Browsing by Department "Program II"

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Open Access
Assessing Cardiovascular Disease Burden in Rural Uganda and Informing Future Interventions
(2018-01-07) Benson, Kathryn
This senior thesis seeks to investigate cardiovascular disease (CVD) risk in a rural region in Uganda and to use insights from field experience and the literature to explore possible interventions. The thesis research involved a total of 232 participants, including village residents (142), market workers (50), religious leaders (20), and village health workers (VHTs) (20). The village sample data are part of a larger longitudinal study, conducted under the Community Health Collaboration project of the Student Research Training Program (SRT) at Duke University. Recruitment for the other three cohorts of market workers, religious leaders, and VHTs began with this current study, conducted in the summer of 2016. The current study continued the biometric assessments of CVD risk within the village cohort and extended the testing to market workers. A total of 192 individuals participated in these three biometric assessments of their body mass index (BMI), systolic and diastolic blood pressure, and fasting blood glucose. In addition, the research team conducted surveys using an interview format with all four cohorts. The survey assessed demographic information, lifestyle factors, CVD perceptions, and CVD knowledge, and religious influences on CVD. Overall, the biometric findings show substantial CVD risk in the village sample and the persistence of risk for individuals over time, as evidenced by the results from longitudinal, linear mixed-effect models. Beyond this high, persistent CVD risk for villagers, the market workers had even higher CVD risk as evidenced by elevated BMI and fasting blood glucose. The elevated CVD risk for market workers is possibly due to differences in lifestyle factors including diet and exercise that are associated with urbanization. The survey results show near unanimous agreement among participants that CVD is a problem in their community. Despite the overall concern, the findings expose inaccuracies in knowledge about CVD across all cohorts. Regarding the role of religion, more than 90% of participants across all cohorts believe that religion can alleviate CVD symptoms. Further questioning about religion and CVD reflected a broad array of direct and indirect interpretations of the role of religion. Exploratory regression analyses, which link survey data to CVD risk indicators, yielded results that have implications for tailoring CVD interventions to rural Uganda. To further connect the findings to intervention strategies, the discussion summarizes the method and results of a literature review on possible CVD interventions. The literature review advances three principal categories of intervention: education, policy, and programming. For each of these categories, the study findings together with the literature review provide the basis for recommending three integrative strategy for CVD intervention: VHT CVD education programs, policy reform to address CVD medication stock-outs, and religiously-based CVD programs. The strategies have promise for reducing CVD risk and improving the lives of individuals in rural Uganda.
Open Access
Blurring Contagion in the Information Age: How COVID-19 Troubles the Boundaries of the Biomedical and Socioinformatic
(2021-04-19) Petronis, Caroline
This project reexamines contagion in the time of the internet through utilizing COVID-19 as a case study. I first look at the biomedical implications of the term contagion through a historical lens and then track its leakage into sociocultural theories and mass media, where the term was used in an effort to explain the seemingly irrational behavior of mobs and crowds in the nineteenth and twentieth centuries. I then chronicle COVID-19 and its existence as an Information Age virus- one that troubles the distinction of biomedical and cultural contagion, ultimately requiring a reimagining of the term. I argue that the introduction of the internet has made conceiving of contagion in purely biomedical terms impossible, and instead suggest that there is a biomedical-socioinformatic blurring that occurs in infectious disease today. Through interpreting contagion as a part of a constantly (re)assembling rhizome, I postulate that the internet has allowed information about an infectious disease to outpace its biomedical transmission, and that content and relationalities produced online become part of the virus itself, rendering the biomedical and the socioinformatic indistinct from one another. Finally, I suggest that the biomedical-socioinformatic virus is fundamentally political, and propose future directions for an incomplete and multiple immunity for society that finds resilience in the boundary-queering tendencies of contagion, using that logic as a framework to resist the perpetuation of oppressive ideologies and structures that contribute to the spread of both scientific misinformation about viruses and the viruses themselves.
Open Access
Challenges and supports to aging in place in a gentrifying context
(2020-05) Kumar, Manish
Background and Objectives: Neighborhoods play a critical role in healthy aging, with changes to neighborhoods having a profound impact on individuals’ ability to age in place. Using gentrification as an indicator of neighborhood change and applying the theoretical framework of the Environmental Press model, this study examines the relationship between changing environments, affordable housing, and environmental attributes that support and hinder the health and well-being of older adults. Research Design and Methods: This study used a qualitative, case-study approach to interview low-income, majority Black older adults in a gentrifying ward of Washington D.C. Thirty-two adults (16 in non-profit and 16 in for-profit affordable housing) aged 55 and older participated in semi-structured interviews. Transcripts were analyzed using the framework method of analysis. Results: Despite perceiving gentrification, most participants desired to age in place. Many appreciated gentrification related improvements to the built environment but lamented its negative impact on social capital. By providing both proximity to physical amenities and a sense of stability, affordable housing promoted participants’ ability to age in place, though many expressed uncertainties over their long-term ability to do so. Discussion and Implications: This study suggests that while gentrification may improve physical amenities for older adults, its detrimental impact on social capital exacerbates their risk of social isolation. To better support older adults, this study calls for gentrifying areas to invest in affordable housing and promote interventions to preserve older adults’ social capital.
Open Access
Creating Meaning Through Storytelling at the End of Life
(2017-05-08) Morton, Claire
This thesis will examine how patients, families, and doctors in the United States create narratives around dying. While this study does not focus extensively on narrative theory, it will explore how different people look back and tell the stories of their lives and the ways in which that storytelling affects dying. Furthermore, the thesis will focus on physicians, rather than the many other essential members of a health care team. This thesis will examine both individuals who craft their own stories as well as the stories that are told about them after their deaths. Examples of this, including fictional examples, help to illustrate these topics. The process of active storytelling can empower patients to create how they want to be remembered and shapes how families use stories in their process of grieving. I argue here that death is a process that expands beyond the biological realm into the narrative. Narratives may help to interpret and revise a patient’s life story, transforming them from passive participants in the end of lives to active creators. This thesis asserts that patients, family members, and physicians use language and narratives at the end of life as a means of attempting to understand and maybe even control death.
Open Access
Improving the impact of health services delivery: The relationship between physician and patient in the Aravind Eye Care System Outreach Camp Project in Rayavaram, India
(2011-12-08) Veerappan, Malini
This paper investigates the relationship between physician and patient at an outreach eye camp in Rayavaram, Tamilnadu, India. This outreach eye camp represents free ophthalmic care delivery to a rural, medically underserved population (n=32). In order to distinguish the effects of two different determinants (rural vs. urban setting and free vs. full cost care), the study included two additionally patient cohorts: urban, non-paying patients (n=33) and urban, paying patients (n=30). Audio recordings and interviews constituted data collection methods. The three components of a doctor-patient relationship that were studied through these data were power dynamics, treatment decision-making, and communication. Results indicate that the doctor-patient relationship in a rural, non-paying setting is characterized by a paternalistic power dynamic, paternalistic treatment decision making model, and moderately effective communication. This means that medical consultations were largely driven by the physician and fostered little patient control. The physician alone made decisions about treatment (when choices were available). Furthermore, there was a moderate level of communication from doctor to patient about the diagnosis and treatment protocol. Lastly, each consultation was largely a one-sided exchange as it offered little opportunity for the patient to express concerns or ask questions. Though medicine of the western world has increasingly come to embrace the concept of patient-centered medicine, the study discusses the harm associated with activating rural, poor patients who are ill-equipped to take personal health into their own hands. The study hopes that this understanding of the doctor-patient relationship will lay the groundwork for future research and inform strategies to enhance this interaction, thereby improving health outcomes of global health development projects.
Open Access
Labor Attrition between South Africa’s Public and Private Health Sectors: A Mixed-Methods Case Study of KwaZulu-Natal Dietitians
(2018-04-25) Perper, Raichel
The South African health care system has a highly inequitable distribution of human and financial resources. The private sector only serves 28-38% of the population but has 59% of medical specialists. Applying the concept of job satisfaction as a mediator of labor attrition, the study aims included (1) evaluating the factors influencing choice of workplace amongst clinical dietitians, and (2) analyzing the policy implications for improving labor retention. This cross-sectional study employed a mixed-methods design, including job satisfaction surveys (N=66) and semi-structured interviews (N=7). The sample included public and private clinical dietitians in KwaZulu-Natal, South Africa. Data were analyzed using regression modeling and thematic content analysis. The regression analysis revealed private dietitians to be 12.43 points happier than public dietitians on a 12-question job satisfaction survey (95% CI: 6.74, 18.13), after controlling for salary level, degree, job setting, time in current job, university, and specialty. The private sector offers perceived advantages in physical workplace, workday flexibility, and salary level. Government dietitians expressed more favorable professional relationships with dietetic and non-dietetic colleagues, feelings of value, and salary stability. Private dietitians were dissatisfied with income insecurity, colleague competitiveness, and marketing one’s dietetic services. Public dietitians noted poor physical working conditions and limited promotion opportunities. These findings suggest that retention strategies should target public sector staffing shortages, career pathing, and contract flexibility regarding working hours. Further research is needed to evaluate these findings on a national scale and assess the comparative feasibility, favorability, and impact of private contracting models across other allied health professions.
Open Access
Living Life in the Face of Death: An Ethnographic Exploration of Healing, Temporality, and Connection in Suicide
(2024) Sperber, Benjamin
Suicidality is a visceral, frightening reality that many with mental illness face on a daily basis. Treated with contempt in society, much of the scholarship surrounding suicidality focuses on the family or the effectiveness of treatment options. This thesis represents an effort to hold space for those who suffer from suicidality. Through ethnographic research on reddit and through semi-structured interviews with those who have been involuntarily committed in the state of North Carolina, the author offers a new analysis of the contingencies of healing, time, and connection for those who fail in their aimed desire of death through suicide. Split into three chapters, the author first examines how western biomedicine and the telos of medicine (i.e., treating to cure) necessarily is complicated by mental illness, leaving those who experience suicidality to feel that they are incapable of healing. Moreover, the author undertakes an exploration of differing tropes within biomedicine in an attempt to shed light on how dominant notions of healing are confounded or complicated by suicidality. In Chapter Two, the author explores time; namely, how suicidality subverts productivity-centered, future-oriented understandings and experiences of time. To this end, the author poses a new temporal schema, suicidal temporality, which seeks to explain how those who fail at suicide attempts experience time, the accumulation of life stressors, administrative labor, and more. In the final chapter, the author explores two forms of relationships—those between patient and physician, as well as those between suicidal individuals—to demonstrate how differing contexts can afford or limit a suicidal person varying levels of connection, trust, and aid from their interlocutor. Offering no solutions to eradicate suicidality, the author instead hopes to allow readers to gain a greater understanding of the experiences, emotions, and sensorial experiences that accompany suicidality.
Open Access
Making Meaning through Music: How Older Adults’ Lifelong Experience with Music Creates Connections, Purpose, and Legacy
(2024-04-29) Pawlak, Anika
This project seeks to begin answering the question of how older adults perceive the way music has shaped their lives, experiences, and memories. Using an ethnographic approach, I interviewed nine current or previous residents of Croasdaile Village, a continuous care retirement community in Durham, North Carolina. Interviews were centered around themes of music across the lifespan, asking about origins of musicianship and music taste, experiences with music, and how these themes change during a lifetime. While initially, I wanted to gather first-person perspectives of how older adults view music's presence in their lives, being connected with many lifelong musicians quickly provided evidence that music is so much more than a soundtrack playing in the background. For my participants, music was, is, and will continue to be essential to who they are, the relationships they have, and the means by which they live their lives. The stories gathered in my interviews demonstrate the way interviewees organized their life narratives around music. This suggests that others might also do this. Through this means of storytelling, it became evident that for these folks, music provides purpose and dimension in life. Based on their narratives, it is clear my interlocutors believe that music is a lifelong experience that facilitates relationship building and meaning making in a way no other pursuit could. This interview project exposes and lifts up the importance of music as a mode of communication, connection and comfort across the lifespan.
Open Access
Mental Health of the Latinx Community in the United States
(2023-04-20) Junek, Amanda
Recent spark in political activism for minority communities in combination with social de-stigmatization of mental health has shined light on negative mental health outcomes for minority communities in the United States. Literature has found that the Latinx community faces diminished mental health due to social, political, and economic pressures, and furthermore the need for additional investigation into mitigation tactics of this discrepancy. This analysis first describes five factors which impact mental health of the Latinx community: mental health literacy, stigma surrounding mental health, acculturative stress, discrimination, and financial stress. As young adulthood is pivotal in an individual’s mental health trajectory, the paper describes the study which aims to understand the psychological stress Latinx college students experience as compared to their white counterparts at a prestigious university in the United States. Participants included 67 students from Duke University who voluntarily participated in an online survey including the full Brief Symptom Inventory (BSI). Results in this study found no statistically significant difference amongst BSI and Global Severity Index (GSI) scores of Latinx and White participants. Additionally, no statistical significance was found in the difference between Latinx and White participant anxiety and depression dimension scores. It is critical to understand the role that cultural and racial identity plays in Latinx mental health and minority mental health as a whole. The null findings of this study serve to inspire further investigation to understand the mental health state of Latinx individuals in their young adulthood, and what role their educational environment plays in their psychological stress levels.
Open Access
Navigating the Social Media Landscape
(2024-05-01) Blanding, Erin
How does the TikTok algorithm know what you are thinking before you even search it up? How do influencers rise to popularity? What does it take to capture a digital audience's attention in a saturated online atmosphere? Given the trajectory of artificial intelligence and its proliferation online, will there be any way to distinguish what is “real” and what is “fake”? Navigating the current social media landscape for creators and brands alike is a constantly evolving game of attempting to work with the algorithm instead of against it. TikTok’s “for you” feed revolutionized social media by prioritizing predictions of what users would want to see, rather than curating content they have already expressed an interest in. This has changed the way many popular social media platforms have organized their content. In combination with recommendations backed by unthinkable amounts of data, users are inundated with a never ending stream of addicting media that can have consequences socially and financially. This thesis delves into the relationship between content, data and data privacy concerns, artificial intelligence, and digital strategy as it relates to both individuals and companies in an ever changing, deeply interconnected digital environment.
Open Access
Out of the Laager, Into the Streets: The Origins, Rise, and Fall of Gay Reform Organizing in Apartheid South Africa
(2014-08-18) Tobia, Jacob
This paper chronicles the history of South Africa's gay reform movement from the beginning of apartheid in the 1950s through the fall of apartheid in the late 1980s. The gay reform movement spanned from 1968 to 1987, centered on a single-issue Western understanding of gay and lesbian identity, and focused on working with the apartheid state to gain respect and rights for gay and lesbian people within its existing structures. The story of the gay reform movement began in the 1950s and 1960s, when white gay communities predicated on a Western model of gay identity began to form in the major urban centers of Johannesburg, Cape Town, and Durban. It continued through 1968, when white gay men and women formed the first coherent—albeit clandestine—gay political movement aimed at combatting state persecution of homosexual acts. It revived in the early 1980s when white gays and lesbians formed the Gay Association of South Africa and undertook a host of community-building and reform-oriented political activities. And it ended in 1987, when the white organizers of the Gay Association of South Africa finally realized that, given South Africa’s political and racial differences, a reformist struggle for gay rights could never succeed.
Open Access
Power Plays: The Use of Forum Theatre in Senegal and Kenya to Perform Participation and Rehearse Change
(2013-06-07) Sorrenson, Claire Allegra
This thesis examines the possibilities and limitations of theatre as a development intervention by exploring its contested execution on the ground. Ethnographic investigations compare NGO-directed “Theatre for Development” initiatives in Senegal to community-directed theatre projects in Kenya. In Senegal, a theatre troupe’s implementation of top-down theatre fails to align with the ideals of the participatory “forum theatre” approach on which the troupe models itself. In Kenya, the process of creating forum theatre uncovers problematic moral attitudes and replicates pre-existing power dynamics. Ultimately, the thesis finds that successful theatre work is premised on strong relationships between facilitators and participants and the ability to facilitate stories that contest and challenge hegemonic versions of reality. Theory and practice align in the final chapter, which provides actionable insights for hopeful and questioning practitioners and practitioners-to-be.
Open Access
The Long History of Policing Black Durham
(2016-05-02) Meredith, Eliza
Open Access
The Long History of Policing Black Durham
(2016-05-05) Meredith, Eliza
This is a story that I have had unique access to as a concerned community member and student. While I could have focused on one specific moment, this thesis surveys a variety of key periods throughout Durham’s past in order to provide an historical context and broader framework for understanding and looking at the relationship of the Durham Police Department and black community in Durham. My work is divided into four chapters: Durham at the turn of the century, the 1944 Hayti Police, the Civil Rights Era in Durham, and the contemporary period. A story frames the beginning of each chapter: from an enslaved person running away from Stagville Plantation around 1844, the legal hanging of a black man accused of raping a white woman in 1907, a race riot in 1944 that was sparked by the murder of a black soldier who refused to sit in the back of the bus, the demonstrations after the 1963 election of Mayor Grabarek and growing demand for racial equality in Durham, and the shutdown of North Carolina Highway 147 in December 2014 after the non-indictment of the police officers in Ferguson and New York City who were responsible for killing Michael Brown and Eric Garner, respectively. The product that emerges is a story-based analysis that traces Durham’s history alongside the institution of policing. This thesis challenges the general American assumption that the police department was created to protect and serve citizens, particularly against crime. On the contrary, the history of policing black Durham is directly intertwined with a perceived need to maintain political and social order, not necessarily to address the problem of crime. I will argue that the institution of policing is enmeshed in the maintenance of white supremacy and the social, economic and political exploitation of black bodies. Policing was never an institution to keep black people safe: there has been little emphasis on protecting and serving the black population. The reality was ⎯ and continues to be ⎯ just the opposite. In her 2005 article, published in The Journal of American History, historian Jacquelyn Dowd Hall coined the term “Long Civil Rights Movement” to recast and extend the dominant narrative of the civil rights movement as a set chronology of events, beginning with the Brown v. Board of Education decision in 1954 and ending with the passage of the Voting Rights Act of 1965. Hall argues that the civil rights movement was a freedom struggle that was waged long before the 1950s and encapsulates many movements that continue today. This same concept of a “long” history inspired the title of this thesis. I do not intend to present a linear narrative of the relationship between the Durham Police Department and Black Durham: there are significant continuities throughout the city’s history, but each specific period is rooted in its own distinct moment. While exploring the deep mistrust in the black community towards law enforcement, I will demonstrate how Black Durham continues to experience the police in a very different, and disproportionate way, from the rest of Durham. By placing special emphasis on the human narrative, I hope to uplift stories from Durham that are rarely told. The pages that follow, therefore, are an attempt to broaden and deepen the history of policing black Durham: a story that is rooted in slavery and continues to our current moment.
Open Access
The Person in Society: Active and Relational
(2017-07-02) Rooney, William
This paper is a three-part examination in philosophical anthropology that reflects the curricular framework of my Program II major, "Markets, Society, and Personalism," which focuses on the consequences of a society's working account of the human person for its cultural, economic, and political structure and ethos. The first part is an exploration of the philosophical anthropology known as Thomistic personalism, which combines a metaphysical account of the human person grounded in the thought of St. Thomas Aquinas and W. Norris Clarke, S.J. with the philosophy of personal action and community of St. Karol Wojtyla. The second part traces the roots of the utilitarian Enlightenment anthropologies of John Locke, Jeremy Bentham, and John Stuart Mill and aims to expose their shortcomings, especially as they concern the existential, relational, and moral dimensions of the human person. The third part turns to the economic arena and assesses the vastly different understandings of the nature and meaning of economic action that flow from the Thomistic personalist and utilitarian anthropologies. In Part Three, the thesis draws primarily from the thought of Adam Smith and the social teaching of Pope St. John Paul II for its analysis. Ultimately, the paper concludes that the Thomistic personalist anthropology provides a vastly superior account of the nature of the human person, the meaning of the moral life, and the means by which the person relates to others in community.
Open Access
Through the Lenses of Q’eqchi Maya: (Re)Framing the Story of Development in a Guatemalan Indigenous Community Through Participant-Created Photographs
(2016-08-24) Funk, Lara
The question of evaluations of development projects has been widely debated within the field of international development, with scholars and development practitioners calling for increased community-driven evaluations. However, there has been a paucity of research in community-led project evaluations, and a largely absent investigation utilizing visual anthropology/sociology methodologies. This paper seeks to shift this power by giving voice to the intended beneficiaries of an eco-tourism project in a rural indigenous Guatemala village. Through photographs taken by community members and corresponding interviews, this paper shows the way in which community members have and continue to reframe the idea of development in their village. Specifically, my analysis reveals how residents see changing forms of access, how they reframe ideas of beauty and modernization, and how they reframe their relationship to the land through Western conservation and private property ideals. This research thus provides an alternative narrative to the Western NGO’s evaluations and knowledge production, especially in respect to development and indigenous knowledge. By showing how community members are reframing the story of development, this paper demonstrates the usefulness of using participatory documentary photography in community-led evaluations, and helps balance the playing field by providing a much-needed alternative narrative of project evaluation.
Open Access
Why Designers Should Study Semiotics: Applications of Semiotics to User Interface Design
(2023-04-10) Carroll, Sophia
Adopting a semiotic perspective greatly benefits user interface designers, however its potential has remained largely untapped in the field of human computer interaction and user interface design. In this essay I explain the most pertinent theories of semiotics for designers, including Peirce’s nonstructuralism and sign complex model, Eco’s theory of sign production, critique of iconicity, and theory of interpretation, Jakobson’s speech act model, Bolinger’s rejection of the sign as arbitrary, and Lotman’s semiosphere. I base my analysis in relevant theories of user interface design and human computer interaction (HCI) including Norman’s cognitive engineering and user centered systems design models, as well as Kammersgaard’s four perspectives on HCI. I synthesize these theories by analyzing existing applications of semiotics to HCI by Andersen, Nadin, and de Souza. The major themes that emerge from this analysis are frequent misinterpretations of Peirce rooted in structural semiotics, the usefulness of Eco and Lotman’s semiosphere level view, the significance of viewing the interface as a mediating non-physical sign system, and the importance of using consistent logic and code within interface languages.

Browsing by Department "Program II"

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