Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation





First Advisor

Dr. Patricia B. Howard


Individuals diagnosed with schizophrenia commonly experience problems with accurately assessing their health status due to cognitive deficits including impaired working memory, amotivation, and communication difficulties. Little is known about whether these deficiencies influence health behavior decision-making among individuals with schizophrenia. Individuals with schizophrenia die an average of 25 years earlier than those without a mental illness. Approximately 60% of premature deaths in this population are from medical comorbidities; mortality rates due to cardiovascular and pulmonary diseases are two to three times higher than the general population. In order to reduce morbidity and mortality, it is important to find effective ways to assist these individuals in modification of risky behaviors (e.g., smoking, poor dietary habits, and sedentary lifestyles) and to incorporate daily health promoting behaviors (e.g., balanced diet and regular exercise). This qualitative descriptive study was conducted to describe the decision-making processes used by adults with schizophrenia when making health behavior decisions, identify what it means to be healthy from the perspectives of adults with schizophrenia, and identify the perceived barriers and facilitators that affect health behavior decisions. Ten adults diagnosed with schizophrenia were interviewed for this study. Fifty-percent of participants were female, ages 28 to 59 years, and received treatment in a community mental health centers. Data were analyzed using content analysis. Methods included the use of field notes, open and axial coding, and development of a visual model. Trustworthiness of the findings was established through the qualifications and experience of the investigator, peer scrutiny, and member checks. Three phases of health behavior decision making were identified: Recognizing Complex Components of Health, Personalizing Components of Health, and Tracking Health Status. The main category that described health behavior decision making was “Tracking Health Behaviors,” which resulted in the ability to maintain physical and mental health. Within each phase, specific actions associated with achieving and maintaining physical and mental health were identified and were displayed in a visual model. These findings provide a guide to clinicians in identifying health behavior decision making processes and may lead to the design of clinical interventions that improve the health status of adults with schizophrenia.