Factors and Coping Strategies that Impact Children and Adolescents with Alopecia Areata

279 Pages·2014·3.29 MB·English

by  Janice J. Wolf

FACTORS AND COPING STRATEGIES THAT IMPACT CHILDREN AND
ADOLESCENTS WITH ALOPECIA AREATA: AN EXPLORATORY FACTOR
ANALYSIS

Janice J. Wolf
A Dissertation
Submitted to the
Graduate Faculty
of
George Mason University
in Partial Fulfillment of
The Requirements for the Degree
of
Doctor of Philosophy
Education and Human Development

_________ Chair
_________

_________
_________ Program Director

____________________________________________ Dean, College of Education
and Human Development

Date: _________ Spring Semester 2014
George Mason University
Fairfax, VA
Factors and Coping Strategies that Impact Children and Adolescents with Alopecia
Areata: An Exploratory Factor Analysis
A Dissertation submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy at George Mason University
by
Janice J. Wolf
Masters of Education
George Mason University, 2007
Bachelor of Nursing
George Mason University, 1984
Bachelor of Business Education
Bowling Green State University, 1976
Director: Pamela Hudson Baker, Associate Professor
Education and Human Development
Spring Semester 2014
George Mason University
Fairfax, VA
This work is licensed under a creative commons
attribution-noderivs 3.0 unported license.

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DEDICATION
This research is dedicated to the children and adolescents who are adapting to and
managing their altered appearance due to alopecia areata.
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ACKNOWLEDGEMENTS
Thank you to my amazing committee. It was a pleasure and honor to work with
you. I would like to express my deepest gratitude to Dr. Pam Baker for accepting this
challenge, organizing ideas for the project, and mentoring me with patience and
understanding. Appreciation also goes to my methodologist, Dr. Galluzzo for his
excellent and invaluable guidance in directing this study. Dr. Urban, thank you for your
encouragement, medical expertise, and for supporting my effort to change the lives of
children and adolescents with alopecia areata.
Thanks also to NAAF for their support and accessibility throughout this study.
A special thank you to my boys Steve and Doug (and Doug’s wife Kelly) for their
loving support, continuous encouragement, and understanding when dinners and family
events were missed.
Finally, thank you to all my family and friends who supported me on my yearly
progress and cheered for my successful completion of this study.

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TABLE OF CONTENTS
Page
List of Tables ..................................................................................................................... ix
List of Figures ................................................................................................................... xii
Abstract ............................................................................................................................ xiii
1. Introduction ..................................................................................................................... 1
The Cycle of Alopecia Areata .................................................................................... 3
Children and Adolescents with Alopecia Areata ....................................................... 4
Treatments.................................................................................................................. 8
Statement of the Problem ........................................................................................... 9
Rationale .................................................................................................................. 11
Purpose of the Study ................................................................................................ 13
Research Questions .................................................................................................. 13
Significance of the Study ......................................................................................... 14
Definition of Terms.................................................................................................. 15
Assumptions ............................................................................................................. 16
Delimitations ............................................................................................................ 17
Summary .................................................................................................................. 18
2. Literature Review.......................................................................................................... 19
Characteristics of Alopecia Areata .......................................................................... 20
Alopecia Areata and the Immune System ................................................................ 22
Variations of Alopecia ............................................................................................. 24
Across Genders ........................................................................................................ 25
Potential Impact Factors .......................................................................................... 28
Potential Types of Coping Strategies ....................................................................... 42
Medicinal Treatments ........................................................................................ 42
Alternative Treatments....................................................................................... 45
Cosmetic Cover-up. ........................................................................................... 48
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Community and Outside Support....................................................................... 50
Communication/Technology.............................................................................. 51
Family Support................................................................................................... 52
Summary .................................................................................................................. 57
3. Methods........................................................................................................................ 58
Research Design....................................................................................................... 58
Sampling .................................................................................................................. 60
Ethical Considerations ............................................................................................. 60
Survey Development ................................................................................................ 62
Survey Validation .................................................................................................... 64
Revised Survey ........................................................................................................ 67
Independent Variables ............................................................................................. 68
Dependent Variables ................................................................................................ 69
Piloting of Survey .................................................................................................... 71
Potential Participants ......................................................................................... 72
Procedures .......................................................................................................... 73
Outcomes ........................................................................................................... 74
National Distribution of Survey ............................................................................... 74
Potential Participants ......................................................................................... 75
Procedures. ......................................................................................................... 76
Outcomes. .......................................................................................................... 77
Qualitative Follow-up .............................................................................................. 78
Potential Participants ......................................................................................... 79
Procedures .......................................................................................................... 79
Outcomes ........................................................................................................... 83
Qualitative Reliability and Validity ......................................................................... 84
Data Analysis ........................................................................................................... 85
Summary .................................................................................................................. 90
4. Results .......................................................................................................................... 91
National Study ......................................................................................................... 92
Click-through Rate ................................................................................................... 92
Participants ............................................................................................................... 93
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Research Question 1 ................................................................................................ 97
Research Question 2 .............................................................................................. 102
Research Question 3 .............................................................................................. 107
Comparing Gender and Duration Factors ........................................................ 107
Comparing Age and Onset with Impact Factors. ............................................. 111
Research Question 4 .............................................................................................. 121
Comparing Gender and Duration with Types of Coping Strategies ................ 121
Comparing Age and Onset with Types of Coping Strategies. ......................... 125
Research Question 5 .............................................................................................. 135
Research Question 6 .............................................................................................. 140
Research Question 7 .............................................................................................. 143
Personal Experiences ............................................................................................. 147
Stories. ............................................................................................................. 147
Lessons learned ................................................................................................ 149
Emergent Themes .................................................................................................. 150
Coping .............................................................................................................. 153
Acceptance. ...................................................................................................... 155
Social issues ..................................................................................................... 156
Additional Connections ......................................................................................... 158
Summary ................................................................................................................ 159
5. Discussion .................................................................................................................. 161
Observations about Participant Demographics ...................................................... 162
Conclusions and Implications Regarding Impact Factors ..................................... 163
Impact Factor 1 (Confidence/Self-esteem). ..................................................... 164
Impact Factor 2 (Psychological Effects). ......................................................... 165
Impact Factor 3 (Appearance/Acceptance). ..................................................... 167
Impact Factor 4 (Socialization). ....................................................................... 168
Impact Factor 5 (Communication .................................................................... 169
Conclusions and Implications Regarding Types of Coping Strategies .................. 170
Type of Coping Strategy 1 (Physiological). .................................................... 172
Type of Coping Strategy 2 (Cover-up/Avoidance). ......................................... 173
Type of Coping Strategy 3 (Outside Support). ................................................ 174
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Type of Coping Strategy 4 (Social Network). ................................................. 176
Type of Coping Strategy 5 (Family Support). ................................................. 177
Qualitative Insights ................................................................................................ 178
Acceptance with Links to Impact Factors ........................................................ 179
Social Issues with Links to Impact Factors...................................................... 181
Types of Coping Strategies Linked with Factors ............................................. 184
Limitations ............................................................................................................. 190
Recommendations .................................................................................................. 192
Future Research ..................................................................................................... 194
Final Remarks ........................................................................................................ 197
Appendices ...................................................................................................................... 199
Appendix A ............................................................................................................ 200
Appendix B ............................................................................................................ 201
Appendix C ............................................................................................................ 202
Appendix D ............................................................................................................ 208
Appendix E ............................................................................................................ 214
Appendix F............................................................................................................. 220
Appendix G ............................................................................................................ 227
Appendix H ............................................................................................................ 232
Appendix I ............................................................................................................. 238
Appendix J ............................................................................................................. 244
Appendix K ............................................................................................................ 245
Appendix L ............................................................................................................ 246
Appendix M ........................................................................................................... 247
References ....................................................................................................................... 249
Biography ........................................................................................................................ 264

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LIST OF TABLES
Table Page
Table 1. Literature Review-Based Impact Factors .......................................................... 55
Table 2. Literature Review-Based Coping Strategies ...................................................... 56
Table 3. Summary of Independent and Dependent Variables
with Corresponding Questions ...................................................... 70
Table 4. Follow-up Individual Interview Criteria ........................................................... 80
Table 5. Data Analysis Summary ................................................................................... 86
Table 6. Click-through Response Rate ........................................................................... 92
Table 7. Demographic Characteristics of Participants .................................................... 94
Table 8. Eigenvalue and Percentage of Variance Explained
by Each Impact Factor .................................................................. 97
Table 9. Five Identified Impact Factors .......................................................................... 99
Table 10. Component Loadings for the Rotates Solution
by Size – Impact Factors ............................................................. 100
Table 11. Eigenvalue and Percentage of Variance Explained by
Each Type of Coping Strategy .................................................... 103
Table 12. Five Identified Types of Coping Strategies ................................................... 104
Table 13. Component Loadings for the Rotated Solution
by Size – Types of Coping Strategies ......................................... 105
Table 14. A Comparison of Gender and the Five Impact Factors ................................. 109
Table 15. A Comparison of Duration and the Five Impact Factors ............................... 111
Table 16. ANOVA Age Group Comparisons of Impact Factor 1
(Confidence/Self-Esteem) ........................................................... 112
Table 17. ANOVA Age Group Comparisons of Impact Factor 2
(Psychological Effects) ............................................................... 113
Table 18. ANOVA Age Group Comparisons of Impact Factor 3
(Appearance/Acceptance) ........................................................... 114

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