In this study, certified nursing assistants (CNAs) who work regularly with long-term care residents with dementia were interviewed to investigate whether they considered providing social and emotional support to people with dementia an important part of their jobs. They were given an online survey, then each participated in an in-person interview that was recorded and later transcribed and analyzed for common themes. Through data analysis, I found that the participating CNAs unanimously considered social support to be an important aspect of caring for someone with dementia, and several personal values were associated with this perspective. They also reported the trainings they had received in preparation for dementia care were largely not sufficient to prepare them for interacting effectively with the residents. Additionally, they cited various other barriers that impede their ability to provide the social support they feel is necessary to provide. Overall, this sample of CNAs did not provide great diversity, and future research should compare these results to more diverse groups.

An alarming portion of youth experience traumatic events during childhood, and there is a robust body of literature documenting the adverse consequences of trauma exposure on the developing child. Fortunately, numerous empirically-supported phase-based interventions have been developed for youth that target the deleterious effects of trauma. While several of these interventions have demonstrated symptom reduction from the baseline to completion of treatment, much less is known regarding the trajectory of posttraumatic stress symptoms (PTSS) during the course of treatment. Information in this regard may have important implications for service delivery and help to illuminate the mechanisms of change responsible for treatment outcomes. Furthermore, gender-related differences in the prevalence and expression of PTSS following trauma exposure have been observed, but the reasons for these differences is unclear and there is a paucity of research concerning whether boys and girls may progress differently through trauma-focused treatment. As a result, the aims of this study were to (1) examine the progression of PTSS during the various components of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); (2) assess whether symptoms progress differently for males and females; (3) examine whether (a) sexual abuse history or (b) age moderates any gender-related symptom differences identified; and (4) explore the trauma narratives of boys and girls. This study utilized an embedded sequential mixed methods design. For the quantitative strand, aggregate scores on the UCLA Posttraumatic Stress Disorder Reaction Index (UCLA PTSD-RI) were mapped for the entire sample and then according to gender at baseline, during various components of TF-CBT, and at termination among a sample (N = 138) of polyvictimized youth ages 7-18 who completed TF-CBT at a university-based child trauma treatment clinic. Mixed Analysis of Variance (ANOVA) analyses were conducted for each of the outcome measures (UCLA-PTSD RI overall, arousal, avoidance, and intrusion scores) to examine whether there were symptom differences between males and females from baseline to completion of TF-CBT, and 2 X 2 full factorial ANOVAs were conducted to determine whether sexual violence history or age moderated the relationship between gender and symptom severity during any phase of TF-CBT. For the qualitative strand, trauma narratives (N = 16) completed during TF-CBT were analyzed through the use of thematic analysis. Findings revealed that males and females reported differences in PTSS symptoms from baseline to termination of treatment, and during various phases of treatment. Additionally, thematic analysis of the trauma narratives augmented findings from the quantitative strand and revealed variations in the narratives of males and females. Although further investigation is warranted, study findings help to further understand the complex interplay between gender and the progression of PTSS during treatment. Implications for practice, policy and social work education are discussed.

This research aims to facilitate better understanding of perceptions of gender roles and gender equality among members of the Evangelical Church and to determine whether these perceptions differ by gender. The evangelical community’s ideologies and values have come to shape social and political dialogues within the United States. A key component of the faith is understanding the role each member plays within his or her family unit and community at large. The evangelical faith’s organizational structure and ideologies are informed by a patriarchal model that’s placed women at internal and structural odds, based on research exploring evangelically informed organizations. However, there is a gap in literature related to gender roles and equality within the faith, and how these perceptions may differ by gender and the influence a church’s organizational structure may have on these perceptions. This process involved the examination of perceptions of gender among evangelical Christians in a nationally representative sample. These findings informed a series of questions designed to explore, at greater depth on a regional level, the views of evangelicals regarding gender roles and gender equality within their organizations. The study provided a multidimensional construct of how the evangelical community defines themselves, understands gender roles and gender equality, and how these definitions affirm and conflict with definitions outside of the church as well as their own church’s leadership and organizational structure.

Diverse student populations are increasing in local, state, and national settings. There are achievement gaps in college readiness which must be closed between various student demographic groups. It is important for schools to know what methods work best for language acquisition to close the gaps and open postsecondary opportunities for all students. The purpose of this sequential, explanatory, mixed-method, formative program evaluation study was to examine the effects of a dual language (DL) program on improving the college readiness of students. Guided by the framework of learning and second language acquisition, college readiness levels between DL and non-DL students were examined and the perceived effects of DL as described by parents, students, and teachers were explored. The quantitative portion of the study used descriptive statistics to examine various transcript academic measures between 11 DL and 11 English immersion students. Qualitative interviews were conducted with 2 DL students, 6 English Immersion and DL staff, and a DL parent. The English Leaner students in the DL program passed more Advanced Placement courses and took more Advanced Placement exams than the English Learner students in the English Immersion program. District stakeholders interviewed for the qualitative portion of the study reported positive effects of the DL program including high levels of college preparation and increased parent involvement for the DL program. The study includes a white paper with recommendations for improvement and expansion of the DL program. Positive social change can be created in school districts by implementing effective language programs to prepare all students for the increasing demands of universities and the workplace.

The Patient-Centered Medical Home (PCMH) is a new model for primary care delivery intended to improve the care experience for both patients and providers, improve the health of populations, and reduce health care costs. Adopting the PCMH model into practice requires considerable investment of time and resources which often act as barriers for many small primary care practices; especially in rural areas. Few studies have examined performance of the PCMH model in rural clinics that have successfully implemented the model. It is important to obtain a comprehensive understanding of how context from the surrounding environment relates to implementation and performance of the model and whether there are differences between rural and urban primary care clinics. This study used a sequential explanatory mixed methods approach to assess differences in performance of the Patient Aligned Care Team (PACT) model between rural and urban primary care clinics within the Veterans Health Administration (VHA). Generalized Estimating Equations with repeated measures were used to estimate associations between rurality and five process-oriented endpoints among a national sample of 891 VHA primary care clinics. Results indicate that, after adjusting for patient characteristics and clinic structural capacity, clinics located in large rural or small/isolated rural areas demonstrated difficulty with enhancing access through use of non-traditional encounters (i.e. telephone visits, group visits, or secured messaging) and facilitating care coordination through post-discharge follow-up compared to urban clinics. Findings also suggest that rural clinics were more likely to struggle to meet system-wide performance standards for these same two PACT-related processes than their urban counterparts. A multiple-case study of five VHA primary care clinics was conducted to obtain a contextual understanding of the relationships between rurality and performance of PACT processes from the perspective of primary care staff engaged in PACT implementation. A comparison of the experiences of staff across the five cases revealed cross-cutting themes that are important to understanding the implementation and performance of PACT-related processes within these clinics. These themes included: both rural and urban clinics experience distance-related barriers; patient preferences and behavior impact performance of PACT-related processes; and primary care clinics experience frequent change. Findings from this qualitative assessment highlight the importance of understanding the unique context and circumstances experienced by each clinic and how they relate to performance and implementation of the PACT model. Insights gained through the qualitative assessment revealed that performance of PACT is influenced by complex relationships with both internal and external context. Combination of both quantitative and qualitative methods provided a more comprehensive understanding of these relationships beyond what could have been learned from a solitary assessment of standardized metrics by gaining additional context directly from the voices of those engaged in PACT care delivery. Identifying differences in PACT performance between rural and urban clinics calls attention to the possibility of unique advantages and challenges for PACTs delivering care to rural patients which need further exploration. Findings from this study contribute to the current understanding of PCMH implementation in rural settings by moving beyond the barriers related to structural capacity to performance of processes aligned with PCMH principles. More widespread implementation of PCMH will require additional attention to the complex relationships between the PCMH and surrounding context in order for primary care practices to successfully implement the model.

The nutrition transition is a global phenomenon in which diets have become increasingly westernized and processed while lifestyles have shifted from labor intensive to sedentary, largely on account of the advent of technology, globalization n and urbanization. Despite the prevalence of this phenomenon, very little is known regarding how the nutrition transition has affected the risk of comorbid chronic diseases among indigenous Kichwas communities in Ecuador. Aims of this study are : 1) Identify specific health outcomes (such as diabetes, hypertension, and high cholesterol) associated with the lifestyle risk factors of the nutrition transition among the Andean Kichwas indigenous population; 2) Explore the sociocultural factors (such as gender roles, culinary traditions, urbanization and globalization) which influence dietary behavior and food choices within Kichwas indigenous households; 3) Assess the construct relevance of the Nutrition Transition Questionnaire (NTQ), a pilot instrument designed to measure key constructs of the nutrition transition within indigenous Kichwas Andean households. The current study is a convergent parallel mixed methods design that consists of two components: 1) Secondary data analysis of the internal reliability of the Nutrition Transition Questionnaire, a pilot instrument designed to assess obesogenic lifestyles at the individual and household levels; 2) Primary ethnographic qualitative data collection among the Kichwas community residing in the Imbabura province of Ecuador. Thirty-four interviews were conducted with nutritional gatekeepers (i.e. women who make the majority of household dietary decisions) to explore lifestyle trends related to diet and exercise within the Kichwas community. Twenty-five intercept interviews were conducted at various food vending locations throughout the community. Internal reliability of the NTQ was assessed using Cronbach’s alpha and inter-item correlations while qualitative data were analyzed using applied thematic analysis. Chronic disease occurrence in the sample was also assessed for diabetes, hypertension, high cholesterol and obesity. Results suggest that key constructs in the Nutrition Transition Questionnaire are relevant to assessing lifestyle risk and protection regarding chronic disease. Main qualitative themes include gender roles within food preparation; the impact of collective culture upon food choices and household dietary behavior; and the protection offered by access to home gardens. The discussion highlights several differences between this study population and other indigenous populations. It also posits that a new emergent theory, Geo-Nomics theory, can provide a useful future tool in framing additional ethnographic nutrition transition research. The conclusion indicates this study’s most useful contributions to the literature, which include the development of a potential thermos intervention to decrease fast food consumption when Kichwas men commute far from home to work.

Doctor of Philosophy / Research has shown that the school-based experiences of same-sex attracted (SSA) young people are frequently less than ideal, often fraught with verbal and physical harassment and social isolation from peers. School-based victimisation of SSA students has been correlated with their negative mental health outcomes, drug and alcohol use, decreased academic outcomes and lowered tertiary aspirations. These outcomes raise issues related to duty of care for educators, including the general responsibility of schools to create safe, equitable learning environments for all of their students. In order to better meet the needs of SSA students in Australia’s secondary schools, this nationwide study examined the current school climate toward same-sex attraction as described by SSA young people aged 14-19 through their reported experiences and perceptions of environmental stresses and supports, using Margaret Spencer’s PVEST model as the theoretical framework. A web-based survey instrument, advertised through both mainstream and lesbian/gay/bisexual-orientated youth sources, was used to sample Australian SSA students (N = 282). The relationships between SSA students’ perceptions of their school climate (including the treatment of SSA students and topics), their sense of connection to their school community, and their reported academic self-concept and motivation toward learning were investigated using bivariate and multivariate techniques, including structural equation modelling. In-depth interview sessions were conducted with six SSA young people in order to further examine these findings. Results indicated that SSA students’ perceptions of their school climate were directly related to their sense of safety within the school environment, their social connection to their peers and teachers, and their feelings of connectedness to the school environment in general. SSA students’ connection to their teachers and their school environment had the strongest total impact on their academic self-concept and motivation to learn. Of key import was the clear indirect impact of SSA students’ perceptions of their school climate on both of these important academic outcomes, through their connection to both their school community and general school environment. These findings allow for the generation of informed recommendations for school policy and practice with the academic outcomes of Australia’s SSA students in mind.

Among the health disparities affecting the U.S. Hispanic population today are those relating to risky behaviors such as substance abuse, intimate partner violence (IPV) and HIV/AIDS. However, few studies have examined how these conditions may impact this population. The purpose of this dissertation was to explore the experiences that Hispanic women in South Florida have with regard to substance abuse, IPV and risks for HIV/AIDS, to describe how these conditions may be related, and to develop a model that can be used to guide research and interventions targeting this population. This dissertation uses data collected in Project DYVA (Drogas y Violencia en las Americas- Drugs and Violence in the Americas), a pilot research study that utilized both qualitative (Phase I) and quantitative (Phase II) research methods to describe the experiences of Hispanic women in South Florida between the ages of 18 and 60 with regard to substance abuse, violence and risky sexual behaviors. Three studies were conducted as part of this dissertation. The first study utilizes data collected during the qualitative phase of Project DYVA. During this phase eight focus groups were conducted and analyzed using qualitative content analysis (N = 81). The second and third studies utilize data collected during the second phase of Project DYVA. In this phase cross-sectional questionnaires collecting information regarding demographics, acculturation, self-esteem, depression, substance abuse, IPV and risks for HIV, were administered to 82 Hispanic women. Univariate and multivariate statistics were used to explore the relationships between substance abuse, IPV and risk for HIV (study 2) and between resource availability, IPV and depression (study 3). The findings from this dissertation suggest that substance abuse, IPV and risk for HIV are closely related intersecting health issues. IPV, the condition that emerged as the most salient of the three, also appears to be closely associated with resource availability (i.e., self-esteem and income) and depression. Additional individual, cultural, relationship and socio-environmental factors that may play a significant role in shaping the experiences that Hispanic women have with regards to these intersecting conditions were also identified and organized into a model.

This study aimed at investigating the attitudes of English language teachers in Turkey toward computer technology and the extent to which they use technology in language instruction. The data were collected from a sample of English teachers working at public schools all throughout Turkey. In order to ensure triangulation and complementarity, mixed methods research was used combining both quantitative and qualitative research methods. A questionnaire and semi-structured, face-to-face interview were used in order to collect the data. Both descriptive and inferential statistics as well as content analysis were conducted so as to analyze the data. The results of the data analysis yielded positive findings regarding English teachers

This thesis consists of four empirical studies on ethnic integration in the Swedish labor market. Studies I-III draw on a field experiment testing ethnic discrimination in the hiring process. Study I documents the existence of employer discrimination in response to equally merited applications with Arabic/African or Swedish names, and shows that foreign-named applicants have to send twice as many applications to receive a callback compared to Swedish-named applicants. Results also suggest that employers in female-dense occupations practice ethnic and gender compensation while employers in male-dense occupations practice only gender compensation. Study II reveals gendered differences in the intensity of employer stereotypes by testing how much more work experience is needed to eliminate the disadvantage of having an Arabic name on a job application. Results indicate a reverse gender gap, as initial differences in call-backs disappear for female applicants when CVs for Arabic-named applications are enhanced but remain strong and significant for male applicants. Study III evaluates criticism directed at residual analysis and field experiments that claims that they tell us nothing about real world discrimination and its long-term effects. By combining experimental and register data, Study III responds to this criticism by showing that the results of Study I correspond closely with real world labor market inequality of identical ‘twins’ (identified through propensity score matching) to the fictive individuals of Study I. Study IV explores the strategies underlying surname change from a Middle Eastern name to a more Swedish sounding one, drawing on 45 interviews with surname changers with a Middle Eastern background. The results indicate that immigrant name change is a pragmatic assimilation strategy. The study also illustrates how the institutional enabling of name change both creates and enables pragmatic assimilation. / <p>At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 1: Submitted. Paper 2: Submitted. Paper 3: Manuscript.</p>