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Better access to financial literacy programs in underserved communities has the potential to improve financial decision making and to help individuals and families escape poverty. This multimethod dissertation explores some of the challenges of developing financial literacy programs for underserved individuals and provides insights into the cultural and institutional factors that discourage financial literacy and sound financial decision making. This research re-examines the construct of financial literacy, reviews relevant past research, and presents a conceptual model with hypotheses regarding factors that affect financial literacy. To test the model, multiple studies were conducted in underserved communities in rural and urban areas to understand the complexity of the relationship between financial literacy and financial decision making. These studies were supplemented by a series of in-depth interviews with financial literacy experts, community leaders, and underserved individuals. The results indicate the importance of refining both financial literacy instruments and training to rural and urban underserved communities, while also building stronger ties to community leaders and financial institutions. / Business Administration/Finance

The pursuit of underrepresented and underserved graduate students who attend Predominantly White Institutions to pursue disciplines and careers in STEM (Science, Technology, Engineering, and Mathematics). Despite the increase in the number of underrepresented minorities in graduate school, underrepresented and underserved graduate students in STEM disciplines are encountering experiences that directly affect their graduate matriculation. This study took a case study approach to investigate the Virginia Tech George Washington Carver Assistantship Program's impact on supporting underrepresented and underserved graduate students in STEM disciplines and to assess further the extent to which their participation in this support program influences their academic and career success. Given the substantial financial resources allocated to the program and the annual student enrollment, a comprehensive case study needed to be conducted to gain deeper insight into the Carver program and the stakeholders that engaged with the program to enhance future programming and sustainability. It was essential to assess the Carver program's effectiveness in promoting student success and addressing the factors that impact underrepresented and underserved graduate students in STEM fields. Triangulation is used in this study to inform and strengthen the research findings from past program scholars, current scholars, and faculty. The Carver program is not generalizable to other programs, students, and faculty because the experiences are specific to the participants in this study. The findings illustrate that the evolution program's evolution cultivates a culturally engaging culture and climate to foster graduate student success. / Doctor of Philosophy / This study explores how a Virginia Tech College of Agriculture and Life Sciences institutional program, the George Washington Carver Assistantship Program, supports underrepresented and underserved graduate students in STEM disciplines. Despite an increase in the number of underrepresented minorities entering graduate school, these student populations faced challenges that impacted their graduate matriculation. This study utilized a case study approach to examine the impact of the Carver program on students' academic and career success. By taking a deeper look into the experiences of past program scholars, current program scholars, and faculty members, this study aims to gain deeper insight into the program's effectiveness on student success beyond supporting students through funding. While the study findings shed light on how the Carver program creates a supportive environment for graduate students, it is important to emphasize that the Carver program does not apply to all programs, students, and faculty. The experiences are specific to the participants in this study. This study highlighted that the Carver program has successfully supported students toward reaching student success by establishing a culturally engaging campus environment. Recommendations for future work in this study are to utilize a systems thinking approach to examine the program more broadly and investigate the systems in place that allow the program to function and be sustainable.

In the United States context, there is a particularly prevalent dialogue about the transformative power of an engineering degree for underserved students. Long positioned as a mechanism for moving up the social ladder, engineering education is often discussed as a mechanism for upward mobility, promising underserved students the opportunity to climb. However, a critical examination of who enrolls and persists in engineering degree programs suggests not everyone can equitably leverage the transformative power of an engineering degree, with persistent inequities for underserved students. Though literature highlights systemic barriers faced by underserved engineering students, much less is known about how underserved students navigate barriers to pursue an engineering bachelor's degree. Accordingly, the purpose of my study was to explore how students from underserved backgrounds navigate their educational trajectories, focusing on the interplay between structures and agency. Using a Bourdieusian lens, my study was guided by the overarching research question: In their narratives, how do students from underserved backgrounds describe navigating their educational trajectories towards a bachelor's engineering degree? I used a single case study methodology with embedded units of analysis to explore this research question. My primary data sources included narrative interviews with 32 underserved engineering students and geospatial community-level data extrapolated from students' home zip codes. My results indicate that underserved engineering students describe a variety of strategies to enact agency by planning, optimizing, and, at times, redirecting their educational trajectories. This study also highlights the influence of family, community, economic, and political environments on the educational journeys of underserved engineering students, as students described navigating and adapting to these various social environments. Students also describe their environments as dynamic, with trajectories changing based on critical incidents such as a parent illness or loss of work. Lastly, students' narratives highlight a diverse range of reasons for pursuing engineering, which often extended beyond private goods approaches to engineering education. My results present implications for engineering education, the most notable of which is that underserved students are not a monolithic group and represent a diverse range of lived experiences. My results also highlight agency as a collective endeavor, challenging popular notions that agency is operationalized at the level of a single individual. Lastly, students' lived experiences with material hardship highlight the dynamic and multidimensional nature of economic disadvantage. Such insights compel engineering educators to reexamine how we conceptualize and measure economic disadvantage in higher education. Ultimately, this research highlights opportunities to increase access and equity in engineering education for underserved students. / Doctor of Philosophy / In the United States, engineering is often viewed as a transformative career for underserved students. Long positioned as a mechanism for moving up the social ladder, engineering education is positioned to underserved students as an opportunity to climb. However, inequities in engineering education persist, with low income and first generation students underrepresented in engineering. The purpose of my study was to explore how students from underserved backgrounds navigate their educational trajectories, focusing on the interplay between societal forces (i.e., structures) and individual decision-making (i.e., agency). My study was guided by the overarching research question: In their narratives, how do students from underserved backgrounds describe navigating their educational trajectories towards a bachelor's engineering degree? My primary data sources included narrative interviews with 32 underserved engineering students and geospatial community-level data. My results indicate that underserved engineering students describe a variety of strategies to plan, optimize, and, at times, redirect their educational trajectories. This study highlights the influence of family, community, economic, and political environments on the educational journeys of underserved engineering students. Additionally, students describe their environments as dynamic, with trajectories changing based on critical incidents such as a parent illness or loss of work. Lastly, students' narratives highlight a diverse range of reasons for pursuing engineering, which often extended beyond private goods approaches to engineering education. My results highlight agency as a collective family endeavor, challenging popular notions that agency is operationalized at the level of a single individual. Lastly, students' lived experiences with material hardship highlight the dynamic and multidimensional nature of economic disadvantage. Such insights compel engineering educators to reexamine how we conceptualize and measure economic disadvantage in higher education. Ultimately, this research highlights opportunities to increase access and equity in engineering education for underserved students.

Background: The utilization of telehealth has had a substantial impact on transforming and enhancing the methods by which healthcare is presently delivered. The potential benefits of telehealth in improving the health of vulnerable populations and underserved communities are substantial. The aims of this study were to examine the association between social determinants of health and patient perceptions of their experiences with telehealth. We will analyze how perceptions differ across specialization, race, gender, and other key determinants; examine how patient’s self-rated physical health and mental health influences perceptions and attitudes about telehealth utilization; and evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences between mental health providers and non-mental health providers. Methods: A scoping review was completed to explore literature regarding telehealth administration and underserved populations following the PRIMSA-ScR guidelines. Multivariable logistic regression was then conducted to assess the relationship between self-rated mental health and self-rated physical health and the primary predictor variables telehealth usability, telehealth satisfaction, and telehealth experiences. Finally, a mixed-methods study was conducted to evaluate differences in perceptions and attitudes, experience with patient interactions and overall telehealth experiences mental health-care providers and non-mental healthcare providers. Results: The scoping literature review highlights how telehealth is used in diverse settings, but more research needs to be done to determine best practices for both healthcare providers and patients utilizing telehealth. The study focused on self-reported health found significant associations between high mean scores on telehealth usability, telehealth satisfaction, and telehealth experiences and good self-reported mental and physical health. Lastly, the study looking at provider differences highlighted that the reliability of the telemedicine platform, the ability to trust the telemedicine application, and video visits being a convenient form of healthcare delivery was greater for mental healthcare providers than non-mental healthcare providers. Implications: These findings highlight the need for studies examining telehealth satisfaction, telehealth usability and telehealth experiences amongst providers and patients in underserved areas. Further research is needed to gain a deeper understanding of the telehealth access requirements of underserved communities and can aid in the development of evidence-based guidelines for the delivery of telehealth services.

Class of 2009 Abstract / OBJECTIVES: Truck drivers one of the most vital components of a country’s economy, and also one of the most medically underserved populations. To date, few studies have explored the healthcare needs of over the road truck drivers. The objective of this study is to determine if a need exists for the creation of a healthcare education program for over the road truck drivers and if retail pharmacy could be an effective setting for such a program. METHODS: A needs assessment analysis was used to examine available literature concerning the healthcare of over the road truck drivers. A multi-question survey was designed to illicit the feasibility of initiating a healthcare education program to over the road truck drivers in a retail pharmacy setting. This survey was administered to third year pharmacy interns, and 67 completed surveys were collected. RESULTS: Statistics from the selected literature showed over the road truck drivers had increased health risks and barriers to receive proper healthcare. Sixty-two percent of the pharmacy interns felt they could help provide healthcare education to over the road truck drivers, but 71% of interns felt that management wanted to have as little time as possible expended providing education and counseling. CONCLUSIONS: Over the road truck drivers are at increased risk of healthcare problems due to the demands of the profession and a healthcare education program is warranted to help

INTRODUCTION: Street medicine programs utilize a nontraditional healthcare model to provide care to populations experiencing homelessness. Through street medicine programs, clinicians take to the streets to offer services to individuals who are living unsheltered. Many street medicine programs offer health professional students the opportunity to volunteer and provide care to this vulnerable population. AIM: This exploratory study aimed to answer the following question: what influence does volunteering with a street medicine program have on the career trajectories of student volunteers who ultimately choose to work with medically underserved populations (MUPs)? METHODS: This study used an exploratory mixed methods approach to answering the research question. The core ideas that emerged from the qualitative data collected from street medicine student volunteers were used to inform the development of a web-based survey administered to a broader, national sample of street medicine student volunteers. The survey included closed- and opened- ended questions, as well as demographic questions. The Health Professionals’ Attitude Towards the Homeless Inventory (HPATHI; Buck et al., 2005) questionnaire was embedded into the survey to measure students’ attitudes towards the population experiencing homelessness before and after volunteering with a street medicine program. RESULTS: The results suggested that 15 (65.22%) of the 23 participants who completed the web-based survey reported that volunteering with a street medicine program influenced their decision to ultimately work with MUPs. Of the 19 participants who provided qualitative feedback, 7 (36.84%) mentioned that their decision to work with MUPs was influenced by their increased exposure and awareness to the barriers and needs of MUPs while volunteering with a street medicine program. Additionally, 6 (31.58%) participants mentioned that their previous decision to work with MUPs was reinforced while volunteering with a street medicine program. CONCLUSION: Volunteering with a street medicine program appears to help motivate students to work with MUPs. Incorporating opportunities to volunteer with a street medicine program into current health professional school curriculum has the potential to impact a greater network of students, as well as influence decisions regarding the students’ careers.

Objective: According to the Joint Commission (2012), about 80% of serious medical errors are related to miscommunication between healthcare providers. The Joint Commission (2012) recommended the utilization of standardized communication tools to reduce the number of medical errors related to the miscommunication. The Situation-Background-Assessment-Recommendation (SBAR) communication tool is a standardized tool that has been used to improve the effectiveness of communication between healthcare providers. The purpose of this project was to evaluate the effectiveness of using SBAR communication tool for warm handoff between primary care providers and behavioral health providers in order to provide a continuous and complete transition of care for patients with psychiatric disorders or psychosocial issues. Method: A mixed method design was implemented in an integrated primary care clinic at two locations in Phoenix, Arizona. A brief presentation about the SBAR tool and copies of the SBAR tool was provided for the clinic staff. Data were gathered from four participants (two nurse practitioners and two behavioral health workers) using structured observation, pre-and post-test surveys, and structured interviews. Length of study was one month. Results: During the data collection, there were 40 observed warm handoffs, 12 unobserved warm handoffs between primary care nurse practitioners and behavioral health workers. Seventy-five percent of the participants felt that the SBAR helped them in organizing their thoughts and providing/obtaining adequate information during warm handoff. They reported satisfaction when using the SBAR tool. There was no statistically significant difference in the scores of collaboration and satisfaction about care decisions between pre and post-SBAR intervention. Conclusion: The SBAR communication tool has the potential to improve communication between primary care providers and behavioral health workers to improve the quality and safety of care for patients with psychosocial concerns. Utilizing SBAR may increase teamwork and ensures adequate hand-off information on the warm handoff. Multiple PDSA cycles should be conducted to refine the change and make it applicable and sustainable in the integrated care setting.

The dissertation aims to examine the potential for diabetes self-management education (DSME) technology interventions to be used by underserved adults in routine clinical practice and issues regarding its use that may be unique to this population. In Chapter One, the problems of providing sufficient access and appropriate DSME to underserved adults with type 2 diabetes mellitus (T2DM) is introduced and their significance is described. In Chapter Two, a systematic review of the literature and meta-analysis synthesizes data from 3,257 subjects that participated in 13 randomized controlled trials that examined the effect of health information technology (HIT) DSME interventions on glycemic control in medically underserved adults. Chapter Three presents the general and technology-related characteristics of the urban, underserved sample of adults with type 2 diabetes mellitus from eight federally qualified health centers who participated in the Mobile Diabetes Detective (MoDD) randomized controlled trial. It also describes the technology training required to support use and engagement during the MoDD intervention period. In Chapter Four, the potential for broad dissemination of a novel HIT DSME intervention, MoDD, into everyday clinical practice is examined using the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance). In Chapter Five the findings of these studies are summarized and the overarching conclusions are presented, which include the strengths, limitations and implications for practice, policy and future.

Orientador: Manoel Henrique Salgado / Banca: Regina Celia Baptista Belluzzo / Banca: Jose de Souza Rodrigues / Resumo: A área de saúde pública e privada, segmento de serviços, em 2012 consumiu 8% (oito por cento) do Produto Interno Bruto Brasileiro, apesar desse volume de recursos direcionados para a área da saúde, em comparação com outros países, o investimento deveria receber um aporte adicional de um terço do valor atual. No cenário atual, faltam recursos compatíveis com a necessidade da população (que envelhece), e sobram queixas dos usuários, prinicipalmente pela demora no atendimento e na falta de atenção dos agentes envolvidos. A saúde suplementar (setor privado) que iniciou suas atividades no Brasil na década de 50, atendendo as necessidades dos funcionários de algumas empresas multinacionais que se instalavam no país, atende hoje 46 milhoes de beneficiários. Com menor número de usuários e com mais recursos, o setor privado recebe menos reclamações que o setor público, mas as reclamações existem e em número considerável, pelas mesmas causas do setor público. O modelo SERVQUAL desenvolvida e posteriormente aperfeiçoada por Parassuraman, Zeithaml e Berry (1990), permite a mensuração da qualidade dos serviços prestados. A medição proposta pelos autores começa na expectativa do cliente, antes do consumo, e a sua percepção após a utilização, bem como a visão dos gestores, dos fucionários e ainda o impacto da comunicação midiática ada empresa na expectativa do cliente. O presente trabalho tem como objetivo: avaliar a qualidade hospitalar em dois hospitais de Bauru com a adaptação do model SERVQUAL. A pesquisa foi realizada em dois momentos: no momento da venda do plano, antes do uso (questionário de expectativa) e, no momento do uso (questionário de percepção), comparando sua expectativa (antes do uso) e a percepção (após o uso). Seguindo a metodologia proposta pelos autores, foram... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The public and private health area services segment in 2010 consumed 8% (eight percent) of the Brazilian Gross Domestic Product, despite this volume of resources allocated to the health sector, compared with other countries, the investment should receive an additional one third of the current value. In the current scenario, there is a lack resources compatible with the needs of the population (aging), and abound complaints from users, mainly by delays in care and the lack of attention of the agents involved. The supplimental health (private sector) that began operations in Brazil in the 50s, meeting the needs of employees of some multinational companies settled in the country, today serves 46 million beneficiaries. With fewer users and more resources, the private sector receives fewer complaints than the public sector, but there area complaints and in a considerable amount, for the same reasons the public sector. The SERVQUAL model developed and subsequently refined by Parasuraman, Zeithml and Berry (1190), permits the measurement of service quality. The measure proposed by the authors starts on customer expectation, before consumption, and their perception after use, as well as the vision of managers, employees and even the impact of media communication company in customer expectation. The present sudy aims: to assess hospital quality in two hospitals in Bauru with the adaptation of SERVQUAL model. The research was conducted in two stages: at the time of the plan sale, before use (expectation questionnaire), and at the time of use (perception questionnaire), comparing their expectation (before use) and perception (after use). Following the methodoloy the methodology proposed by the authours, gaps were identified in questions and dimensions of quality. In summary, the adaptation of the model SERVQUAL questionnaires... (Complete abstract click electronic access below) / Mestre