BACKGROUND: Patient navigators have been shown to reduce cancer disparities among racial/ethnic minorities by improving timely diagnosis and treatment of cancer. We sought to determine if race/ethnicity and language concordance of patients and their navigator improved time to diagnostic resolution of breast and cervical cancer screening abnormalities. METHODS: Demographic data on patients and navigators from the Boston Patient Navigation Research Program were used to assess concordance by race, ethnicity, and language. Kaplan-Meier survival curves and Cox proportional hazards regression models examined the association of race/ethnicity and language concordance on time to definitive diagnosis of cancer screening abnormalities. All analyses were performed separately for breast and cervical groups. RESULTS: There were 1257 patients and 23 navigators in this study. In the breast group (n=655), 44% of patient-navigator pairs were concordant by race/ethnicity and 75% were language concordant. In the cervical group (n=602), 70% of patient-navigator pairs were race/ethnicity concordant and 87% were language concordant. There was no association with race/ethnicity concordance and time to diagnostic resolution for the breast group, aHR 1.19 (95% CI: 0.97, 1.46) or cervical group, aHR 1.23 (95% CI: 0.99, 1.53). However, in the stratified analysis, race/ethnicity concordance was associated with timelier resolution for minority women with breast and cervical cancer screening abnormalities but not for Whites. For cervical cancer screening abnormalities resolving in less than 90 days, language concordance was also associated with timelier resolution, aHR of 1.46 (95% CI: 1.18, 1.80) but there was no association in the breast group. In the subgroup analysis of Spanish concordance there was also an association of timelier resolution for those with cervical cancer screening abnormalities resolving in less than 90 days. CONCLUSION: Patient-navigator race/ethnicity concordance is associated with timelier diagnostic resolution of breast and cervical cancer screening abnormalities among minority women. Language concordance is also associated with timelier resolution in participants with cervical cancer screening abnormalities despite the availability and use of interpreters. Given poorer cancer outcomes among minority women, the use of patient navigators that are diverse by race/ethnicity and multilingual may help address barriers to care and improve health outcomes among low-income minorities.

Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of participants, cross-sectional methods, and participant report of clinical services utilized. Few researchers have sought to analyze actual clinical presentation, service utilization, or clinical outcome of sexual minority women in a treatment-setting. This study is an in-depth clinical analysis of 215 sexual minority woman who sought services at a large Midwestern university counseling center over a period of two years and nine months. The analyses conducted allowed for the initial clinical presentation, service utilization, and clinical outcome of sexual minority women to be described and compared to comparative samples of service-seeking female college students. Sexual minority women were found to have a greater incidence of prior suicidality and prior counseling compared to heterosexual women at the same agency. Sexual minority women also reported greater symptoms of social anxiety, eating concerns, and family distress than heterosexual women at the same agency. Of seven examined predictors of service utilization, sexual minority identity label, age, and academic term of service initiation differentiated brief and extended service utilization from moderate service utilization. Prior use of counseling, psychological distress, racial-ethnic minority status, and time in the semester of initiation of services were not significant predictors of service utilization. Implications and limitations of these findings are presented, and future directions for research and intervention are discussed.

No description available.

Research on diversity in the workplace is expanding to include multiple categories including, race, gender, and LGBT identities. Government agencies should have a workforce that represents a diverse public. This is a challenge because agencies and their employees are not immune to the social processes that produce inequalities. A central question in public administration is how to improve practices in the recruitment, management, and retention of a diverse workforce. I theorized that employee perceptions are affected by inequalities based on the intersections of race, gender, and sexuality. The purpose of this study was to determine if employee perceptions were influenced by intersectional identity patterns. The dominant framework in the literature proposes that the separate and additive effects of stigma, stereotypes, and bias influence employee perceptions at work. Intersectionality challenges this approach by conceptualizing social identity as the combination of identity categories. I provide a methodology for comparing the difference in fit between additive and intersectional models.The findings of this study demonstrate the greater explanatory power of intersectionality through replication and extension of Sabharwal et al.'s (2019) study of turnover intention. The replication analysis finds errors in the original models that, when corrected, provide stronger evidence for their hypotheses. Tests indicate that the intersectional model fit the data better than the additive model. The models show that patterns of turnover intention are conditional, shaped by intersectional combinations of race, gender, and sexuality. The patterns of diversity revealed in these models show that the effect of diversity is complex—it is more than the sum of its parts. The results change our understanding of diversity inclusion within the federal workforce, employee retention, and satisfaction. I discuss recommendations for managers in government agencies seeking to improve diversity inclusion practices in the federal workforce.

No description available.

This dissertation study used Yosso’s (2005) concept for Community Cultural Wealth as a conceptual framework to explore the identities, lived experiences, and aspirations of ten mothers of color from Jackson Heights, Queens, N.Y., as it relates to the education of their children to inform culturally relevant education in New York City K-12 schools. The following research questions guided the study: 1. What educational aspirations do mothers of color have for their children? 2. How have the mothers’ lived experiences informed their decisions concerning the education of their children? 3. In what ways can the identities, lived experiences, and narratives/perspectives of mothers of color in Jackson Heights inform culturally relevant education policy, leadership, and practice? This study used qualitative methods (Few, Stephens, & Rouse-Arnett, 2003) and standpoint theory (Harding, 1991; Smith, 1974) to capture the identities, lived experiences, and aspirations of mothers of color, to recognize and mobilize experiences of inequity, injustice, and marginalization in the education of students of color. The inclusion and expansion of research that centers and reflects the points of view of mothers of color can create greater opportunities for school leaders and teachers committed to dismantling racial inequities in schools to increase their consciousness and improve their leadership and practice.

This study focused on the self-efficacy and experiences described by a purposively sampled case (n = 8) of high school-aged underrepresented minority women (URMW) as they entered the medical career pipeline through their participation in a formal medical pipeline program. The study was framed by three theories: intersectionality, positionality, and self-efficacy. Research questions were analyzed qualitatively, using case study methods, and quantitatively, using a paired sample t-test. Study data revealed that participants came into the program with high levels of self-efficacy in several self-efficacy factors. Yet, participants in the pipeline program made significant improvements in their self-assertive efficacy. Analysis of other data revealed that students remained motivated and persisted in the pursuit of their aspirations in spite of challenges they encountered because of their ethnicities and gender. Also, students described a lack of engagement with science courses, indicated poor relationships with science instructors, and revealed inadequate understanding of important high science content that, along with ethnic and gendered factors, caused them to negatively position themselves in science. This study provides valuable information to K-12 science educators, medical education institutions, and policy makers concerned with extending science education and healthcare-related career opportunities to minority women.

No description available.

Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed. / Doctor of Philosophy / LGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.

The purpose of this qualitative narrative research study was to interpret the meaning found throughout the formal educational experience stories of Native American, Asian American, and African American women born after 1944, who had earned an education doctorate degree after 1976, and were working with adults in an educational capacity within the community. Utilizing the snowball technique, 14 participants from across the United States volunteered to collaborate with the researcher. The study's conceptual framework included adult learning principles and practices, Nussbaum's 'narrative imagination,' which were used to examine the women's motivation to participate in an education doctorate program as well as the barriers, the enhancers, and the application of the degree in the community. Data collected included an in-depth, face-to-face interview, two reflective narrative guides, document analysis, and researcher journals and analytic memos. All data was coded and analyzed with Atlas -ti 5.0 software, and thematic analyses completed in order to triangulate the data. Six major themes for motivation to participate were found: self-awareness through placement in the family, family and community expectation in importance of education, personal strengths and weaknesses, perceived differences in the classroom and mainstream society, and knowledge of motivation to pursue doctorate. Five barriers emerged: racism, gender, advisers, institutional changes and problems, and juggling multiple roles in limited time. Five main enhancers arose: family and community foundation, financial, friends, and others which motivated participation. / The women applied their doctorates through leadership activities in community-based organizations such as role modeling, mentoring, and other scholarly activities which advocated "giving back culturally," which was the ultimate meaning or value of the degree; however, achievement and credibility were also valued a doctorate degree was "only step in the process." This study provided a space for rich descriptive storytelling about each woman's successful experience pursing and completing an education doctorate program. Adult learning discussion of the findings, contributions to the literature, and recommendations for graduate education and future research were included. / by Jo Ann Marie Bamdas. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.