abstract: This study aims to unearth monological and monocultural discourses buried under the power of the dominant biomedical model governing the HIV/AIDS debate. The study responds to an apparent consensus, rooted in Western biomedicine and its "standardizations of knowledge," in the production of the current HIV/AIDS discourse, especially in Sub-Saharan Africa. As a result, biomedicine has become the dominant actor (in) writing and rewriting discourse for the masses while marginalizing other forms of medical knowledge. Specifically, in its development, the Western biomedical model has arguably isolated the disease from its human host and the social experiences that facilitate the disease's transmission, placing it in the realm of laboratories and scientific experts and giving full ownership to Western medical discourse. Coupled with Western assumptions about African culture that reproduce a one-sided discourse informing the social construction of HIV/AIDS in Africa, this Western monopoly thus constrained the extent and efficacy of international prevention efforts. In this context, the goal for this study is not to demonize the West and biomedicine in general. Rather, this study seeks an alternative and less monolithic understanding currently absent in scientific discourses of HIV/AIDS that frequently elevates Western biomedicine over indigenous medicine; the Western expert over the local. The study takes into account the local voices of Sub-Saharan Africa and how the system has affected them, this study utilizes a Foucauldian approach to analyze discourse as a way to explore how certain ways of knowledge are formed in relation to power. This study also examines how certain knowlege is maintaned and reinforced within specific discourses. / Dissertation/Thesis / M.S. Biology 2014

Class of 2012 Abstract / Specific Aims: To identify and assess cultural competency courses for healthcare professionals that are available to pharmacy students. Methods: A literature review was performed to identify research articles discussing pharmacy courses in health care disparities. Additionally, a systematic review of all curricula for ACPE accredited schools of pharmacy was conducted and these syllabi were subsequently evaluated. Main Results: The search identified XXX articles focusing on specific health disparities curricula in schools of pharmacy and XXX syllabi about specific courses. Out of those articles and syllabi XXX were included in the analysis. Results are pending. Conclusions: Anticipated results will be utilized to design effective health disparities curricula at the University of Arizona College of Pharmacy.

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Background: Disparities in care for seriously ill African American (AA) elders exist because of gaps in knowledge regarding culturally sensitive physiological, psychological, social, and spiritual needs and preferences. Conceptual Framework: The foundation of culturally sensitive patient-centered PC is formed from social, spiritual, psychological and physical experiences of serious illness. Purpose: Aim 1 was to describe categories and patterns of psych-social-spiritual healing from the perspective of AA elders with serious illness. Aim 2 was to examine the NIH Clinical Center's psych-social-spiritual healing measure as a valid, culturally appropriate measure for this population. Methods: A purposive sample of 28 AA elders with serious illnesses and from the Jackson MS area participated in this study. Aim One used the qualitative method of narrative analysis. Aim Two used cognitive interviewing methodology, including verbal probing and think aloud techniques. Findings: Aim One: Prior experiences, I changed, and Across past, present experiences and future expectations were the three main of the thematic analysis. The thematic categories in prior experiences were: been through it...made me strong, I thought about…others, and went down little hills...got me down. The thematic categories in I changed were: I grew stronger, changed priorities, do things I never would have done, and quit doing. The thematic categories in Across past, present experiences and future expectations were: God did and will take care of me, close-knit relationships, and life is better. The most prevalent theme of God did and will take care of me was divided into subthemes of: God did, God will and developing faith. Aim Two: Of the fifty-three items on the Psychological-Social-Spiritual Healing instrument, thirty-seven items were retained, eight items revised, and eight items deleted. Conclusions: Aim one: The narratives were stories of remarkable strength. This strength was grounded in the participants' "faith" in God that helped the aging seriously ill AA elder "overcome things." Aim Two: Linguistic validity was enhanced with expert input from the seriously ill AA elders. Pragmatic validity, using both the research team and participants' input, improved the content validity. These findings provide evidence towards a more valid and culturally sensitive tool.

Despite advances in health, science, and technology, U.S. healthcare lags in providing access to care and quality care to racial and ethnic minorities. Cultural competence has been noted as a strategy to improve access and quality. The purpose of this project was to assess public health nurses' cultural competence before and after participating in cultural competence informational modules. Two conceptual models were used in this project for theoretical guidance: Leininger's cultural care diversity and universality theory and Campinha-Bacote's process of cultural competence. To assess the nurses' cultural competence, the Cultural Competence Self-Assessment Checklist questionnaire was e-mailed to 57 public health nurses at a local health department. Survey participants remained anonymous. Data were collected on demographics. A paired t test was conducted to compare the statistical significance of the results. A quantitative software tool was used to analyze the data. Study results showed a confidence interval of 95% at p = 0.15, indicating that cultural competence informational modules made a significant difference between the pretest and the posttest of the Cultural Competence Self-Assessment Checklist. Thus, cultural competence informational modules make a difference in public health nurses' awareness, knowledge, and skills, which can enhance their ability to provide culturally competent care to racial and ethnic minorities. The implications of this project for social change include supporting health care professionals' ability to promote and implement cultural competence practices for all populations to decrease health disparities

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This dissertation examined the extent to which medical educational institutions adapt their curriculum to meet the needs of a marginalized patient population, lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Because LGBTQ populations experience significant health and health care disparities in comparison to heterosexual and cisgender populations, medical education and medical curriculum about LGBTQ health has been described as a key area of intervention for improving doctor-patient interactions and health system structures to better accommodate these populations. Through a 10-month long ethnography of a medical school, I examined the formal, informal, and hidden curricula surrounding LGBTQ health to explore how medical schools train and thus adequately prepare medical students to provide care to these patients. To investigate these issues, I conducted over 100 hours of participant observation of medical classes and clinical rotations, with particular attention to clinical case studies and online learning modules that are relevant to LGBTQ health, and LGBTQ health initiatives on the academic medical center campus. I also conducted 46 semi-structured interviews with faculty, students, administrators, LGBTQ Health Center employees, and LGBTQ patients about LGBTQ health care at the medical school and about how these groups define and implement LGBTQ health at the institution. Findings suggest that the content, placement, and delivery of LGBTQ health in the curriculum influence how medical students learn to see themselves as capable of providing care to these patients. In particular, the nebulous nature of LGBTQ health makes it difficult for students to learn to enact it in practice. This research asserts that to create medical curriculum about LGBTQ health that will help alleviate health care disparities, medical schools cannot simply add LGBTQ health into their curriculum without fundamentally changing how they teach sex/gender and sexuality to their students as well as centering intersecting inequalities in their teaching. As such, this dissertation calls for a shift to queer health to decentralize sex/gender and sexuality binaries and focus on the practice of learning about LGBTQ health rather than fulfilling a competency. Ultimately, this research theorizes medical education as a space for the enactment of LGBTQ health whereby the complexity of sex, gender, sexuality, and identity gets negotiated by medical faculty, students, administrators, and LGBTQ community members. / Doctor of Philosophy / This research examined how medical schools change their curriculum to incorporate health topics related to lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Because LGBTQ populations experience worse health and in comparison, to heterosexual and cisgender populations, medical education about LGBTQ health has been described as a key area for medical educators to adapt the curriculum to meet the needs of these patients. Medical educators hope to improve doctor-patient interactions and health system structures to provide better care to these populations. Through a 10-month long ethnography of a medical school, I examined the teachings surrounding LGBTQ health to explore how medical schools train and thus adequately prepare medical students to provide care to these patients. To investigate these issues, I observed over 100 hours of medical classes and clinical rotations, with particular attention to clinical case studies and online learning modules that are relevant to LGBTQ health, and LGBTQ health initiatives on the academic medical center campus. I also interviewed 46 people, including faculty, students, administrators, LGBTQ Health Center employees, and LGBTQ patients, about LGBTQ health care at the medical school and about how these groups define LGBTQ health. Findings suggest that where LGBTQ health is located in the curriculum as well as who teaches the subject influences how medical students learn to see themselves as able to provide care to these patients. In particular, the broadly defined nature of LGBTQ health makes it difficult for students to learn how to provide this care to patients. This research asserts that to create medical curriculum about LGBTQ health that will help alleviate health care disparities, medical schools cannot simply add LGBTQ health into their curriculum without fundamentally changing how they teach sex/gender and sexuality to their students as well as centering intersecting inequalities in their teaching. As such, this dissertation calls for a shift to queer health to focus less on sex/gender and sexuality binaries and to focus more on the practice of learning about LGBTQ health rather than fulfilling a competency. Ultimately, this research states that medical education is a space for the enactment of LGBTQ health whereby the complexity of sex, gender, sexuality, and identity gets negotiated by medical faculty, students, administrators, and LGBTQ community members

Currently only 5.7% of physicians in the United States (U.S.) are Black/African American. This comprehensive analysis explores the significant underrepresentation of Black/African American physicians in the United States, a problem that has persisted for over 100 years. This investigation traces this disparity back to the Flexner report, a document that revolutionized medical education for the benefit of the white population but to the detriment of Black and other vulnerable populations. There is a critical examination of the ethical implications of the Flexner report, arguing that it has contributed to health disparities resulting in shortened lives for Black men, women, and children. Moreover, the roles played by private institutions such as the Carnegie Foundation, the Rockefeller Foundation, the Accreditation Council for Graduate Medical Education and the American Medical Association and the U.S. federal government in initiating, funding or upholding the changes resulting from Flexner’s report are delineated. Most importantly, the efforts, as a result of the formation of the National Medical Association to overcome the obstacles placed in front of Black healthcare providers in caring for people of color is revealed. In exposing the damage done to physicians and patients of color there are also proposals of solutions to reverse the ethical harm done because of the Flexner report's implementation, including reparations for Black healthcare providers and patients adversely affected by the Flexner report. In conclusion there is an in-depth analysis of the history and impact of the Flexner report, the ethical and moral imperatives of reparations, and the feasibility and potential impact of these reparations. / Urban Bioethics

Despite the existence of effective treatments, mental health care disparities exist in the availability, accessibility, and quality of services for racial and ethnic minority groups. People living with serious mental complaints often resist engaging in treatments and experience high rates of dropout; poor engagement can lead to worse clinical outcomes. Addressing the complex mental health care needs of racial and ethnic minorities warrants considering evidence-based strategies to help reduce disparities. This systematic review sought to provide an analysis of published literature about the barriers and effective strategies in identifying and treating minority patients with mental health disorders. The practice-focused question of this systematic review was: What are the barriers and effective strategies to identification and treatment of mental health disorders among minority populations. This project was guided by PRISMA and SQUIRE guidelines and Fineout-Overholt and Melnyk’s appraisal form, comprising 11 studies published between 2014 and 2019, identified through Thoreau, Cochrane, CINAHL with Medline, EBSCO, and ProQuest, SAMHSA and PubMed databases. The systematic review results recommend intervention strategies such as integrated/collaborative care, workforce diversity, providers in minority neighborhoods, improving providers’ cultural skills, and stigma reduction to help reduce mental health care disparities. These findings are significant to lowering the gap in practice and can be used by the entire health care system to improve mental health care, thereby leading to a positive social change. Implementing these strategies would benefit patients, families, their communities, and the entire health care delivery system.

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