Author ORCID Identifier

Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Jeanne Salyer, PhD, RN, FNAP

Second Advisor

Antonio Abbate, MD, PhD

Third Advisor

Leroy Thacker, PhD

Fourth Advisor

Gonzalo Bearman, MD

Fifth Advisor

June Carrington, PhD, MPH


Background: The Theory of Cultural Distress offers a framework for understanding the potential outcomes in patients who do not receive care that incorporates their cultural beliefs (DeWilde & Burton, 2017).This study represents initial steps in researching the theory byexploring the layering of stressors that place the patient at risk for Cultural Distress. Methods: Utilized aCross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) to develop understanding of the potential effects of these variables on psychological stress. Independent variables included intersecting identities, perceived ethnic discrimination, concern for stereotype confirmation, own group conformity pressure, and group membership. The dependent variable was perceived stress. Participants were also asked to define the word culture. Results: Stereotype confirmation concern, perceived ethnic discrimination, group membership, and own group conformity pressure were significantly associated with perceived stress. Intersectionality was not significantly associated with perceived stress but was significantly associated with perceived ethnic discrimination. Regression analysis revealed stereotype confirmation concern, own group conformity pressure, and group membership as significant predictors of perceived stress. Participant definitions of culture primarily fell under two themes, Collectiveness and Individualness, indicating that the way we live is highly influenced by our shared experiences, and also a product of individual choices. Discussion: Results indicated that structural stressors had no influence on psychological stress but were associated with perceptions of discrimination. The experience of otherness significantly influenced psychological stress. Additional research and tool development is needed to better understand how structural stressors may influence psychological stress.


© Christine T. DeWilde

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission


Available for download on Friday, May 05, 2023