The purpose of this study was to better understand the way that intersectional identities affect one's perception of one's healthcare experience. Many previous studies focus on one facet of the minority experience, such as race or sexual orientation, and even then, limit it to a comparison between the majority population and one small subsection of the population of interest (ex: studying only African-Americans as racial minorities and disregarding other minority races). This study was more of a broad survey that sought to account for the unique intersection of different minority identities that one may possess and which ultimately affects how they are perceived and treated in society. This study surveyed 115, primarily college-aged, participants that fell into one of four categories: White/Caucasian and Cisgender/Heterosexual, White/Caucasian and LGBTQ+, Racial Minority and Cisgender/Heterosexual, and Racial Minority and LGBTQ+. Participants were asked to complete an open-ended survey and a Likert scale to rate and review their experiences with healthcare in general, and in regards to their identity. Results showed that although minority participants, especially those who were double minorities (racial minority and LGBTQ+) did not always explicitly express being discriminated against, they often showed it through other ways, such as being more likely to report distrust of their healthcare provider or an unwillingness to seek healthcare despite possessing health concerns. LGBTQ+ individuals were also much more likely to report discriminatory practices in healthcare than racial minorities or the majority group on a statistically significant level. This indicates that minority identities predispose individuals to lower quality of care and this health discrepancy manifests at different intensities based on an individual's specific minority makeup.

Although the concept of culturally responsive practices (CRP) began in the 1990’s, intentional study and professional development varies across schools and districts with limited impact on sustained pedagogical efficacy and shift, which is particularly concerning during the current socio-political climate. This phenomenological case study examined the impact on participants studying culturally responsive practices in peer led professional learning communities as a blueprint to feasibly address adult skill gaps. The study centers on four core questions on the impact of the initiative in general, the ability of participants to address implicit bias, the use of peer facilitation, and additional unforeseen factors related to this method of learning. Each participant ultimately indicated significant growth by moving from a technical approach to adaptive and cognitive shifts within the 6-month study, increased emphasis on reflective practice and elevated urgency to address culturally non-responsive practices. Finally, core conditions for successful implementation of peer-led professional learning communities studying culturally responsive practices are discussed. Schools and districts who recognize the need for staff to improve in cultural proficiency have few excuses pertaining to their ability to engage in this critical work, provided they have the courage and will to address implicit bias and culturally non-responsive pedagogy which negatively impacts BIPOC students across the nation and world.

Heavy/at-risk alcohol use among young adults is an important public health problem given its association with health risk behavior and negative consequences. Dual process models of self-control characterize heavy/at-risk alcohol use as a function of (1) automatic appetitive processes and (2) conscious control processes. While existing interventions typically focus on individuals’ conscious control processes, recent research has focused on targeting automatic appetitive processes directly through strategies such as Cognitive Bias Modification (CBM). Although there is some evidence that CBM may improve outcomes for patients in treatment for alcohol use disorder, there is less evidence for its efficacy among young adults. This has been attributed to utilizing CBM as a stand-alone intervention and recruiting samples with low motivation to change drinking in prior studies. To address these limitations, this study examined the efficacy of CBM as an adjunct to brief web-based motivational intervention among young adults interested in changing their drinking. Heavy drinkers, ages 18-34, were recruited through social media platforms and completed an online screener. Eligible participants (N = 81) completed baseline assessment and a web-based motivational intervention (NIAAA- Rethinking Drinking). Participants were randomized to one of two adjunct intervention conditions—CBM or SHAM (control)—that was completed following the motivational intervention and over 4 sessions in the ensuing week. Weekly number of drinks, weekend drinking, alcohol-related consequences, readiness to change, and implicit biases toward alcohol were measured at baseline, 1-week and 1-month follow-up. Intervention condition did not significantly predict the primary outcomes of weekly drinking or consequences at 1-month, controlling for sex. In addition, intervention condition was not associated with implicit bias toward alcohol at 1-week or 1-month follow-up, controlling for sex. Post-hoc analyses revealed the intervention may be differentially efficacious for individuals high, versus low, in readiness to change. Overall, this web based CBM intervention did not reduce drinking behavior, consequences, or implicit biases compared to SHAM. Future work should focus on alternative strategies to modify automatic processes to enhance motivational web-based interventions, particularly among individuals highly motivated to change their behavior.

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The pediatric emergency department (PED) provides a unique environment to consider ethical issues faced in modern healthcare. Using a combination of personal reflections and a review of current literature, ethics within the PED is explored as it pertains to four categories: informed consent, health literacy, language barrier, and implicit bias. Parental consent is generally required for pediatric care, but there are exceptions encountered in the PED. Although children typically cannot provide consent, soliciting assent respects their autonomy and maturing cognitive development. Limited health literacy is a prominent issue in the U. S., yet healthcare information continues to be delivered in ways that do not adequately account for this. Change will necessitate creative solutions and reorientation to a focus on health equity and justice. Physician implicit bias may be related to a patient’s negative behaviors or inherent characteristics (e.g. race), and can result in adverse health outcomes for affected children. Physicians should confront their subconscious biases through introspection, open discussion, and implicit-bias training. Access to healthcare information in one’s native language is a basic human right protected by law. Use of qualified medical interpreters can alleviate disparities faced by patients with limited English proficiency, but may be underutilized in the PED. / Urban Bioethics

This study sought to understand how high school social studies teachers identify and evaluate uses of digital technologies to implement in their classrooms. The research was a case study of three teachers guided by the question: What factors and relations shape social studies teachers' uses of digital technologies within a unit of instruction? The research question was intentionally broad to help grasp the factors and relations perceived by the teachers and not ones predetermined by the researcher. For more than thirty years the literature on digital technology use in social studies classrooms has been filled with promises of potential, calls for change in instructional practices with technology, and expressions of frustration when that change does not come. It is still fairly unclear how teachers experience uses of digital technologies and internalize their experiences to form perceptions of best practice with technology. This dissertation looked at how three high school social studies teachers experienced and defined effective technology use and the factors impacting their perceptions. The findings indicate the teachers' pedagogical approach to social studies instruction, their perceptions of their students engagement, technical knowledge, and behavior, and their experiences with the reliability and accessibility of the technology tools available to them were the biggest factors and relations impacting digital technology use in a unit of instruction. Teachers acted as gatekeepers of technology integration through a reliance on defensive teaching tactics limiting student access to digital technology beyond watching presentations and videos. These actions were, in part, due to actions that aligned with implicit racial biases found in other research around how teachers perceive students of color uses of technology. Despite stated beliefs about the desire to engage students with technology, each teacher knowingly chose to focus on using technology for knowledge transmission to meet their ultimate goal of higher SOL test scores. / Doctor of Philosophy / This study sought to understand how high school social studies teachers identify and evaluate uses of digital technologies to implement in their classrooms. The research was a case study of three teachers guided by the question: What factors and relations shape social studies teachers' uses of digital technologies within a unit of instruction? This dissertation looked at how three high school social studies teachers experienced and defined effective technology use and the factors impacting them. The findings indicate the teachers' instructional approach to social studies, their perceptions of their students engagement, technical knowledge, and behavior, and their experiences with the reliability and accessibility of the technology tools available to them were the biggest factors and relations impacting digital technology use in a unit of instruction. Teachers acted as gatekeepers of technology integration through a reliance on limiting student access to digital technology beyond watching presentations and videos. These actions were, in part, due to what aligns with an implicit racial biases found by research around how teachers perceive students of color's uses of technology. Despite stated beliefs about the desire to engage students with technology, each teacher knowingly chose to focus on using technology for knowledge transmission to meet their ultimate goal of higher SOL test scores.

Purpose: The Standardized Patient [SP] Program is a potential avenue through which students from races and ethnicities underrepresented in medicine [URiM] experience bias, due in part to the inherent subjectivity of an SP’s evaluation of the doctor-patient interaction. In most training programs, medical students are assessed on their clinical and interpersonal skills via simulated encounters where students assume the doctor role and SPs act as patients. Researchers conducted this qualitative study to (1) understand the SPs’ perception of their role within the Objective Structured Clinical Exam and medical school education, (2) investigate biases that medical students may experience during SP evaluations of simulated clinical encounters.Methods: Participants were recruited from Lewis Katz School of Medicine at Temple University. Interviews and focus groups were conducted between August through October of 2022. A total of 14 medical students, 11 of which self-identified as URiM, were distributed into 6 focus groups. A total of 9 SPs were interviewed, 3 of which self-identified as non-white ethnic minorities. All interviews were then transcribed and analyzed using a combination of first-cycle coding methods. In the final stages of analysis, we examined the data to determine frequent themes across the study populations. Results: The results demonstrated conflicting sentiments between SPs and students. Although SPs described an intensive training process that promoted standardization of DPI scoring across SPs, URiM students reported high interrater variability, referring to the variation in the interpretation of a student’s communication skills by SPs. The consensus amongst minority students was that SPs evaluate students more leniently in interactions where the SP and student share ethnic identities. The themes present in the resulting data aligned closely with a social determinants of health conceptual framework, illustrating how disregarding the topic of implicit bias in the SP Program leads to a downward trajectory of differential attainment. Conclusion: Although medical education administrators have begun shifting their attention towards diversity, equity, and inclusion initiatives, there has been minimal focus on the key perspectives necessary to navigate this space. Our research analyzes those perspectives as an important first step towards acknowledging and effectively mitigating bias in medical education programs. / Urban Bioethics

Augmented reality (AR) is an emerging technology with immense potential for enhancing human-to-human interaction tasks, particularly in high-risk environments such as mass casualty incident (MCI) tri-age. However, developing practical and effective AR tools for this purpose necessitates a meticulous user-centered design (UCD) process, thoughtfully crafted and validated through iterative testing with first responders in increasingly contextually relevant simulations. In academic circles, the perceived complexity and time requirements of such a process might discourage its adoption within the constraints of traditional publishing cycles. This is likely due, in part, to a lack of representative applied UCD examples. This work addresses this challenge by presenting a scholarly UCD framework tailored specifically for MCI triage, which progresses seamlessly from controlled, context-free laboratory settings to virtual patient simulations and finally to realistic patient (actor) scenarios. Moreover, MCIs and triage are under-served areas, likely due to their high intensity and risk. This means developers need to 'get it right' as quickly as possible. UCD and evaluation alone are not an efficient means to developing these complex and dangerous work domains. Thus, this research also delves into a cognitive work analysis, offering a comprehensive breakdown of the MCI triage domain and how those findings inform future AR sup-ports. This analysis serves to fortify the foundation for future UCD endeavors in this critical space. Finally, it is imperative to recognize that MCI triage fundamentally involves human-to-human interaction supported by AR technology. Therefore, UCD efforts must encompass a diverse array of study stimuli and participants to ensure that the technology functions as intended across all demographic groups. It is established that racial bias exists in emergency room triage, creating worse outcomes for patients of color. Consequently, this study also investigates the potential impact of racial biases on MCI triage efficacy. This entire body of work has implications for UCD evaluation methodology, the development of future AR support tools, and the potential to catch racially biased negative performance before responders ever hit the field. / Doctor of Philosophy / Augmented reality (AR) is uniquely situated to make work within high-risk work environments, like mass casualty incident (MCI) response, safer and more effective. This is because AR augments the user's reali-ty with context-relevant information, like by providing a temperature gauge for firefighters that is always in their visual field. Development of such AR tools for a sensitive arena like MCIs requires several rigor-ous steps before those tools can be deployed in the field. It is crucial to engage in a user-centered design (UCD) process in partnership with actual emergency responders so they can help us understand what help they need. We outline that UCD process in Chapter 2. Once we understand what responders say they need help with, we then need to evaluate those pinch points in the broader context of their work. This means that we evaluate how their job process creates the situation where responders need the kind of help they are asking for. Understanding this helps us create solutions that address the responder's needs while we minimize any new problems created with implementing a new tool into the job. What we learned from examining the work domain is described in Chapter 3. Once we have this firm foundational understanding of responder needs and work and we have designed an AR support tool, we need to evaluate that tool for effectiveness. It is too dangerous to put the AR tool straight into the field, so Chapter 4 explores how we can create simulations of an MCI scenario to study our AR support tool. Finally, after evaluating our AR tool within the scenarios and the scenarios themselves, we evaluate (in Chapter 5) other facets of the job that may be impacting MCI response. In our case, we explore how racial bias may be impacting patient care. It is important to study bias as it has implications for future MCI training and AR tool development. Perhaps future work can explore an AR tool that offsets bias-based performance, or a training that helps catch bias before responders ever get to the real field.

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