Date of Award


Degree Name

Doctor of Philosophy



First Advisor

Chwalisz, Kathleen


Scholars have called for contextual based explorations of factors impacting implementation of integrated health care (IHC), yet IHC researchers agree that a paucity of research remains. (Kirschbaum, Rask, Brennan, Phelan, & Fortner, 2012; Miller, Kessler, Peek, & Kallenberg, 2011). Even less is known about the process of behavioral and physical health care integration in student health centers on university campuses (Alschuler et al., 2008). The purpose of this study was to address specific gaps in the literature of contextualized processes of integration (Kwan & Nease, 2013; Xyrichis & Lowton, 2008) by examining clinician, support staff, and administrator experiences with the process of integration at a student health center and to identify how values, principles, and attitudes impact this process. The results of a qualitative analysis of nine focus groups show the complexity associated with the process of integration as well as the factors impacting implementation at a university health center. Grounded theory methodology was used to analyze the data in three steps: (a) open-coding, (b) axial coding, and (c) selective coding (Corbin & Strauss, 2015). The analysis revealed three axial level categories comprised of 16 open-coding level categories and subcategories. A grounded theory model was developed and depicts how the various phenomena revealed at the axial level were interrelated in the early stages of the Student Health Center’s integration efforts.The conclusions of this study revealed that this organization’s integration was characterized by a collection of interacting Individual-Level, Organization-Level, and Communication variables, including barriers and facilitators of integration, which impact the process of integration. At the center of the theoretical structure was a co-constructed base of knowledge and attitudes from which staff approached and understood integrationa Shared Construct Representing Integration. However, since staff were at the beginning of the process of integration, the form of this construct had not yet come into focus. Therefore, the model is depicted as a “snapshot” in time. These conclusions have many implications for Administrators of student health centers who are considering integration. Prior to embarking on the integration process, interested parties are encouraged to seriously consider the many variables, processes, and strategies identified in this study.




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