Date of Award

Spring 5-2024

Document Type


Degree Name

Doctor of Philosophy (PhD)


Pharmaceutical Sciences

First Advisor

Lawrence M. Brown

Second Advisor

Marc Fleming

Third Advisor

Enrique Seoane-Vazquez

Fourth Advisor

Ismaeel Yunusa

Fifth Advisor

Yun S. Wang


Challenges in managing MetS include untreated risk factors and ineffective management, resulting in poor health-related quality of life (HRQoL). A significant factor contributing to these challenges is the underutilization of management services, possibly due to patients' perceptions of disease management resource utilization (PMU). Therefore, understanding patients' PMU is crucial for improving health outcomes. The study investigated PMU, explored PMU predictors, and investigated the impact of PMU and patients’ demographics on HRQoL. Using a cross-sectional design, data on perceptions of healthcare, medication, and pharmacy service utilization, prior experience with pharmacy services, demographics, and HRQoL were collected from adult individuals with obesity and comorbidities using validated tools. Purposive sampling was used to select 706 eligible respondents using criteria such as age, body mass index (BMI), and diagnosed comorbidities from the Southern states of the United States, including Washington, DC. Statistical analysis, including Kruskal Wallis, was used to investigate the distribution of PMU and HRQoL across demographics. Also, ordinal regression was used to build proportional odds models to predict PMU and HRQoL. Lastly, process macro mediation analysis through Haye’s Model 4 was used to explore the direct and indirect influence of PMU and other demographics on HRQoL. The respondents had an average of three comorbidities, a median age of 58, and an average BMI of 36.7 kg/m2. A proportion of 68.6% were between 45 and 64-years-old, while 71.1% were female. Only 32.6% of respondents had good PMU, with factors such as prior experiences with pharmacists, personality, gender, and education influencing perceptions. Mobility, usual activities, and pain/discomfort were prevalent dimensions affecting respondents' health status, with only 4 in 10 individuals having good HRQoL in the Southern region. The study highlighted significant associations between HRQoL and factors such as age, race, geographical areas, household income, comorbidities, prescription drugs, BMI, and PMU. Notably, respondents with good PMU were more likely to have better HRQoL, indicating the importance of patient perceptions in healthcare utilization and health outcomes. Lastly, prior experiences with pharmacists indirectly influenced HRQoL through PMU, suggesting the need for healthcare providers to augment service delivery to enhance patient experiences, promote perceptions, and ultimately improve HRQoL.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Available for download on Saturday, May 16, 2026