Racial, ethnic, and linguistic minority workers suffer higher rates of work-related injuries and illnesses in the United States compared to their White counterparts. Explanations for these higher rates include potential socioeconomic causes (education, income, and wealth) and occupational segregation into more dangerous occupations. What is less studied are the post-injury sequelae for minority workers, which is their experiences in the workers' compensation system, as well as their health and return to paid employment. What is known comes primarily from qualitative literature, which includes themes of racial discrimination (from employers, health care providers, and workers' compensation employees), a lack of information on how to navigate the workers' compensation system, and linguistically inappropriate communication with those whose first language is not the majority language. In addition, qualitative studies have found differences in the treatment of minority workers, delays in receiving partial wage payments, and worse health outcomes. Most studies examining minority workers in the workers' compensation system have not provided a theoretical framework from which to test hypotheses as to why differences exist in a social insurance system based on race, ethnicity, and language. The purpose of this dissertation was to test the role of racial discrimination in creating worse post-injury workers' compensation outcomes for minorities, compared to English speaking Whites. This dissertation utilized fundamental cause theory to frame the hypotheses and analyses in a cross-sectional investigation of differences in workers' compensation system outcomes, using both administrative data from the workers' compensation agency, as well as survey responses from a sample of 488 injured workers in Washington State. The survey, conducted by Washington State University Social and Economic Science Research Center (SESRC), provided many variables not available in the WC administrative data including measures of perceived racial discrimination to test the hypotheses that racial discrimination is a fundamental cause of worse workers' compensation outcomes for minorities. Fundamental cause theory suggests that there are basic or fundamental reasons for health disparities that are not caused by mechanisms linking the fundamental cause with a health outcome; in fact, these mechanisms can and do change, but the relationship between the primary cause and the health disparity outcome will remain. In addition, a fundamental cause affects multiple outcomes via multiple mechanisms. Access to resources such as income, wealth, prestige, knowledge, and beneficial social connections can reduce the impact of a disease once it occurs. The analytic chapters in this dissertation are organized first, to address racial discrimination in health care provider outcomes; second, to address racial discrimination in workers' compensation agency outcomes; and third, to address the role of pre-injury racial discrimination in post-injury return to work outcomes. Racial discrimination was tested in this dissertation as the fundamental cause of health-care provider disparities in timeliness of follow-up care, adequacy of care, and patient satisfaction. Racial discrimination was tested in the workers' compensation agency as the fundamental cause of administrative delays and difficulties: delays in diagnostic approval and wage replacement payments, as well as language appropriate communication, and higher counts of independent medical exams. Racial discrimination was also tested as the fundamental cause of poor return-to-work outcomes (feeling a worker returned to work too early and overall general health). Workplace support, as a possible resource (social connection), was tested as a mediator in the relationship between racial discrimination and workplace outcomes. Due to the survey nature of the study design, replicate weights were calculated based upon information available in both the surveyed and not-surveyed population to account for non-response bias, and all analyses were bootstrapped using Stata survey software. The results support the role of racial discrimination as a fundamental cause of outcomes for hypotheses in the workers' compensation agency with clear differences in delays for diagnostic services, a higher number of independent medical exams, as well as linguistically inappropriate communication for language minorities. Racial discrimination (prior to injury) was found to be significant in overall general health for minority workers, and for feeling they had returned to work too early. Workplace support (a potential social resource), was found to mitigate the role of racial discrimination in the workplace return-to-work outcomes. This study is an initial effort to examine racial discrimination as a fundamental cause of disparities in occupational health after an injury. As the majority of adults will spend one-fifth to one-third of their lives in paid employment, the ability to heal and return to full and active employment after a work-related injury is critical to ones' self-worth, as well as to the economic stability of individuals, families, and societies. If racial, ethnic, and language minorities suffer worse outcomes in their post-injury sequelae, these results will have long-lasting implications in any quest for a more equitable society.

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The primary focus of the current study was to identify health disparities between sexual minority subgroups by examining differences of health indicators in lesbians, gay men, and bisexual individuals, and compare these to their heterosexual counterparts. Data was drawn from the National Health and Nutrition Examination Survey (NHANES), and variables examined in sexual minorities were related to health care access and utilization, risky health behaviors, and overall disease prevalence and outcomes. Findings suggest there are still some current health disparities in terms of insurance coverage, access to medical care, substance use, and prevalence of certain health conditions. However, a trend analysis conducted to examine three NHANES panels, suggests a mild improvement in some of these areas. Further findings, discussion, limitations of the study, current implications, and future directions are addressed.

The United States population continues to increase and diversify. The cultural composition within the United States embodies a multitude of people from a variety of belief systems, religious backgrounds, and ethnicities. Within current biomedical practice, many of these differences are often marginalized, leaving populations with unsatisfactory experiences in seeking health care. Cultural competency attempts to address those differences in health care delivery. Many health care institutions are striving to become more culturally competent yet there is not a common understanding of what cultural competency means. In addition, there are many obstacles that limit the implementation of cultural competency in health care delivery. This thesis examines the need for cultural competency in health care, addressing the lack of understanding between institutions regarding cultural competency and assessing its understanding at one particular institution. Recent research at Oregon Health & Science University in Portland, Oregon has provided new insight to the discussion of cultural competency and how uniquely it can be defined in a single institution. Qualitative interviews were conducted with medical students, physicians/physicians-in-training, administrators and nurses/CMA in order to uncover how cultural competency is defined as well as the issues that are involved when delivering culturally competent health care. By being aware of an institution's cultural composition and understanding of cultural competency can help that institution enact health programs and policies that have a better chance of representing and respecting the populations they serve. / Graduation date: 2003

Gender and sexual minorities (GSM) experience considerably worse health outcomes than heterosexual and cisgender people, yet no comprehensive understanding of GSM health exists due to a dearth of research. GSM leaders in Dallas expressed need for a community needs assessment of GSM health. In response to this call, the Center for Psychosocial Health Research conducted a needs assessment of gender and sexual minority health in Dallas (35 interviews, 6 focus groups). Competency was one area highlighted and shared across existing research. Thus, the current study explored how competency impacts gender and sexual minorities' experience of health care in Dallas. We utilized a consensual qualitative research approach to analyze competency-related contents. The meaning and implications of emerging core ideas were explored. These findings were also used to develop a survey instrument.

The study was to investigate the effectiveness of Sociocultural Competency Training (SCCT) as an intervention in enhancing self-efficacy among trainees in the health care profession. The purposes of the study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning ofthe sociocultural competencies, and (c) to identify the factors that contribute to effective outcomes. A sample of 84 participants in the Health Sciences program at the Vancouver Community College was recruited. There were 26 local born Canadians and 32 immigrants in the experimental group, whereas 11 local born Canadians and 15 immigrants were in the control group. Experimental group participants took part in an 18- hour training over a 6-week period as part of their regular Human Relations Skills course curriculum. The control group also took the same training course after post-test data collection. This study used both quantitative and qualitative methods. Self-efficacy and behavioural performance were assessed quantitatively by the results from the General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedback from 28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group. The results of this study supported the hypotheses that the Sociocultural Competency Training was effective in improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The hypothesis that there would be more significant change in participants' social self-efficacy was also supported. The Sociocultural Competency Training offered effective ways of helping people develop positive self-efficacy and behavioural competencies. Participants reported the training enabled them to have the sociocultural competencies to conduct their professional career in a multicultural community. In the future, the training can be used with high school students, college and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success.

The study was to investigate the effectiveness of Sociocultural Competency Training (SCCT) as an intervention in enhancing self-efficacy among trainees in the health care profession. The purposes of the study were threefold: (a) to evaluate the effectiveness of the training in enhancing the trainees' self-efficacy and behavioural performance; (b) to examine their personal experiences in the learning ofthe sociocultural competencies, and (c) to identify the factors that contribute to effective outcomes. A sample of 84 participants in the Health Sciences program at the Vancouver Community College was recruited. There were 26 local born Canadians and 32 immigrants in the experimental group, whereas 11 local born Canadians and 15 immigrants were in the control group. Experimental group participants took part in an 18- hour training over a 6-week period as part of their regular Human Relations Skills course curriculum. The control group also took the same training course after post-test data collection. This study used both quantitative and qualitative methods. Self-efficacy and behavioural performance were assessed quantitatively by the results from the General Self-Efficacy Scale (GSE), Situational Social Avoidance Scale (SSA), Social Self-Efficacy Scale (SSE), and Interpersonal Skills Checklist (ISC-33). Qualitative data was collected through written feedback from 28 participants and semi-structured interviewing with 24 volunteer interviewees in the experimental group. The results of this study supported the hypotheses that the Sociocultural Competency Training was effective in improving the interpersonal skills and lowering the social avoidance tendency among participants in the experimental group when compared to individuals in the control group. The hypothesis that there would be more significant change in participants' social self-efficacy was also supported. The Sociocultural Competency Training offered effective ways of helping people develop positive self-efficacy and behavioural competencies. Participants reported the training enabled them to have the sociocultural competencies to conduct their professional career in a multicultural community. In the future, the training can be used with high school students, college and university students, international students, professionals, business people, and expatriates who need to learn the sociocultural competencies for career success. / Education, Faculty of / Educational and Counselling Psychology, and Special Education (ECPS), Department of / Graduate

This study examined the experiences of United States America nurses caring for Mexican immigrant women; it focused on the language and cultural barriers that appear to be critical factors in delivering culturally appropriate healthcare. The questions that guided the research were: What adjustment issues .related to providing culturally appropriate healthcare to female Mexican patients do nurses have to face? What specific knowledge, skills can nurses learn to handle issues of cultural differences in patient care? Ten U.S. American nurses caring for Mexican immigrant women were interviewed; from these interviews, critical incidents were developed specific to caring for female Mexican women issues. Subsequently four bi-lingual bi-cultural Mexican women reviewed the incidents; their comments and incidents were incorporated into a cultural sensitizer to be used in future trainings of U.S. American nurses caring for Mexican immigrant women. My research shows that in attempting to make sense of ambiguous situations, U.S. American nurses tend to attribute the cause of Mexican immigrant women behavior through their own cultural filter. For this research, I identified salient intercultural concepts and skills that should be taught to U.S. American nurses caring for Mexican immigrant women. These intercultural skills, knowledge, and concepts are incorporated into the cultural sensitizer I designed and can be found in Chapter VI.

The purpose of this study was twofold. First, the study evaluated Loma Linda University Medical Center's (LLUMC) Diabetes Treatment Center's (DTC) effectiveness in providing diabetes education and services to high risk minority populations. Second, the results of the study helped the DTC determine the need for expanding its present efforts in the form of community health prevention services to San Bernardino County residents.

Indiana University-Purdue University Indianapolis (IUPUI) / The increase in diverse populations with unique, culturally specific needs, along with the lack of diverse healthcare providers to deliver culturally competent care, has escalated the need for non-diverse practitioners to gain the knowledge, skills, and attitudes to deliver culturally competent care. Culturally competent care cannot be offered to patients unless nurses understand how cultural values, attitudes, and beliefs impact patients' response to care. Nurses must develop cultural competence to accurately access, develop, and implement effective nursing interventions. The purpose of this exploratory, quasi-experimental, pretest-posttest study was to explore the impact of an intercultural service learning experience (domestic or international) on pre-licensure nursing students' perceived development of transcultural self-efficacy. A convenience sample of senior semester nursing students enrolled in a private, faith-based, baccalaureate degree nursing program in the Midwest United States completed the Transcultural Self-Efficacy Tool (TSET), Cultural Competence Clinical Evaluation Tool-Student Version (CCCET-SV), and reflective journals. All students were immersed in an intercultural service learning experience. Eighteen students traveled domestically and 38 traveled internationally. The data revealed that there was not a statistical difference in TSET scores based on location of the intercultural experience. However, there was a statistically significant difference from pretest to posttest for perceived Cognitive, Practical, and Affective dimensions of transcultural self-efficacy, in change scores (pretest to posttest), and pretest to posttest for pre-licensure BSN students’ perceived clinical competence behaviors (culturally sensitive and professionally appropriate attitudes, values, and beliefs) following an intercultural service learning experience.