Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Lindsey L. Cohen

Second Advisor

Lisa Armistead

Third Advisor

Laura McKee

Fourth Advisor

Erin Tully


The overall theme of this dissertation is an examination of the relationship between family level factors and health-related psychosocial concerns in pediatric sickle cell disease (SCD). In the first chapter, overviews of SCD, common health-related psychosocial concerns in SCD, and family level factors in pediatric conditions are provided. Rationale is provided for the need to further investigate family level factors in SCD, particularly as it relates to child health-related psychosocial outcomes. Additionally, areas of growth related to assessment, analytic methodology, and intervention are discussed in the context of understanding the relationship between family level factors and health-related psychosocial outcomes in SCD. In the second chapter, I present a study examining family functioning in SCD using the Family Assessment Device (FAD). This study further characterizes family functioning in SCD as assessed by the FAD, elucidates the relationship between family functioning and child health-related psychosocial outcomes in SCD, and describes targets of intervention. In the third chapter, I present a study examining the relationship between child health-related quality of life and parent and child pain catastrophizing in SCD using a novel dyadic analysis. The findings of this study highlight the interrelationship between parent and child pain catastrophizing, the value of multi-informant assessment, the need to incorporate dyadic analyses to examine complex parent-child relationships and perspectives, and the potential benefit of family-based intervention. The fourth chapter consists of a systematic review of interventions for enhancing medication adherence in SCD. This systematic review delineates the extent to which families are included in adherence interventions and the efficacy of such interventions. The final chapter synthesizes how the collection of studies included in this dissertation fits within the extant literature on family functioning pediatric SCD and describes directions for future research.


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