Community engagement in health assessment enables researchers to better understand and prioritize community needs. The value of community engagement is increasingly documented; however, few studies engage youth. Research and assessments are often done for youth, but not with youth. Youth bring a unique contextual lens to community issues; without engagement, the likelihood that resultant efforts would be accepted by or appropriate for youth decreases. This dissertation explores opportunities and methodological approaches for, and contributions and feasibility of engaging youth in non-profit hospital community health needs assessments (CHNAs) mandated through the Affordable Care Act. This study has three specific aims, utilizing multiple methodological approaches: • Aim 1: Assess the current level of youth engagement, and prevalence of youth-focused priority areas in Massachusetts CHNAs. CHNAs were reviewed and analyzed using the Community Health Improvement Data Sharing System’s community engagement template. • Aim 2: Compare assessment results of focus groups and participatory photo mapping (PPM) in documenting youth observations of Boston community conditions. Three focus groups and PPM processes engaged 46 high-school age youth. Data were qualitatively compared, with attention to youth-identified community assets, concerns, and recommendations. • Aim 3: Compare youth results with existing CHNAs and identify potential contributions of youth engagement. Using the social determinants of health framework, youth recommendations were compared to Boston hospital community health improvement (CHI) publications to observe the convergence and divergence of priorities. While all MA hospitals minimally complied with required CHNA community engagement criteria, there was no standard practice or approach. 20% of CHNAs engaged youth, primarily through focus groups; yet, 80% of CHNAs that identified priorities included youth-focused priorities. Youth-driven results focused upon social determinants of health factors; furthermore, PPM results provided more detailed and granular CHI recommendations. Youth-identified CHI recommendations complemented those identified by hospitals, indicating that youth engagement can potentially strengthen CHI priorities and identify salient strategies for addressing youth health, specifically. Findings can be extrapolated to the many institutions conducting assessments, including health departments and Community Action Agencies. Findings will be disseminated through a series of practice briefs that make recommendations to hospitals, assessment practitioners, and youth organizations to consider for future efforts.

No description available.

Little is systematically known about the collective health and well-being of Virginia American Indian people. This study sought to explore the meaning of health and healing among Virginia American Indian people in the context of a reservation-based, non-federally funded health clinic. Using an emergent approach to qualitative research grounded in a constructivist inquiry paradigm and guided by Indigenous research principles, a total of 24 in-depth, semi-structured interviews were conducted with 17 American Indian service-users of the Clinic. Through an inductive thematic analysis of participant stories, a framework for understanding responsive and responsible health and healing was derived. The framework includes seven dimensions: spirituality, physical processes, mental and emotional processes, social relationships, access to resources, contextual factors, and the interconnection among the dimensions. Personal and collective identity was a significant element woven through the dimensions. From the stories told by participants, health seems to be a continuum and healing seems to be a cycle. With constant motion in each of the dimensions, health has to do with sustained engagement in healing processes that continually seek to bring about functional balance in one’s whole health system. Ill health has to do with when a change in any one of the dimensions overtakes one’s ability to bring about a functional balance in the whole health system. The framework is context-dependent, true for the people who participated in the study at the time of the study.

Although patterns of African American and white women breast cancer incidence and mortality in St. Louis, Missouri is consistent with those seen elsewhere in the United States, rates vary greatly across zip codes within the city of St. Louis. North St. Louis, whose neighborhoods are primarily African American, exhibits rates of breast cancer mortality that are among the highest in the city and higher than the state as a whole. Based on information that up to 50% of women in North St. Louis with a suspicious diagnosis of breast cancer never enter treatment, we conducted three 2-hour group model building sessions with 34 community stakeholders (e.g., breast cancer survivors or family members or caregivers and community support members such as navigators) to identify the reasons why African American women do not begin or delay breast cancer treatment. Participant sessions produced a very rich and dynamic causal loop diagram of the system producing disparities in breast cancer mortality in St. Louis. The diagram includes 8 major subsystems, causal links between system factors, and feedback loops, all of which shed light on treatment delays/initiation. Our work suggests that numerous intersecting factors contribute to not seeking treatment, which in turn may contribute to African American and white disparities in mortality.

In this dissertation, I advance the question of what it means for applied theatre artists to give voice to the community members with whom they work. The study engages with some of the ethical and aesthetic tensions that emerge when one group of people (artists) is entrusted with giving dramatic form to the lived experience of another group (community members). The central premise of the dissertation is that when community participants increase their independent capacity to devise dynamic and compelling theatre, they achieve greater agency. Using a grounded theory analysis, I theorize qualities and characteristics that contribute to the staging of aesthetically arresting theatre, organized into a conceptual lexicon. This praxis-based study is intended to enable applied theatre practitioners to more directly give voice to their community partners. The dissertation presents a vocabulary that offers community participants and professional artists a mutually understood language with which to engage the power of the theatrical event. / Graduate

This dissertation is about Indigenous and settler health, wellbeing and health policy in rural Manitoba. Across Canada, both sweeping and incremental provincial health system changes have profound effects on marginalized communities facing existing health inequities, including rural settler and Indigenous peoples. Increasingly, the centralization of provincial health care systems has led to the elimination of health services within rural settings. The research I present in this dissertation arose from advocacy efforts in a rural community in southwest Manitoba. The community sought representation and recognition in health decision-making in the midst of the largest health care system transformation in provincial history and called for local research production. The community-led study grew to the larger inquiry and analysis presented here, including a First Nation and Métis community, which were both affected by the transformation. The objectives of this dissertation were to analyze the ideas and structures used to inform provincial decisions, and to understand community experiences of rural health care before and during system transformation. As a settler researcher, I undertake an anti-colonial, strengths-based, community-engaged approach to research, developed through ongoing relationship with the community. In addition to a critical thematic analysis of key policy documents, semi-structured interviews were conducted with settler, First Nations, and Métis community members and service providers regarding their experiences within the health care system, their perceptions of change and the impacts of transformation on health and wellbeing. Arising themes include the importance of relational health care relationships in determining wellbeing, and the sense that the government undertook dehumanized decision-making in developing and implementing health system change. This dissertation concludes with policy recommendations for provincial governments, including the prioritization of community voices, and the visibility and involvement of rural and Indigenous peoples in health system decision-making. / Thesis / Doctor of Philosophy (PhD)

No description available.

No description available.

Recent policy change allows states to spend federal dollars directly on teen-led driver safety efforts and requires regular evaluations of effectiveness. There are currently no standardized instruments to measure change in teen driving behavior relevant to teen leaders. This study serves the Tennessee Department of Safety and Homeland Security, Tennessee Highway Safety Office and their network of teen leaders to empirically test and refine the I Drive Smart survey developed by partners and grounded in the Theory of Planned Behavior (TPB). The survey is designed to be administered by teen leaders to their peers and produce data relevant for use in improving planning as well as tracking changes occurring from their work. The survey measures attitudes, perceptions of social norms (peer, family, and law enforcement), perceptions of behavior control, and both driving and passenger behavior intentions. The I Drive Smart web survey was administered by a group of teen leaders to 175 of their peers. Findings were used to inform local planning and in this quasi-confirmatory study aimed at optimizing the survey. An exploratory factor analysis revealed a four factor model aligned with TPB that explained 61.618% of variation. Item reliability analysis demonstrated high internal consistency for the behavior intention scale with a Cronbach’s alpha of .884. An ordinary least squares regression test found the predictive validity of the identified components to be strong, explaining 64.5% of variation in the model and identifying perceptions of behavior control as the best predictor of behavior intentions, followed by family and peer norms. The behavior control component retained so much variation that the optimized survey assesses both volitional and non-volitional control concepts. Further, teen leaders were able to successfully administer the survey and found data helpful in supporting their planning. This study demonstrates that teen leaders are capable of directing evaluation activities and that the refined version of the I Drive Smart survey has appropriate psychometric properties for teen leaders in highway safety to use. Standard procedures for using the survey are discussed along with recommendations for analysis that includes triangulation with other local data points.

The The’wá:lí Community Digital Mapping Project is a collaborative, scholarly project for which the final product is a digital, layered map of the reserve and traditional lands of the Stó:lō (Xwélmexw) community of The’wá:lí (Soowahlie First Nation). The map, containing over 110 sites and stretching from Bellingham Bay, Washington in the west to Chilliwack Lake, B.C. in the east, is hyperlinked with audio, visual and textual media that tell stories about places of importance to this community. The map is intended to give voice to many different senses of and claims to place, and their intersections, in the The’wá:lí environment, while also exploring the histories of how these places and their meanings have changed over time. It expresses many, often conflicting, ways of understanding the land and waterways in this environment, and presents an alternative to the popular, colonial narrative of the settlement of the Fraser Valley. Thus, the map, intended ultimately for The’wá:lí’s use, is also meant to engage a local, non-Indigenous audience, challenging them to rethink their perceptions about where they live and about the peoples with whom they share their histories and land. The essay that follows is a discussion of the relationship-building, research, writing and map-building processes that have produced the The’wá:lí Community Digital Map. / Graduate / 2017-08-21 / 0740 / 0509 / 0366 / sabinatrimble@gmail.com