this study suggest that weight-management programs targeting perimenopausal GCC women should be planned based on the multilevel factors that are expressed by them.