07/15/2025
By Stephanie Madden

The College of Fine Arts, Humanities, and Social Sciences, Department of Psychology, invites you to attend a doctoral dissertation defense by Stephanie Madden on “Harmony in Health: Exploring the Interplay of Caregiver—Provider Alliance, Familial Factors, and a Multi-Rater Approach on Child Health Outcomes.”

Candidate Name: Stephanie Madden
Degree: Doctoral
Defense Date: Monday, July 28, 2025
Time: 10 a.m.
Location: Coburn Hall Room 245
Please contact stephanie_madden@student.uml.edu for a Zoom link if needed

Committee:

  • Advisor Samantha Miadich, Ph.D., Assistant Professor, Department of Psychology, University of Massachusetts Lowell
  • Joseph Gonzales, Ph.D., Chair, Associate Professor, Department of Psychology, University of Massachusetts Lowell
  • Jiabin Shen, Ph.D., Associate Professor, Department of Psychology, University of Massachusetts Lowell

Dissertation Title: Harmony in Health: Exploring the Interplay of Caregiver—Provider Alliance, Familial Factors, and a Multi-Rater Approach on Child Health Outcomes

Brief Abstract:
Optimal health in childhood is essential to ensure not only wellbeing throughout childhood, but also has implications for health into and throughout adulthood. Individuals with whom children have close contact with, such as caregivers, healthcare providers, and families each have strong influences on child mental and physical health outcomes. Caregiver—provider alliance is an important aspect to consider for positive child health outcomes as this involves the partnership and relationship between pediatric providers and caregivers of children. Family factors, such as socioeconomic status (SES) and family functioning, are also linked to the health of children. Based on Bronfenbrenner’s Social Ecological Model (1977), the work in this dissertation examined the influences of caregivers, healthcare providers, families, (microsystems) and their interactions (mesosystems) on health indicators (global health status, body mass index [BMI], weight-related health, lung function, internalizing symptoms) of school-aged children. Specifically, this body of work included the scale development of a novel caregiver—provider alliance measure (Paper 1), the CACPPQ, which was found the be a reliable and valid measure of caregiver—provider alliance. However, validity testing also demonstrated there may be a higher order factor of general attitudes and behaviors toward healthcare providers. Next, the associations between family factors (functioning and SES) and child health outcomes (global health status, internalizing symptoms, and body mass index [BMI]) along with the moderating role of caregiver—provider alliance on these associations were investigated (Paper 2). Results indicated that better family functioning and strong caregiver—provider alliance were associated with better global health status and less internalizing symptoms in children while high SES was associated with poor global health status and lower BMI. Further, caregiver—provider alliance moderated the association between family functioning and child internalizing symptoms, such that strong family functioning was associated with fewer internalizing symptoms at low, average, and high levels of alliance. This finding suggests that family functioning plays a critical role in the mental health of children, regardless of caregiver—provider alliance. Finally, this body of work assessed the differences in associations between caregiver and child reports of child mental health (multi-rater approach) with child physical health and if these associations differed based on whether the child has asthma (Paper 3). Most of the findings were null, with the exception that caregiver reports of more child internalizing symptoms were associated with poor global health status from both caregiver and child perspectives. Overall, findings from this body of work underscores the importance of individuals that are closest to children (e.g., caregivers, families, healthcare providers) as they affect children’s general health and wellbeing. This work suggests that promoting positive health outcomes for children may require fostering a strong alliance between caregivers and primary healthcare providers, enhancing positive family dynamics, and considering diverse perspectives when evaluating child health outcomes. Results from this work have the potential to inform prevention programs and interventions for caregivers and families, inform workshops and trainings on the importance of interpersonal relationships and building alliance for healthcare providers and medical trainees, and to highlight the importance of incorporating multi-rater approaches in pediatric health research.