Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Degree Program

Nursing, PhD

Committee Chair

Hutti, Marianne

Committee Co-Chair (if applicable)

Ridner, Lee

Committee Member

Ridner, Lee

Committee Member

Coty, Mary Beth

Committee Member

Pearson, Donna

Author's Keywords

illness uncertainty; client-healthcare provider; fibromyalgia syndrome


Illness uncertainty and impaired client-healthcare provider (HCP) communication are critical healthcare problems for women with fibromyalgia syndrome (FMS). However, the relationship between illness uncertainty and client-HCP communication has not been previously examined. The purposes of this dissertation were to (a) gain a deeper understanding of the lived experiences of women with FMS, (b) to examine the relationships among client-HCP communication, illness uncertainty, helplessness, and subjective well-being (SWB) in women with FMS, and (c) evaluate the psychometric properties of the patient-HCP communication scale (PHCPCS) in women with FMS. A mixed-methods design enhanced validity of the findings. The qualitative pilot study showed that multiple factors contributed to the anguish experienced by the sample of women living with FMS. Participants’ narratives revealed illness uncertainty was a salient experience and that client-HCP interactions influenced the women’s uncertainty. The results of the quantitative study revealed a statistically significant relationship between illness uncertainty and SWB. However, the results of the mediation testing demonstrated the effects of uncertainty on the participant’s SWB were indirect and mediated through helplessness. The overall regression model explained 46% of the variance in SWB. There was a lack of empirical evidence to support the posited moderating effect of client-HCP communication on the relationships between illness uncertainty and helplessness, and helplessness and SWB. Inconsistencies found between the samples’ mean score on the PHCPCS and the narrative communication data indicated future research is needed to evaluate the content validity of the PHCPCS in women with FMS. The qualitative findings provide support for the theoretical work of Mishel (1990) and contribute to the literature by increasing understanding of the lived experiences of women with FMS. In addition, the data suggest that while illness uncertainty is associated with emotional distress in women with FMS, it is the individual’s perceived sense of helplessness that strongly influences the impact of illness uncertainty on SWB.