Browsing by Author "Proeschold-Bell, Rae Jean"

Background: Teacher wellbeing is important because it impacts teachers’ ability to complete their work and also impacts student wellbeing. While published literature on teacher wellbeing has increased since the early 2000’s, a disproportionate amount of that work has been conducted in North America and Europe which has limited the generalizability of what is currently understand about teacher wellbeing. Additionally, contextual factors, such as gender, are thought to be potentially influential factors on teacher wellbeing but have yet to be extensively researched. This study aims to assess the relationship between gender and teacher wellbeing in Battambang, Cambodia and Bungoma, Kenya. Methods: Fifty-five teachers from Cambodia and Kenya, including both men and women, contributed to in-depth interviews. Thematic analysis was conducted on interview transcripts to assess gendered relationships and differential treatment, wellbeing facilitators, and participants’ responsibilities in addition to teaching. Additionally, demographic data was collected through surveys. Results: The thematic analysis revealed subtle differences in perceptions of treatment and relationships between participants who identified as men versus women, potential wellbeing facilitators for men and women, and insight into non-school roles and responsibilities for men and women teachers. Conclusions: Based on the nuances between men and women participants’ responses, findings from this study indicate that there may be an important relationship between gender and teacher wellbeing that is worth further researching. This study points to the need to further research in a few key areas including: (1) how do (if at all) gendered relationships and differential treatment make teachers feel/impact teacher wellbeing, and (2) how do (if at all) outside responsibilities in addition to teaching impact teacher stress, fatigue, burnout, and general wellbeing. Lastly, given that there were some differences in activities and opportunities that facilitate teacher wellbeing between men and women participants, this formative research can inform gender-specific interventions addressing teacher wellbeing in Cambodia and Kenya.

There are many orphaned and separated children (OSC) in the world and caregivers play a crucial role in caring for, supervising, and educating them. However, caregiving work is stressful and overwhelming, which sometimes bring negative influences to caregivers’ physical and mental health such as depression and anxiety that can be a great threat to caregivers’ mental health. Current studies mainly focus on caregivers’ mental illness instead of caregivers’ positive mood and mental health which are also very important. Besides, there is little information on caregivers’ daily life and work schedule which likely have a strong relationship with their positive mental health. This study’s objective was to describe OSC caregivers’ daily lives and how their work and activities are related to their positive mental health. Data collected included diary entries, surveys, and interviews from caregivers from five geographic locations: Hyderabad, India; Nagaland, India; Ethiopia; Kenya; and Cambodia. A total of 82 participants completed surveys and diary entries, and 69 of them finished interviews. Diary data were coded to learn about time spent on every activity; how caregivers perceived an activity’s importance, meaningfulness, pleasantness, and unpleasantness; and how time spent on activities related to caregivers’ daily mood. We focused on five main activities: cleaning, cooking, caring for children, supervising children and teaching children. We found that caregivers sometimes spend more hours on cleaning and cooking than staying with children in terms of caring for children, supervising children, or teaching children. These findings are important for OSC residential care centers to consider rearranging caregivers’ work schedules and planning more activities for caregivers to improve their positive mental health.

Objective: Though the role of negative mental health has been investigated, positive mental health in medical students remains an under-investigated topic. This study sought to describe and explore mental well-being in a population of medical students in Sri Lanka, by investigating the range and level of both positive and negative mental health and covariates and by comparing the results with those of US studies. Methods: Students at University of Ruhuna Faculty of Medicine completed paper-based, cross-sectional questionnaires that included demographic items, the Mental Health Continuum-Short Form (MHC-SF), the Kessler 10 Psychological Distress Scale (K10), and the Oldenburg Burnout Inventory (OLBI). Analysis took place in Stata and RStudio. Results: Most students were categorized with moderate positive mental health (64.8%) and severe psychological distress (40.4%). Negative and positive mental health outcomes were moderately associated. None of the demographic factors was a significant predictor of positive mental health nor academic performance, and none of the mental health outcomes predicted academic performance. Females reported significantly higher levels of burnout. Conclusions: Medical students in Sri Lanka may experience different levels of positive and negative mental health by year in school. In the current study, final year students reported significantly higher levels of psychological distress and burnout than first year students. Males and older students were significantly more likely to have poor academic performance. Institutions should monitor medical student well-being and direct resources toward evidence-based activities, allowing students to continue along the upward spiral of well-being and flourish into successful medical practitioners.

Background: Increasing evidence suggests that early diagnosis of Alzheimer’s disease and related diseases (ADRD) offers opportunities for access to supportive services and disease management. However, most cases of ADRD are diagnosed in the later stages of the disease limiting the benefits of supportive services and increasing challenges related to the disease. This study aimed to understand facilitators and barriers to early ADRD diagnosis among Black and White individuals seeking racial differences in this process. Methods: Our sample included 21 racially diverse caregivers (n= 21) of older adults with ADRD, including Black caregivers (n=11) and White caregivers (n= 10). Semi-structured interviews were conducted individually with participants. Duke University Health System (DUHS). Data were coded for emerging themes and analyzed through the lens of the life course framework using NVIVO analysis software. Results: Facilitators and barriers along the diagnosis process were shaped by the individual, family/caregiver, and interactions with the healthcare system. Racial differences were particularly evident regarding family/caregiver's lower knowledge about ADRD, care approach offered to the care recipient, and prevalent negative interactions with the healthcare system among Black caregivers. Conclusions: The diagnosis process pathways were lengthy, characterized by caregivers' persistence, challenges to receiving an adequate cognitive assessment, and limited access to supportive services. Black caregivers experienced a more prolonged process, lower knowledge about ADRD, and challenging interactions with the healthcare system.

Background: Down Syndrome (DS) is the most commonly identified aneuploidy amongst children in Sri Lanka, with a prevalence of 76.3%. This study intended to determine the level of disability of children with DS aged 5-12, level of caregiver burden and impacts of family access to external services and social supports in Galle, Sri Lanka. Methods: A cross-sectional survey and interview study was conducted to determine caregiver burden, the level of disability for children with DS, and their access to social supports and external services. Within the study, 125 caregivers took the Caregiver Priorities and Child Health Index of Life with Disabilities (CP-CHILD) and Caregiver Difficulties Scale (CDS) assessments and 15 participated in interviews. Simple bivariate and multivariable regression were used to determine the impacts of resource usage on the child’s level of disability and caregivers burden. Results: The mean level of disability of children with DS was 64.8 and caregiver burden was 50.2. Positively associated predictors of the level of disability include school, type, caregiver gender and income level. Approximately one-third (36.8%) of caregivers reported receiving assistance from external supports, 20% received government assistance, and 92.8% of caregivers relied on assistance from friends and family. Conclusions: Assistance from external sources and behavior therapy was shown to negatively moderate the relationship between the level of disability of the child and caregiver burden. Future longitudinal research, alongside more resource promotion and creation could improve resource access, disability levels and caregiver burden.

Background: Employees in occupations with high job-related distress are at a higher risk of depression and obesity, both of which relate to worse physical functioning. Poor physical functioning can, in turn, lead to several adverse health outcomes. There is a high co-occurrence of obesity and depression and we, hence, sought to assess the independent and joint effects of obesity and elevated depressive symptoms on physical functioning among United Methodist Church clergy in North Carolina, the United States. Methods: We analyzed data from 1,422 clergy who participated in the Clergy Health Initiative Longitudinal Survey in both 2014 and 2016. Elevated depressive symptoms were assessed using Patient Health Questionnaire-9 and obesity was defined based on participants’ Body Mass Index. The physical functioning score was measured using the Physical Component Summary of Medical Outcomes Study 12-Item Short Form Survey. We described the participants’ characteristics in 2014 and analyzed the data from the 2014 and 2016 waves to assess the association between obesity, elevated depressive symptoms, and physical functioning by using Ordinary Least Squares regression. The joint effect was assessed by including the interaction term between elevated depressive symptoms and obesity in the regression model. We further adjusted covariates including age, gender, race, educational attainment, marital status, physical exercise, financial distress, and work hours per week in the regression model to control for confounding factors. Results: The study population was largely composed of male (69.90%) and white (91.84%) individuals. Additionally, the vast majority of participants (82.56%) held a master's degree or higher level of education. The prevalence of obesity and elevated depressive symptoms was 39.52% and 7.17%, respectively, among United Methodist Church clergy in North Carolina in 2014. Obesity and elevated depressive symptoms were both independently related to poor physical functioning. The co-occurrence of obesity and elevated depressive symptoms in 2014 had a larger negative effect (β = -4.34; 95% Confidence Interval: -7.87, -0.81) on physical functioning in 2016 than the sum of the individual effects of obesity (β = -4.02; 95% Confidence Interval: -4.93, -3.11) and elevated depressive symptoms (β = -3.25; 95% Confidence Interval: -4.63, -1.17) on physical functioning. Conclusions: The results suggest that there is a joint effect of obesity and elevated depressive symptoms on worse physical functioning among United Methodist Church clergy in North Carolina. More attention should be paid to the diagnosis and treatment of depression and obesity in this population to prevent the negative health sequelae of worse physical functioning.

Background: Although used previously as a function of the judiciary primarily in custody battles, the best interest of the child because an international human rights standard with the 1989 adoption of the United Nations Convention on the Rights of the Child (UNCRC) by the UN General Assembly. The ‘best interest’ standard has consequently been adopted and used in many State-level child protection polices, particularly in reference to orphans and separated children (OSC), in low and middle-income countries (LMICs), including India. However, little attention has been paid to how State-level actors, including both policy stakeholders as well as direct carers of OSC, interpret and implement this standard in their local contexts.

Objective: This study’s objective was to explore how the best interest of the child as a norm of international human rights is interpreted and applied to the care and protection of OSC in residential care policy in India.

Methods: Using a qualitative, experimental, design we conducted semi-structured in-depth interviews and focused group discussions with two distinct groups: 1) Child Protection Policy Stakeholders and 2) Direct caregivers of OSC in a residential care center (RCC). Policy group participants completed in-depth interviews about current child protection policies in India and their interpretation of the best interest of the child. Direct caregivers of OSC completed in-depth interviews and, for certain caregiver sub-categories, focused-group discussions on their daily lived experience working with and, sometimes, living with OSC in residential care settings.

Results: Thirty-eight direct caregivers of OSC from one particular residential care center in New Delhi took part in the study. Eighteen policy stakeholders, including government bureaucrats, policy researchers, child rights advocates, and directors of RCCs also took part. Interview results were grouped into ‘key area domains’, with five domains emerging per participant group. Ultimately three domains were overlapping between the groups: Resources, Accountability, and Approaches to Care while two domains were distinct for each group: Policy Frameworks and Reforms (Policy Stakeholders) and Institutional Processes and Perceptions of the Experience of the Child (Direct caregiver group). Distinct differences and similarities were noted amongst all of the domains between the two participant groups. All domains were somehow related to the attempt to construct the best interest of the child in RCCs in India.

Conclusion: Although a de jure standard, both internationally and nationally, the best interest of the child seems to be a de facto reality in India, especially as defined by direct caregivers of OSC. In this setting, the best interest emerged not as a standard that individuals and organizations held themselves to, but as a construct that was created and re-created based on , in particular, availability of resources, accountability mechanisms, and the way in which individuals approached caring for children.

Caring for, raising, and educating orphaned and vulnerable children (OVC) is important work that is critical to the long-term well-being of those children. Despite the importance of caregiving, it can be overwhelming and stressful. A large part of the available literature addresses the burden of caregiving, such as burnout and fatigue. There is little information about the characteristics that caregivers need to deliver effective care in institutions for OVC, and yet such information would be very useful to the directors of these institutions as they hire and train caregivers. This study’s objective was to identify the characteristics of effective caregivers through qualitative interviews with directors of institutions for OVC across four countries: Cambodia, Ethiopia, India and Kenya. A total of twenty-eight interviews were conducted across all countries in their local languages. Interviews were translated, transcribed in English and analyzed using NVivo (Version 11) software. A thematic analysis of the data yielded three domains: personal qualities, skills, and religion. Each domain is comprised of themes that participants perceived as contributing to good caregiving. Across the four sites, most participants looked for similar characteristics in caregivers. That being said, there were also some participants who indicated unique characteristics they sought in caregivers. These findings can inform plans to enhance effective and sustainable caregiving at institutions.