All ETDs from UAB

Advisory Committee Chair

Carmen Capo-Lugo

Advisory Committee Members

Patricia Perez

William Reed

John Sturgeon

Zina Trost

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


Pain-related injustice appraisal has emerged as a psychosocial predictor of deleterious chronic low back pain (CLBP) outcomes. The appraisal is defined as the individual’s perception regarding the magnitude and irreparability of pain-related loss and suffering, externalized blame, and unfairness. Research in diverse samples revealed racial differences in pain-related injustice appraisal, suggesting that it may reflect broader racial/ethnic, sociocultural, and socioeconomic factors. This agrees with theories recognizing the role of ethnic and cultural characteristics in ethnic minorities’ health. Despite global data showing that Arabs represent the population with the second-highest prevalence of CLBP worldwide, a reliable characterization of CLBP among Arabs in the US is almost lacking. Given their unique ethnic characteristics and cultural challenges, this dissertation aimed to examine the role of pain-related injustice appraisal on CLBP outcomes among Arab Americans. The first aim sought to obtain an in-depth understanding of how Arab Americans conceptualize injustice appraisal concerning their CLBP. Twelve participants reflected on the Injustice Experience Questionnaire (IEQ); the principal questionnaire to assess pain-related injustice appraisal. Qualitative data suggested that Arabic culture and Islamic beliefs influence the interpretation of the IEQ. The second and third aims sought to establish an understanding of the relationship between injustice appraisal and CLBP outcomes as well as the role of other factors in this iv relationship. For the second aim, data from 92 participants revealed that pain-related injustice appraisal is associated with higher CLBP-related pain intensity, disability, and depressive symptoms, and predicted disability and depressive symptoms above and beyond other pain-related variables. For the third aim, data from 96 participants demonstrated that ethnic identity and religiosity attenuated the relationship between pain-related injustice appraisal and CLBP-related depressive symptoms. History of discrimination was associated with greater pain intensity, disability, and depressive symptoms. Pain-related injustice appraisal appeared as a potential mechanism in which discrimination affected disability and depression. In summary, although Arab Americans distinctly interpreted pain-related injustice appraisal, its manifestations concerning CLBP outcomes were comparable to other populations (e.g., appraisals of pain magnitude and irreparability). Also, their unique ethnic and cultural characteristics influenced CLBP-related injustice appraisal (e.g., acceptance appraisals and buffering effects of ethnic identity and religiosity).



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