Date of Award

Fall 2020

Degree Type

Open Access Dissertation

Degree Name

Public Health, DPH


School of Community and Global Health

Advisor/Supervisor/Committee Chair

Alan Stacy

Dissertation or Thesis Committee Member

Bin Xie

Dissertation or Thesis Committee Member

Kim D. Reynolds

Terms of Use & License Information

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Rights Information

© Copyright Anna Yu Lee, 2020 All rights reserved


This dissertation is a collection of four studies which collectively explore a hypothesized construct of ‘moral evaluation of patient behaviors’ (MEPB) as a driver of health professionals’ readiness to interact humanistically with their patients. In these studies, ‘humanistic interactions’ refer to the non-technical, intangible skills and factors of clinical competence; the factors specifically explored in these studies were compassion toward patients, self-efficacy for treating patients, and optimism toward patient treatment. For the purpose of specificity, all factors were examined as they pertained to patients with substance use disorders. Survey data from a convenience sample of 524 health professionals (i.e. physicians, nurses, and other health professionals) from three culturally distinct areas of the world (i.e. California (n = 173), urban France (n = 102), and urban China (n = 249)) were analyzed using analyses of variance, Welch’s t-tests, confirmatory factor analyses, and structural equation models. Results indicate: 1.) Psychometric support for the survey tool that was created for the assessment of the hypothesized construct of MEPB among health professionals, and information on differences on this hypothesized construct by age group, occupation, and country of residence; 2.) Indication that this survey tool operates differently among health professionals in different countries, which supports the notion that people from differing cultures have differing notions about morality. 3.) In the California sample, results indicate that while moral judgements of patients’ behavior carries mixed associations with factors of health professionals’ readiness to interact humanistically with these patients, moral judgements of the self (or, moral self-image) have only positive associations with factors of this readiness for humanistic interaction. This finding supports the notion that having a healthy self-concept strengthens one’s ability to support others. 4.) In all three countries, moral evaluations were positively associated with optimism toward treating patients, and in urban China, they were additionally positively associated with compassion and with self-efficacy. Given weak measurement invariance (i.e. differences in the operation of the measurement of moral evaluations by country), more research is needed in this area. The current research provides a tool for examining research of just this nature, and most importantly suggests that morality does not need to be eliminated from perspectives of mental illness or addiction, but rather that more nuanced moral perspectives are needed. Future research may explore distinctions between moral appraisals and stigma, and associations between moral evaluations (both among health professionals and among patients) and clinical/health outcomes such as rates of relapse and recovery.