The Labrador Innu lived for millennia in the Quebec-Labrador Peninsula as nomadic hunters. Commencing in the 1950s, successive policies imposed on the Innu by federal and provincial governments brought significant disruptions to their traditional way of life. Today, the Labrador Innu are settled in the communities of Sheshatshiu and Natuashish in the province of Newfoundland and Labrador, Canada. They have maintained their language and culture, anchored in their understanding of territory and their relationship with their ancestral land, and have increasingly asserted their self-determination, including in research. The Innu articulated a Healing Strategy in 2014 after extensive community consultations. The Strategy states that a contemporary return to culture would provide healing to individuals and communities. Healing is important due to the social suffering experienced through sudden forced settlement and schooling in a non-Innu system. These abrupt changes altered the social fabric that had sustained Innu society for millennia. As part of the Strategy, the Innu decided to undertake a study to articulate their concept of wellbeing (minuinniuin) and their process of healing. Wellbeing and healing are intrinsic concepts for Innu; however, these concepts need to be uncovered for health and service providers, and policy makers. Having lived in Labrador and worked for the Innu, I was invited to be part of this community-initiated research. The Grand Chief of the Innu Nation directed that the research involve Innu researchers and utilize Innu ways-of-knowing and knowledge as fully as possible. Innu knowledge, like all Indigenous knowledges, is specific to the place where Innu live and to their experiences. Indigenous concepts of health and wellbeing, connections to land, and cultural identity are wholistically connected and culture-specific. The main objective of this dissertation is to articulate the Labrador Innu understanding of wellbeing and their distinctive process of healing. This qualitative study involves interviews and focus groups with 39 participants older than 16 years of age. This is a dissertation by articles. It consists of a general introduction to Indigenous health inequities, a literature review, a description of the methods, and the results as three separate manuscripts. It concludes with a summary of findings and implications. The first manuscript focuses on the process of developing an Innu framework for health research involving a partnership between Innu and non-Innu researchers. An Innu community-based participatory research (CBPR) framework for health research is proposed where Innu knowledge is foundational to the study. The framework is based on the metaphor of Innu and non-Innu canoeing together in one canoe. Within the space that joins all researchers, Indigenous knowledges are uncovered. This CBPR framework is used in the following two manuscripts. The second manuscript describes the contemporary process of healing of the Labrador Innu. Healing practices have been developed to deal with the historical and contemporary effects of colonialism and Innu people consider them effective. Healing is grounded in self-determination, culture, and non-reliance on bio-medicine. Five stages of healing are described: being “under the blanket”; finding spiritual strength; extending hands out; finding strength and power; and helping others. The findings highlighted the enablement of healing through spiritualities, support from Elders, return to culture, and resistance to negative stereotypes. The third manuscript aims to understand Innu views of wellbeing, and the influence of the land on health and wellbeing. Findings highlight that the experience of being on the land with family and community, learning cultural knowledge, and enacting Innu identity play a major role in enhancing wellbeing. For the Innu, the land sustains wellbeing by emplacing knowledge systems and cultural identity. The work presented in this dissertation contributes to the literature on Labrador Innu population health by highlighting that access to and experience of land build up health and wellbeing by providing and facilitating togetherness, fostering a relationship to all living beings, and enacting culture and a positive Innu identity. The findings add new knowledge to Indigenous health studies literature, particularly Innu health studies – holding promise for reducing health inequities. Implications for research, practice, and policy are also addressed.

Cultural competency is theorized as the sensitivity of practitioners from the dominant culture towards the diverse cultural backgrounds of their patients. Less attention is placed on how communication between providers and patients can enable patients to share their health care beliefs. An evidence review of the literature around the conceptualization of cultural competency in health care was performed, and interviews were conducted aiming to understand what immigrant patients perceive as culturally competent care and its effect on the relationship between them and their providers. Definitions of cultural competence varied, and no conclusive studies linking cultural competence to improved health outcomes were found. Findings from the participant interviews helped to address gaps in the literature by confirming a preference for a patient-centred approach to culturally competent care, in addition to identifying pre-existing expectations for the health care encounter and patient-dependent factors as additional elements influencing the physician-patient relationship.

abstract: In this study, I used critical, qualitative methods to explore how the material and symbolic dynamics of milk banking complicate expectations of organizing and (in)effective lactation. Guided by theories of alternative organizing, in/voluntary membership, the structuration of d/Discourse, and corporeal commodification, I conducted document analysis, fieldwork, and interviews with hospital and milk bank staff and maternal donors and recipients. Results trace the (her)story and protocols of the milk banking industry and examine the circumstances of donation and receipt; the d/Discourses of filth, suspicion, and inadequacy that circulate the lactating, maternal body; and the presence or resistance of commodification within each organization. Milk banking occurs when mothers provide excess breastmilk to parents with low supply or compromising medical conditions. “Milk banking” is used as an umbrella term for different ways of organizing donor milk; organizing evolved from wet-nursing to a continuum of in/formal markets. Formal markets include for-profit and non-profit milk banks that pasteurize and/or sterilize breastmilk for Neonatal Intensive Care Units. Informal markets involve self-organized exchanges online that are driven by monetary ads or donation. Both formal and informal markets elicit questions regarding flows of capital, labor, reproductive choice, and exploitation. However, current research resides in medicine, law, and popular press, so we know little about how milk banking happens in real time or how participation affects maternal identity. My analysis makes four contributions to organizational communication theory: (1) alternative organizing punctuates the construction of and conflicts between in/formal markets and shows why such theories should be represented as cyclical, rather than linear; (2) membership in milk banking is unintentional and distinct from in/voluntary membership; (3) the obscured organization is a necessary alternative to Scott’s (2013) hidden organizations; and (4) d/Discourses of “safety” are used to discipline and indict, not just represent operational differences. Social-rhetorical implications reveal how milk banking operates as an affective economy (Ahmed, 2004) and mark where privileges and inequalities are present in the absence of data; practical implications suggest consideration of policy changes. Methodologically, this study also offers insight into crystallization (Ellingson, 2009) and participant witnessing (Tracy, forthcoming) and challenges the hegemonic underpinnings of fieldwork. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2019

Cancer-related fatigue (CRF) as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer and cancer treatment that is not proportional to recent activity, such as physical activity, that interferes with usual functioning (Howell et al., 2015; National Comprehensive Cancer Network, 2020). CRF is one of the most common symptoms experienced by cancer patients at all stages of the cancer trajectory which significantly impacts patient’s quality of life, return to work, mental health, and can lead to disability (Bower, 2014b; Jones et al., 2016). Much research has focused on the development of CRF assessment and intervention strategies which have promoted the development of comprehensive evidence-based guidelines (Howell et al., 2015; National Comprehensive Cancer Network, 2020). However, previous research has identified many practice gaps in their implementation (Berger et al., 2015; Borneman et al., 2007; Pearson et al., 2015a, 2017b). This thesis’ objectives were to gain a deeper understanding of potential barriers to CRF clinical guideline implementation to identify potential knowledge translation strategies of CRF guidelines into practice following a Knowledge-To-Action (KTA) framework perspective (Graham et al., 2006; Straus et al., 2013). In Study 1, a qualitative research design was used to recruit a total of 62 participants—16 patients, 32 healthcare providers (HCPs), and 15 community support providers (CSPs). Drawing on the KTA model, the goal of the study was to explore key stakeholders’ (patients, HCPs, CSPs) experiences and opinions on CRF assessment and management and to explore underlying causes of CRF treatment gaps. No specific hypothesis were determined given the exploratory nature of the study. The results of this study highlight CRF guideline implementation gaps, patient dissatisfaction with CRF care, and challenges contributing to CRF assessment and management gaps. The results also suggested the presence of two underlying mechanisms contributing to treatment gaps: A Perfect Storm and Patient-Provider Communication Gaps. Understanding these mechanisms provides clarity on the potential causes maintaining CRF treatment gaps and can help direct targeted knowledge translation strategies to improve the implementation of CAPO CRF guidelines into practice. Consistent with a recent Delphi study (Pearson et al., 2017b), the results supported the need for professionals’ training on CRF guidelines to fill knowledge gaps. In Study 2, a mixed-methods pilot study with 18 HCPs and CSPs was used to develop and evaluate the acceptability and feasibility of a one-time training session for HCPs and CSPs on CAPO CRF guidelines, once again flowing the KTA framework (Graham et al., 2006; Straus, 2011). A secondary objective was to evaluate the learning outcomes of the training session including CAPO CRF guidelines knowledge, self-efficacy, and intent to apply CAPO CRF guidelines in practice. Overall, results suggest that offering a brief one-time training for HCPs and CSPs on CRF guidelines may be effective in increasing knowledge, self-efficacy, and intent to apply guidelines into practice. Similarly, that KT tools are appreciated by HCPs/CSPs and may be used in practice to supplement and sustain the knowledge and skills gained in training.

This essay is firstly a methodological pilot study. We have investigated if qualitative methods, in this case semi-structured interviews and focus group interviews, can be used to complement existing empirical findings about food consumption. The study’s approach has also been to map out what variables that affects individuals choices regarding food consumption and how their choices are affected by governmental information. Through a historical overview of food consumption in Sweden, we can show how the governmental and individual roles have changed due to increased globalization and urbanization. We have also used a social-psychological theoretical framework and previous empirical findings to analyze why individuals not always act as themselves and others wish. The results from this study shows that students generally are more aware than other individuals regarding sustainable choices. Still, they find it difficult to specify why one choice is more sustainable than another, for example between conventional, organic and locally produced food. The majority of the respondents claimed that high pricing was the main obstacle for them to consistently go for the more sustainable choice. When talking about price, some of the respondents expressed that, both the external and the self-perceived image of what the life of a student includes further contributes to the idea of a ‘poor student with limited choices’. There is still an ongoing need to study social phenomena in the everyday live. We can, in line with this study’s litterature, note that several aspects of everyday life are corrected by the government. Regarding food consumption, that is characterized by individualism and act in the grey area between governmental ideals and the practice of everyday life, the need for knowledge is even bigger. Increased knowledge is crucial to make a sustainable urban development possible and we claim that qualitative methods can act as an important tool to illustrate and affect attitudes and norms.

Indiana University-Purdue University Indianapolis (IUPUI) / Sport and exercise psychology practitioners work with military service members to enhance performance prior to and during active duty but have no clear role during military career exits. Given health and wellness concerns veterans face as they transition out of the military and reintegrate back into civilian life, it may be of benefit to establish non-VA practitioners as a transitioning resource. To determine sport and exercise psychology practitioner preparedness to address military to veteran transition needs, similarities and differences between transition experiences of former athletes and military veterans is needed. A mixed methods approach, known as a convergent design, compared the transition experiences of 42 athletes and 64 veterans (N=106) during the quantitative phase and 9 athletes and 15 veterans (N=24) during the qualitative phase. The quantitative phase consisted of independent sample t-tests to determine differences in outcome scores for four valid and reliable measures: Satisfaction with Life Scale, World Health Organization’s abbreviated quality of life measure, Career Transition Inventory, and Patient Health Questionnaire Depression Scale. The qualitative phase consisted of recorded semi-structured phone interviews, which gathered information regarding an individual’s career transition experience. Overall, athlete participants represented 14 sports from the National Collegiate Athletic Association and National Association of Intercollegiate Athletics universities. Veteran participants came from each military branch and a variety of pay grades. Quantitative analysis revealed athlete and veteran participants scored similarly on each outcome measure or domain. Veteran participants had lower physical health and social relationship domain scores, but comparatively better transition control scores. Qualitative analysis revealed four themes: 1) the necessity of preparation for the transition process, 2) factors impacting the career transition process, 3) transitioning resulted in the loss of structure, and 4) establishing oneself outside of former career. Results indicate shared outcomes and perspectives between former athletes and veterans in regard to their career transition process. Transition process similarities indicate sport and exercise psychology practitioners may be qualified to effectively assist transitioning veterans in the same capacity they assist transitioning athletes.

For many American women, insurance restrictions and lack of access restrict women’s options when choosing birth experiences. This research uses a biocultural approach and cognitive anthropological methods to explore the ways and the degree to which alternative birthing practices, such as home-, clinic-, and hospital-based natural births, and midwifery services, physically and emotionally affect the women and infants who experience them. This research explores the reasons women pursue natural or alternative births. These topics are explored through interviews with women who have had natural births, who have used midwifery services, and who have had highly medicalized, OBGYN-attended births. Findings indicate that while there is not an overarching cultural model of how women want to experience birth, there is a shared cultural model concerning the nature of birth among Mississippi women. Results show that women benefit more, emotionally and physically, from natural birth and midwifery care than from highly medicalized birth.

<p>My dissertation is an exploratory study examining the power dynamics that Black women lawmakers navigate in Georgia General Assembly. My project focuses on re-conceptualizing power in legislative studies by centering on the lived experiences of Black women lawmakers. I build on previous work to develop my theory of intersectional resistance. I defined intersectional resistance as individuals with intersectionally marginalizing identities pushing back on behaviors, events, and norms that attempt to marginalize them or their constituents to advance their agenda in the state legislature.</p>

Individualism, the assumption that persons are self-contained and primarily act for the sake of the self, is prevalent in American culture and has arguably perpetuated numerous psychological and societal ills. Relationality, the assumption that persons are always and inextricably constituted by relationships, has been posited as a philosophical and practical alternative to individualist culture. Several scholars, both inside and outside of psychology, have developed relational concepts and practices, including some who have elucidated a relational approach to psychotherapy (e.g., Slife and Wiggins, 2009). This study examines the implications and effects of this therapeutic approach, particularly exploring relationality's therapeutic success in countering the implications of individualism. Greenbrier Academy, an adolescent female boarding school located in West Virginia, has adopted relationality as its guiding therapeutic ethic. This study utilized hermeneutically modified grounded-theory methods to inquire into the lived experience of students at Greenbrier Academy. Eight students were interviewed and the researcher recorded observations of daily programing over a six-day period. Results indicated that Greenbrier's students' experienced marked changes in the quality and meaning of their interpersonal relationships. They increasingly cared for and served their relationships, engaged in more intimate relationships with others, approached (rather than retreated from) others' differences, viewed others more holistically, and accepted personal responsibility in relation to their context.

Scholars have examined how occupational mandates – shared understandings of an occupation’s purpose – are established and how these mandates, to be fulfilled, translate into occupational jurisdictions. To date, however, we lack a clear understanding of how occupational members uphold their mandates when they are impossible to fulfill. I define an impossible occupational mandate as a purpose pursued by a given occupation, but almost impossible to attain. I draw from observations, interviews and archives related to the work of reentry counselors, whose occupational mandate is to ensure former prisoners (i.e., their clients) secure stable employment. My findings suggest that counselors faced multiple challenges in fulfilling their mandate. Faced with an impossible mandate, counselors revised their mandate in different ways, emphasizing their roles as experts in shaping success (advisors), assisting clients with their specific needs (aides), or advancing clients’ cause through their work (advocates). In doing so, they deflected their attention away from their initial mandate and onto their revised mandates. Counselors also shared their mandate with others in their proximate environments. To different degrees, counselors from each group projected partnerships with outsiders to their occupation: they imagined clients, employers, other human and correctional service professionals as possible partners who could share the responsibility for fulfilling their mandate. In doing so, they diffracted the mandate towards people outside of their occupation. Findings suggest that how counselors revised their mandate shaped who they projected as key partners, and how they reported feeling about failed mandate partnerships. Additionally, while all counselors performed the mandate despite the strain it could induce, and used different strategies to cope, the advocates expressed the strongest feelings of emotional strain of all groups. I discuss the connections between deflection and diffraction — namely, the two main strategies people used to uphold impossible mandates — and the conditions under which these strategies can limit professionals’ strain and help them uphold their mandates. Findings add to our understanding of an understudied yet key part of today’s occupational landscape — professionals who hold impossible mandates – and extend the study of occupations and meaningful work. I also discuss implications for labor market inequality, social justice, prisoner reentry programs, and practice. / 2024-05-16T00:00:00Z