Date of Award


Document Type

Doctoral Research Project

Degree Name

Doctor of Psychology (PsyD)



First Advisor

Julie S. Costopoulos

Second Advisor

Nasri Nesnas

Third Advisor

Vida L. Tyc

Fourth Advisor

Robert A. Taylor


Medical nonadherence is a common and formidable problem that many pediatric healthcare providers face when treating children with acute and chronic medical conditions because adhering to a physicians’ treatment recommendations is beneficial for successful treatment, disease prevention, and healthy promotion (Dawood et al., 2010). It was estimated that at least one third of patients are unable to complete or adhere to relatively short treatment regimens (Dawood et al., 2010). Reasons for nonadherence to a physicians’ recommendations range from extended duration of treatment, multiple prescribed medications, and periods of symptom remission (Dawood et al., 2010). Despite a parent’s or family’s reason for nonadherence, between 15 and 20% of children in the United States are estimated to have a chronic health condition, most of which require a formalized or extensive medical treatment regimen (Pai & Drotar, 2010). Despite a moderate prevalence of children with chronic illnesses, 50% of these children are not adequately adhering to their physician recommended treatment protocol (Pai & Drotar, 2010). The potential risks and consequences from engaging in medical nonadherence include increased blood sugar levels, viral loads, increased symptomatology and infections, increased mortality risk, and changes in psychological functioning and quality of life (Pai & Drotar, 2010). In addition to the medical risks a child may face because of medical nonadherence, parents have their children removed from their custody, medical neglect charges, and the potential to have their parental rights terminated. The studies discussed previously demonstrated a prevalence of medical nonadherence behaviors. However, where is the threshold where parents generally consider nonadherence medically neglectful if another parent was doing it? To the author’s knowledge, there are no published studies examining a parent’s threshold to contact the court when a co-parent engages in medical nonadherence. As a result, the present study examined if a children’s health status impacts their likelihood of contacting the court using a questionnaire. Additionally, the present study evaluated how health anxiety and perceived vulnerability of the child impacts parental thresholds for approaching the court regarding a co-parent’s medical nonadherence. U.S. parents completed questionnaires about demographics, children’s health vignettes, the Short Health Anxiety Inventory (SHAI), and an adapted perceived vulnerability questionnaire. Results showed that participants’ decision to contact the court regarding custodial arrangements or parental rights did not significantly differ based on the child’s health condition within the vignettes. However, participants with higher levels of health anxiety were more likely to contact the court when the co-parent engaged in medical nonadherence than those with lower levels of health anxiety in all three health conditions. Parents with health anxiety may fear or be apprehensive about a negative change in their child’s health status in the future. Fear and anxiousness surrounding the potential for negative events to reduce a child’s health may lower the parents’ perceived control, especially since parents cannot control all the aspects of the child’s environment and medical adherence when the child is with their co-parent. Lastly, the current study revealed that the perceived vulnerability of the child did not significantly predict contact with the court, regardless of the child’s health status within the vignette.


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