Browsing by Subject "Social research"

Background: South African adolescents living with HIV (ALWH) experience elevated risk for poor HIV-related outcomes due to challenges associated with HIV disease management. While previous research suggests that social support may mitigate poor HIV-related outcomes, we know little about the specific types of family social support that help ALWH achieve better health outcomes or how this support might be better facilitated. This study aimed to address this gap by characterizing the types of social support provided by family members to assist ALWH in their HIV care management.Methods: We conducted fifty-nine in-depth, semi-structured interviews with ALWH (n=20), their caregivers (n=19), and community stakeholders (n=20) in Cape Town, South Africa. Using deductive and then inductive thematic methods, we triangulated data from these three groups in NVivo to qualitatively analyze family social support. Results: We identified four types of family social support: instrumental support, appraisal support, emotional support, and informational support. Families provided crucial instrumental support through treatment reminders and attending clinic appointments with ALWH. Families also acted as strong sources of appraisal support to help ALWH reflect upon the importance of medication adherence by promoting future orientation and HIV normalization. Similarly, families facilitated adherence through emotional support, such as motivating ALWH and demonstrating interest in their health. Lastly, families offered informational assistance to educate adolescents about managing HIV treatment challenges, such as side effects. Conclusion: In characterizing family social support, our findings highlight sources of struggle and possible solutions to the challenges that ALWH face in their HIV care. Our results suggest that ALWH and providers rely heavily on families to distribute these four types of support in HIV care, emphasizing the importance of exploring how to better facilitate and replicate this support. Understanding these types of social support is a crucial step to identifying potential gaps in care and possible intervention strategies. As such, future research should inquire about the efficacy of incorporating these types of social support into interventions to assist ALWH in their HIV care management.

Background: The landscape of childbirth has transformed over time, shifting from home births guided by midwives to a medicalized procedure predominantly in hospitals, with Cesarean sections (CS) as a significant innovation. Globally, CS rates have risen, including elective CS without medical necessity. Research conducted by the World Health Organization suggests optimal CS rates are between 10-15%, but many countries exceed this value. Initially, in 2014 Cambodia’s rate was at 6.9%, but the latest data released from the Cambodian Demographic and Health Survey has reported a significant increase of almost 18%. Factors like demographic transitions and improved health care are likely to have contributed to this rise. Understanding the decision-making process for childbirth modes is crucial, with medical opinions sometimes differing from patient preferences. This study focuses on Cambodian women, exploring the factors influencing their birth mode decisions, aiming to highlight the significance of women's perspectives in shaping childbirth practices. Methods: Fourteen in-depth, semi-structured interviews were conducted with either nulliparous, primipara, or multipara pregnant women in Phnom Penh, Cambodia. Participants met eligibility criteria such as having single pregnancies over 28 weeks of gestational age, lacking a medical indication from a physician for cesarean section, and being free from known pre-existing medical illnesses or diseases diagnosed during pregnancy. Lastly, participants were not employed as health professionals. Thematic analysis was used on twelve interview transcriptions to analyze the data. Results: Thematic analysis revealed several influential factors, including utilizing external information sources like physicians and family and/or friends, participants’ knowledge of delivery method and procedure recovery, a mode of birth preference largely based on the patient’s individual circumstances, the discussion of patient autonomy and authority to decide, and the recognition that childbirth expectations might change during labor. Conclusion: These research findings highlight that Cambodian pregnant woman processed their mode of birth based on a variety of influences and factors. This data suggests that an individual’s decision is impacted by their environment and the context of their lives. These results can help medical professionals, other maternal health providers, and policymakers better understand how Cambodian pregnant women process their mode of birth decisions.

Composers on the Decks is comprised of three related chapters: an original composition for amplified chamber ensemble and laptop DJ, Alleys Of Your Mind; an extended article entitled "Composers on the Decks: Hybridity of Place and Practice among Composer-DJs Gabriel Prokofiev, Mason Bates, Ari Benjamin Meyers and Brandt Brauer Frick"; and an archive of edited interviews of the four primary research subjects. Chapter 1 is the author's artistic contribution. Chapters 2 and 3 explore the emerging practices of "club classical" and what I am calling "instrumental-electronic dance music" in what may be the first academic study to examine the latter and its connections with the former.

Alleys of Your Mind is a work for seven wind instruments, soprano and laptop DJ composed as social dance music, intended to be performed in a nightclub. Its repetitive style, electronic dance beats and long-form instrumental writing create a musical hybrid of classical compositional techniques and electronic dance music (EDM). The work contains three movements: the first and longest movement is paced at a dance tempo of 124 beats-per-minute; the second movement at half of that speed, 62 beats-per-minute; and Movement 3 returns to the original tempo. The movements are performed without pause and leave generous space for the DJ to improvise with audio effects and an extended interlude in Movement 2. In addition, Alleys Of Your Mind has a documentary dimension: audio samples of medical machinery and voices, recorded by the composer during his recovery in a neuroscience intensive care unit, feature in the second and third movements.

Chapter 2 introduces the related practices of "club classical" and "instrumental-EDM," explaining the musical connections between contemporary classical and EDM and interpreting the hybrid social environments where this music lives. The first section deals with the club classical phenomenon in the practices of composer-DJs Gabriel Prokofiev and Mason Bates, and presenters such as Yellow Lounge. Prokofiev leads Nonclassical Records and hosts monthly club nights in London, during which live sets of recent classical works alternate with sets from Nonclassical's resident DJs. The label's releases adapt classical music to an EDM format, featuring new classical compositions and electronic remixes of these works. Bates presents Mercury Soul, a party in nightclubs that links DJ sets of EDM with live classical sets via composed, electro-acoustic interludes; these nights involve a director, conductor, and a chamber ensemble from a major symphony. Yellow Lounge situates older classical music in nightclubs and employs DJs who spin classical works between live sets. Ari Benjamin Meyers composes instrumental-EDM, music that features classically influenced composition with a dance focus, and has performed it with his Redux Orchestra in Berlin's late night dance clubs from 2005-2012. Brandt Brauer Frick, an EDM trio, formed an 11-piece ensemble of mostly classical instruments that plays their orchestrated techno-like tracks in clubs and concert halls.

Using social and performance analysis, the chapter describes these phenomena as musical and social hybridity. Club classical and instrumental-EDM evince a desire on the part of event planners and classically trained composers to connect on a more physical and social level with their audience. Many of the composers and presenters express a wish that through these practices, classical music can expand beyond the concert hall and potentially see a demographic change in its audience over time. The chapter also delves into the narrow demographics of the classical-EDM scene, the difficulties of instrumental-EDM, and situates the author's dissertation composition, Alleys Of Your Mind, and its presentation at the Duke Coffeehouse, within the greater practice of instrumental-EDM.

Chapter 3 presents edited versions of the author's interviews with the study's four primary research subjects. This documentation, and the dissertation as a whole, is paired with a website, composersonthedecks.org, which provides additional information, photographs, links, and audio and video of Alleys Of Your Mind.

Burn injuries are devastating in both the acute and chronic phases. Survivors face life-lasting effects from such injuries, often decreasing general health, quality of life and employment status. With increased survival rates post-burn injury, increased research is needed to evaluate the recovery status of patients post discharge, and to identify residual patient needs.

This study measured depression, functional dependence in activities of daily living, quality of life (QoL) and return to work (RTW) 3- and 6-months, and identified factors associated with poor outcomes. Inpatients at Wuhan Third Hospital were asked to join the study as they were being discharged. 280 participants completed the baseline survey, where depression severity and functional dependence were measured using Patient Health Questionnaire-9 and the Barthel Index, respectively. QoL was measured using the Burn Specific Health Survey Brief (BSHS-B) 3- and 6-month, and RTW was collected at the same time-points. Factors associated with each outcome were identified through hypothesis tests and logistic regression models.

Nearly 15% of participants met the depression cut-off score, but over 70% required at least some assistance in daily living according to the BI results. Longer length of stay (LOS) resulted in greater odds of having a depressive PHQ-9 score. LOS, along with older age, female gender and full-thickness burns was significantly associated with functional dependence. 64.7% and 70.3% of participants reported a good QoL at 3- and 6- month follow-ups, respectively. Larger total body surface affected by burn and longer

LOS greatly decreases participant odds of having a good QoL at both time points. Three iv

months after hospital discharge, 66.4% of participants returned to work, and increased to 67.2% 6 months after discharge. Significant differences in RTW rate existed by age, education level, burn depth, LOS and BI score. Participants with LOS longer than two weeks had nearly 7 times lower odds of returning to work than those with stays one week or shorter, even after adjusting for burn depth and size.

There does not appear to be a large residual need for mental health services for burn injury patients at Wuhan Third Hospital, and high percentage of participants with favorable high QoL is reassuring that current burn care largely addresses patient needs. The percentage of patients reporting need for assistance in daily activities and lack of RTW demand the most attention in future rehabilitation interventions. The study reveals that participants with LOS longer than two weeks have much higher odds of having poor outcomes compared to patients with shorter stays. Further research should be carried out to establish the direction of the relationship between LOS and recovery outcomes to form plans to mitigate modifiable determinants. This would affect multiple adverse burn injury outcomes.

Parental confidence is an important factor in gaining expertise in the parental role. The process of becoming a confident parent requires a personal belief in one’s own capacity but also the ability to engage in mastery experiences (e.g. repeated exposure to specific behaviors). Yet, this repeated exposure and ability to gain confidence in parenting may be limited when an infant requires complex care and hospitalization. The separation and limited interaction between an infant and parent alter the parenting trajectory and can halt confidence and ability to acquire parenting skills that are needed to meet the complex caregiving needs of an infant with medical complexity.

This dissertation aimed to develop knowledge related to parental confidence among parents of infants with medical complexity by clearly delineating the concept, understanding parent engagement within intensive care, exploring relevant contextual factors, and examining the development of confidence and factors contributing to change in parental confidence. The primary study conducted for this dissertation was an exploratory longitudinal multi-method study to examine the development of parental confidence, relationship between contextual factors and confidence, and the extent to which confidence, contextual factors, and parent/infant demographic characteristics predicted parent and infant outcomes. Findings demonstrated a significant increase in parental confidence over time and significant association between better family functioning and higher confidence. The higher confidence was also predictive of higher maternal psychological well-being three months after discharge. Furthermore, findings from a second mixed-methods study revealed that parents described confidence as either an emotional state of being or their ability to engage in specific behaviors. Using multiple methods to examine the development of confidence, essential knowledge was generated about how parents of infants with medical complexity gain confidence in their parental role. Recommendations for clinical practice and future research are provided to advance our understanding of parental confidence in order to positively impact parent and infant health.

Rising demographic diversity and persistent social inequality are two defining features of youths’ social worlds, and schools and neighborhoods are key developmental contexts where this component of contemporary life plays out. This dissertation aimed to better understand the developmental implications of these twin phenomena, focusing specifically on adolescence, a critical period of development characterized by profound neurobiological and social cognitive changes. Across three studies, I asked, (1) how does exposure to different types of diversity and inequality in schools and neighborhoods relate to adolescent mental health and academic engagement? and (2) how do these relations differ across contexts and according to individual socioeconomic and racial-ethnic identity?The first chapter examined the relation between how schools say they value diversity and adolescent belonging, mental health, and academic engagement across racial groups. Results indicate that when schools’ mission statements conveyed explicit support for diversity (versus exhibiting color-evasive ideologies), racial disparities in mental health, educational aspirations, and reading achievement were smaller. However, when there was a mismatch between how schools said they value diversity and how such values were put into practice, schools’ proclaimed support for diversity was negatively associated with mental health, especially among White youth. The second chapter examined how exposure to rising inequality within neighborhoods—vis-à-vis gentrification—may impact educational outcomes. I found small positive associations between living in a gentrifying (versus chronically disinvested) neighborhood and 12th grade cumulative grade point average, intentions to pursue higher education, and one dimension of school quality: exposure to experienced teachers. However, these potential benefits of gentrification were concentrated among youth who were not economically disadvantaged and White youth. Further, for Black youth, the relation between gentrification and postsecondary plans varied according to the degree of racial turnover occurring in gentrifying neighborhoods—Black gentrification was positively associated with intentions to pursue college, but White gentrification was not. The third chapter examined two psychological mechanisms through which living in a gentrifying neighborhood may impact reading and math achievement: educational aspirations and psychological distress. Overall, there was a positive direct association between gentrification and achievement, and limited evidence of mediation. However, the pathways linking gentrification to educational aspirations, psychological distress, and achievement differed across socioeconomic and racial groups in nuanced ways that illuminate the potential costs and benefits of living in a changing neighborhood during adolescence. These three studies contribute to advancing the education, adolescent, and neighborhood literatures by examining understudied aspects of schools and neighborhoods. Findings suggest that the relation between context, identity, and development is more nuanced than is often assumed, with policy implications for how schools and neighborhoods can better address rising demographic diversity and persistent inequality.

Background: The burden of mental health is increased in humanitarian settings, and needs to be addressed in emergency situations. The World Health Organization has recently released the mental health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG) in order to scale up mental health service delivery in humanitarian settings through task-shifting. This study aims to evaluate, contextualize and identify possible barriers and challenges to mhGAP-HIG manual content, training and implementation in post-earthquake Nepal.

Methods: This qualitative study was conducted in Kathmandu, Nepal. Key informant interviews were conducted with fourteen psychiatrists involved in a mhGAP-HIG Training of Trainers and Supervisors (ToTS) in order to assess the mhGAP-HIG, ToTS training, and the potential challenges and barriers to mhGAP-HIG implementation. Themes identified by informants were supplemented by process notes taken by the researcher during observed training sessions and meetings.

Results: Key themes emerging from key informant interviews include the need to take three factors into account in manual contextualization: culture, health systems and the humanitarian setting. This includes translation of the manual into the local language, adding or expanding upon conditions prevalent in Nepal, and more consideration to improving feasibility of manual use by non-specialists.

Conclusion: The mhGAP-HIG must be tailored to specific humanitarian settings for effective implementation. This study shows the importance of conducting a manual contextualization workshop prior to training in order to maximize the feasibility and success in training health care workers in mhGAP.

Background: Acute myeloid leukemia (AML), a rare blood cancer affecting white blood cells, currently impacts approximately 20,380 people living in the U.S. Currently, the 5-year survival rate of AML is 31.7% with Black patients experiencing higher rates of mortality compared to White patients. Black patients have been disproportionately impacted by socioeconomic distress related to historical trauma, social injustices, higher levels of poverty, minimal insurance coverage, and experience higher cancer burden compared to Whites. However, additional research is needed to understand factors that may have contributed to racial disparities among adults with AML. The impact of the cancer care system on health disparities among Black patients has not been well described in the literature. The purpose of this dissertation is to increase understanding of racial disparities in adults with AML and explore factors that may impact disparate outcomes among Black patients.

Methods: A literature review, a qualitative study and a secondary data analysis were used to understand racial disparities in AML and factors that contribute to poor outcomes. The literature review was completed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement to explore disparities in health outcomes among adult survivors of acute leukemias. A total of twenty-five full text published articles were analyzed and included in the synthesis. A qualitative descriptive design was used to explore barriers and facilitators of navigating the cancer care system among a sample of 16 Black adult patients treated with AML at a large comprehensive cancer center. Study findings were analyzed using thematic analysis. Interviews were recorded and coded by two independent coders using Braun and Clark’s method of thematic analysis. A secondary data analysis of cancer registry data was conducted to assess the impact of facility type on the relationship between race and cancer health outcomes (i.e., time to death and time to hematopoietic stem cell transplant) among a sample of 1201 patients with AML. Descriptive statistics were used to explore the structure of the dataset and assess the distribution of the variables. Bivariate analysis was used to examine the differences in facility types across race. Mediation analysis was used to test the mediation effect of facility type on the relationships between race and the health outcomes (time to death and time to HSCT).Results: Identifying as Black, having Hispanic ethnicity, being male, older age, living in areas of high poverty, lack health insurance, and having Medicaid as primary insurance were least favorable conditions for survival among adult AML patients. However, there were limited published qualitative studies exploring the experience of navigating cancer care among adult Black patients with AML. There were also limited published quantitative studies examining causal factors of health disparities among Black patients with AML. The qualitative descriptive study found that Black patients perceived barriers to positive cancer care experiences were discriminatory practices and scarcity in available matched hematopoietic stem cell transplant (HSCT) donors. However, social support, patient-centered care, and empathy from others were perceived as facilitators to care. The secondary data analysis provided evidence the type of facility patients present to for cancer screening may not facility the relationship between race and health outcomes time to death and time to HSCT; however, structural racism does facility this relationship. More research is needed to identify how access to cancer care may contribute to structural racism.

Conclusion: Findings from this dissertation provide empirical data for expanding our understanding factors of the existing racial disparities in cancer care, barriers and facilitators to successful navigation of the cancer care system for Black patients and evidence to identify factors that contribute to structural racism within cancer care. Improving educational curriculum to help clinicians identify signs and symptoms of AML in smaller healthcare and primary care settings, improving insurance coverage for AML treatments and supportive care needs, increasing disease-specific cancer care navigators or social workers, and developing pathways to care for diagnosing AML may be needed to mitigate racial disparities in AML.

Naloxone – an opioid antagonist that reverses the effects of opioids, including potential death from overdose – is increasingly being distributed in non-medical settings. We conducted a mixed methods study administering a survey to 100 treatment seekers and pursuing observant participation at four methadone/buprenorphine Medication Assisted Therapy (MAT) clinics in North Carolina, USA. Female participants were more likely to have gotten a kit and to carry it with them, whereas male participants were more likely to have witnessed an overdose and to have made use of naloxone. Men discussed the difficulties of carrying the naloxone kits, which are currently too large to fit in a pocket. Public health officials may be relieved to know that naloxone users intend to call emergency services.

Background: Ending the global tuberculosis (TB) epidemic by 2035 will substantially depend on the effective control of the “lost to follow-up” (LTFU) from TB treatment. Myanmar is one of the 14 countries with high burden of TB, TB/HIV, and Multidrug-Resistant TB (MDR-TB). The aim of the study is to identify the factors associated with LTFU from TB treatment among migrant and mobile populations in Mon and Kayin States in Myanmar.

Methods: This was a prospective cohort study with a convergent mixed methods design. 146 new TB patients were surveyed and 14 “treatment after LTFU” patients were interviewed between June and September, 2016. Upon the treatment outcome data made available in February 2017, the survival analysis was conducted to measure the effect of potential predictors on time to LTFU during the full duration of treatment using Stata 14.0 version for Mac. Thematic networks analysis was applied to the qualitative data analysis by NVivo software 11.3.2 version for Mac.

Results: Of the 146 patients included, 10 (6.85%) new patients were LTFU from treatment. Having a family and/or community member support during the six to eight months’ treatment was a protective factor (Hazard Ratio (HR) 0.146; 95% CI 0.037 - 0.576; p = 0.0075), whereas the intention to stay for less than three months at the current place was a potential risk factor (HR 6.323; 95% CI 1.403 – 28.499; p = 0.0075) for getting LTFU from TB treatment. Having a lack of knowledge, but a positive attitude towards TB predisposed migrant TB patients to look for health education. However, financial constraint and social stigma of TB reinforced them to get LTFU from TB treatment. Poor provider-to-patient communication and barriers to accessibility of services were the enabling factors for the delay seeking care and treatment.

Conclusions: People on the move who are intended to stay in working area for less than 3 months are the high-risk group for TB treatment default. Having no family and/or community member support is a risk factor associated with tuberculosis treatment default among the migrant and mobile populations in Mon and Kayin States of Myanmar. National Tuberculosis Program should strengthen the existing multilateral community-based TB care with an integrated referral system inclusive of people on the move who are intended to stay in working area for less than three months. Fostering self-efficacy of TB patients by patient-centered communication and informed decision-making in the clinical setting as well as in the community will enable the better adherence to TB treatment among the migrant and mobile populations.

Background: Although many studies have investigated sexual communication between parents and children in Kenya, none have focused singularly on grandparent and grandchild communication when grandparents are primary caregivers. Further, few studies have asked about specific topics related to sex, instead asking generally about “sex related topics” or focusing on HIV/AIDS. This research aims to investigate communication on ten specific sex- related topics between grandparents who are primary caregivers and their grandchildren. The primary research aim was to identify facilitators and barriers to grandparent-grandchild communication associated with frequency of communication. A secondary exploratory question was whether frequency of communication and youth satisfaction with communication were associated with youth’s desire for more communication in the future. Methods: The study was conducted in urban and peri-urban central Kenya. A convenience sample of 193 grandparents and 166 twelve to fifteen year old grandchildren were identified by community health workers. A cross sectional survey assessed nine potential barriers or facilitators to communication (e.g., frequency of communication, perceived grandparent knowledge, grandparent sense of responsibility to communication on a given topic) on ten specified sex- related topics (e.g., peer pressure on sex topics, romantic relationships, condoms). Bivariate and multivariable analyses identified significant associations between communication variables and the outcomes of interest. Results: Bivariate regression showed that higher grandchild age, grandchild gender, higher perceived grandparent knowledge, higher perceived grandparent comfort, higher grandparent-reported sense of responsibility, higher grandparent-reported belief that child should be aware of a given topic before initiating in sex, and higher youth’s own comfort during communication, were significantly associated with higher levels of communication frequency. In the multivariable model, higher grandchild age, gender, higher comfort during communication, and higher perceived grandparent knowledge remained significantly associated with higher levels communication frequency. For the secondary research question, higher communication frequency and higher levels of youth satisfaction were both significantly associated with higher levels of youth desire for more communication in bivariate regression, and higher levels of youth’s satisfaction with communication remained significantly associated with higher levels of youth’s desire for more in the adjusted analysis. Conclusions: This study found that several potential barriers and facilitators of communication are associated with both frequency of and youth’s desire for more communication. The association between grandchild age, gender and perceived grandparent knowledge and frequency of communication is similar to findings from other studies that have examined sex-related communication between parent primary caregivers and children. This finding has important implications for understanding grandparent and grandchild communication, and communication on specific topics in a population from Kenya. The positive association between youth satisfaction of and desire for more communication has important education policy and intervention implications, suggesting that if youth are satisfied with the communication with their caregivers, they may want to learn more.

Abstract

More than 300,000 soldiers have returned from Southwest Asia (i.e., Iraq and Afghanistan) with combat-related mild traumatic brain injuries (mTBIs) associated with exposure to improvised explosive devices (IEDs). Despite less visible physical injuries, these soldiers demonstrate varying levels of physical and cognitive symptoms that impact their post-mTBI family reintegration. The existing literature acknowledges post-mTBI changes in the injured individual affect family functioning; however, post-injury family functioning, such as coping and adaptation, has not been explored. The intent of this dissertation is to explore the problems and challenges of military family reintegration following mTBI.

Nine soldiers with mTBI and their spouses participated for a total of 27 interviews. Both joint and separate individual interviews were conducted to explore their post-mTBI family reintegration experiences. Participants included active duty soldiers with mTBI who were between 2 and 24 months post-deployment and their civilian spouses. Strauss and Corbin's grounded theory methodology was used to collect and analyze the data. This dissertation study consists of three papers, each of which explored experiences that surround family reintegration following mTBI.

The first paper is a comprehensive literature review, examining commonly reported mTBI signs/symptoms, and the impact of these symptoms on the injured individuals and their families. The findings also suggest that psychological distress symptoms such as depression and anxiety are common in injured individuals and their

families after mTBI. The second paper explores the family reintegration processes of post-mTBI soldiers and their spouses. The majority of participants interviewed, both soldiers and their spouses, indicated that symptoms such as irritability, memory loss, and cognitive deficit affected their family reintegration. Some participants reported they had accepted the changes and were working toward a new normal, whereas others indicated these changes were unacceptable and continued their efforts to resume pre-injury functioning.

The third paper examined the experiences of soldiers and their spouses about seeking treatment for mTBI-related symptoms. The majority of interviewed soldiers and their spouses indicated that a delayed diagnosis, difficulty accessing mental health care, and having to navigate an unfamiliar military healthcare system were their biggest challenges. Post-mTBI soldiers experienced significant disruption due to mismatched expectations among themselves and other family members concerning their post-injury capabilities. More research is needed in order to develop effective post-injury rehabilitation programs for soldiers with mTBI and their families.

Background: Limpopo Province has the highest rates of intimate partner violence (IPV) in South Africa, with data suggesting that over half of women experience IPV in their lifetimes. However, data among young, university-attending women in this province is lacking. This study aimed to estimate the prevalence of IPV victimization among university women and examine factors associated with IPV history. The study also aimed to explore how university women recognize IPV, suggest ways victims seek help, and identify a victim’s coping strategies using qualitative methods.

Methods: This study utilized a mixed methods approach and was conducted at the University of Venda (UNIVEN), a rural-based university in Vhembe district. Convenience sampling was used to recruit female participants who were currently enrolled at the university, aged 18 to 31 years, and currently in a relationship or in a relationship within the past year. 113 females were enrolled in the study. After obtaining written informed consent, we conducted a self-administered cross-sectional survey. IPV was measured using the Revised Conflict Tactics Scale (CTS2), which assessed for both past year and lifetime IPV experiences. To explore the association between IPV and other factors, other measures included an alcohol use screening tool (AUDIT-C) and a measure assessing attitudes toward gender roles. Descriptive statistics and Fisher’s exact tests were performed to assess the relationship between potential risk factors and IPV. Logistic regression analyses examined the associations between exposure variables and lifetime IPV victimization. Short explanatory model interviews (SEMI) examining women’s perceptions of IPV-related issues using a custom vignette were administered directly following the survey. The interviews were recorded and later analyzed using thematic analysis.

Results: 92.23% of participants reported being victims of any form of IPV in their lifetime. Psychological aggression (82.52%) was the most prevalent type of lifetime violence, followed by sexual coercion (73.79%), physical assault (37.86%), and injury (15.53%). The joint frequency distribution of IPV victimization by subscale reveals that 9.71% of participants reported being victims of all four forms of IPV at least once in their lifetime, while most respondents reported experiencing two types of IPV (35.9%). Compared to having no sexual partners in the past year, having two or more sexual partners was significantly associated with higher odds of being a lifetime victim of sexual coercion (p = 0.031; OR: 4.41; 95% CI 1.14 - 17.02). Study findings support an increased odds of lifetime IPV (p = 0.030; OR: 7.04; 95% CI 1.21 – 40.97) and physical assault (p = 0.010; OR: 3.77; 95% CI 1.37 – 10.40) for participants who personally knew an IPV victim at UNIVEN compared to women who did not personally know a victim. Participants who disagreed or strongly disagreed that IPV should be viewed as a crime were 11.37 times more likely to be victims of lifetime sexual coercion than those who agreed (p = 0.027; OR: 11.37; 95% CI 1.32 - 97.82). The SEMI revealed most women recognized IPV in the vignette, and the recommended help-seeking behaviors included seeking informal and formal help, leaving the relationship, and changing behavior.

Conclusions: IPV prevalence among the study sample was reported nearly universally. Number of sexual partners, personally knowing a victim of IPV at the university, and attitudes toward gender roles were significantly associated with having a history of IPV. University commitment and multi-sectoral collaboration at all levels are critical for the provision of resources, services, and violence prevention efforts. Future research is needed to inform evidence-based interventions that will reduce victimization by addressing risk factors, under-reporting, and barriers to seeking help.

Intimate partner violence (IPV) is a global health challenge characterized by a high prevalence rate; detrimental outcomes across physical, emotional, and sexual health domains; and heavy financial burden. International efforts that actively involve health sectors are needed to address this urgent issue. As IPV differs depending on its specific cultural and socio-environmental context, careful evaluation is required to ensure that relevant practices and policies are contextually appropriate and effective. This dissertation aims to develop knowledge that contributes to a rich and nuanced understanding of how differences in cultural and socio-economic context shape risks and experiences of IPV among populations in low-resource settings globally by focusing on two underrepresented populations in IPV literature: Chinese women in Mainland China and Latinx immigrants in the US. Specifically, the aims of this dissertation are to (a) synthesize current evidence on risk and protective factors associated with IPV against Chinese women, (b) describe the effects of risk factors for IPV victimization and perpetration among Latinx immigrants with a focus on cultural and socio-environmental factors, and (c) describe the experiences of Chinese women who have experienced IPV. This dissertation addresses its aims by means of the following: (a) synthesis of existing literature on risk and protective factors associated with IPV against Chinese women via a systematic review; (b) analysis of a cross-sectional, descriptive, correlational study on IPV against Latinx immigrants in the US; and (c) analysis of posts from a Chinese forum on domestic violence to describe women’s experiences of IPV using a qualitative descriptive design. This dissertation reveals several major findings. First, IPV risk factors for Chinese women that are consistently supported by evidence include factors at the individual level (e.g., demographics, socioeconomic status, attitudinal factors, behavioral factors, adverse childhood experiences [ACEs], and other personal characteristics); factors at the relationship level (e.g., conflicts, power in intimate relationships, and social capital); and factors at the community level (i.e., geographic locations). However, factors at the societal level and intersections of factors within the same level or across different levels are not examined by existing evidence. Second, acculturative stress, rather than acculturation itself, is associated with a higher risk for IPV victimization for Latinx immigrants, and ACEs are associated with an elevated risk of IPV perpetration. Specifically, family stress emerged as a factor that increases risk for IPV victimization. Although further research is warranted, the profiles of risk factors for IPV perpetration were different for women than for men. Third, Chinese women revealed experiences of IPV that are captured by the following five themes: being trapped in my roles; no power in the relationship; the struggles are real, but I need to tolerate; I want to leave, but have no help; and hope for the future. This dissertation addresses critical gaps in the literature on risk and experiences of IPV among populations in low-resource settings and serves as an empirical foundation to address this global health challenge. Further, this dissertation has significant implications as the nursing discipline is well-positioned to prevent IPV, promote health, and eliminate health disparities through future research, practice, and policy based on its findings.

This dissertation investigates the reciprocal relationship between micro‐levelbeliefs and behaviors involving identity categories and macro‐level features of social structure. Chapters 2 and 3 explore how social psychological processes intersect with persisting network exchange structures or environmental shifts to shape the beliefs or behaviors of embedded actors. Chapter 2 uses original survey data to show how beliefs about occupations shifted shortly after the Covid‐19 pandemic began, and finds these belief changes persist into the following year for occupations made salient as the pandemic began. Chapter 3 presents a novel experiment that assigned participants to exchange networks with different structures and identity compositions. The findings show that (a) persisting network arrangements effect pro‐social behaviors in a similar way regardless of whether the networks contain actors with homogeneous or heterogeneous social identities, and that (b) interacting with dissimilar others over an extended period of time increases an actor’s trust behavior toward unmet members of the out‐group identity. Chapter 4 extends insights from the first two. The results of an agent‐based computational experiment show that initial network arrangements can enable transitive tie formation between dissimilar others – shaping the macrostructure of the network and emergence of homophily, not merely the beliefs and behaviors of the actors within them.

Obesity and overweight disproportionately impact Black American adolescent females—placing them at a lifetime of elevated physical health risks. Despite this burden, the literature that explores the contributors to obesity and overweight among Black American adolescent females remains limited and unclear. This dissertation aims to develop knowledge related to obesity and overweight in Black American adolescent females, by appraising the current understanding of factors that contribute to their obesity and overweight, and explicating the everyday social influences on dietary practices. The primary study conducted for this dissertation used a mixed method, multiple case study design to examine the mother, daughter, and other household contributors to Black American adolescent daughters’ everyday practices of food consumption, acquisition, preparation, and planning. Findings reveal the importance of understanding the complex and dynamic ways mothers and other household members contribute to a holistic view of everyday dietary practices among adolescent daughters. By deeply examining the nuanced ways the multiple cases varied, context-dependent knowledge essential to understanding the complicated health challenge of obesity was produced. Subsequently, recommendations are provided for health providers and scholars to more holistically approach and examine obesity—particularly among populations who are disproportionately affected.

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

As an important form of conservation programming, marine protected areas (MPAs) are now positioned as a key global strategy to protect and conserve marine biodiversity. This context has resulted in a rapid increase in the number and geographic extent of MPAs worldwide. While the benefits derived from MPA establishment are often optimistically framed as beneficial for both marine biodiversity and human wellbeing, this assumption is challenged for several reasons, including the fact that current science and practice frequently fail to account for the full impact of MPAs on human wellbeing. Current science and practice remain focused on a few easily quantifiable indicators in the material dimension. This context poses a danger that the context specific, place based aspects of wellbeing, such as social relations and connections to the marine environment, will not be examined, nor reported in evaluation and decision-making processes related to MPAs. It also reflects a growing need for improved in-depth studies on what wellbeing does and does not mean for particular people, in particular places, to better reflect the diversity in social and cultural constructions of human wellbeing (White 2016).

This dissertation contributes to growing social science scholarship on MPAs and human wellbeing by employing a qualitative, case study design to examine how one’s relational wellbeing can be transformed and challenged by an MPA. It does this by focusing on select small-scale fishing communities living in Mnazi Bay-Ruvuma Estuary Marine Park (MBREMP), located in southern Tanzania. Data collection occurred over 2019-2020 and primarily included 140 semi-structured interviews, which were transcribed, translated, and qualitatively coded for analysis. To explore the range of relationships important to one’s wellbeing, this dissertation engages with relevant literature in development studies, human geography, as well as social science research in fisheries.

Results demonstrate the complex and dynamic nature of human wellbeing, including the fundamental role culture, place, and history have in shaping diverse understandings and constructions of wellbeing. Accounts of wellbeing were found to be woven into the material and emotional realities of everyday life, illustrating how the material, subjective, and relational dimensions of wellbeing are inseparable and co-constituting. Results also show how the construction of one’s wellbeing is formed in and through a history of interactions with others and the environment, which in turn shaped one’s relational values, associated norms and behaviors, and perceptions of the MPA.

Overall, this dissertation contributes to a growing body of social science literature that investigates how one form marine conservation programming, MPAs, interacts with human wellbeing. It presents an empirical case study that advances understanding of the social and cultural constructions of wellbeing, as well as the diverse and nuanced ways people connect with others and their environment. Results from this dissertation have the potential to address persistent tensions between obtaining international targets for marine conservation and the need to ensure the implementation of equitable and just MPAs, including securing the rights of coastal communities.

Sickle cell disease (SCD) is the most common genetic blood disorder in the United States (US) and Jamaica and primarily affects individuals of African descent. SCD can result in severe and debilitating complications, including vaso-occlusive crises and organ damage. To prevent these complications SCD requires complex self-management. SCD is associated with significantly shortened lifespans in both countries. Many personal and background factors including, perceived stigma, demographics (country, age, race, sex, socioeconomic status) and clinical (disease severity, hydroxyurea use, genotype) characteristics may influence self-management strategies and health-related quality of life (QoL) in SCD. These characteristics have not been explored fully in either country and there are many differences between countries in how SCD is managed and stigma is perceived. This dissertation aims to develop knowledge related to the relationships between SCD self-management, stigma of SCD, and health-related QoL.

A systematic literature review was conducted to appraise the current state of knowledge surrounding stigma of SCD. Conclusions from this review revealed that 1) sources of stigma were varied including institutions, healthcare systems and providers, and interpersonal relationships; 2) stigma had negative impacts on participants’ social, psychological, and physiological well-being; 3) stigma had resulted in poor patient-provider relationships and altered care-seeking behaviors in individuals with SCD, and 4) there are gaps in the literature regarding the influence of sources of stigma on self-management and QoL.

The primary study of this dissertation utilized a cross sectional, convergent parallel mixed methods design (individual interviews and self-report surveys). Participants were interviewed about disease self-management strategies and how sources of stigma influence these strategies. Demographic and clinical characteristics were assessed using questionnaires. Quantitative measures were used to assess perceived stigma [SCD Health-Related Stigma Scale (SCD-HRSS) and Measure of Sickle Cell Stigma (MoSCS)] and health-related QoL [Adult Sickle Cell Quality of Life Measures (ASCQ-Me)]. Because there were no publication using the ASCQ-Me to assess health-related QoL in adults with SCD, aside from psychometric studies, a pilot study was conducted evaluating the feasibility of using the ASCQ-Me prior to the primary dissertation study. Use of ASCQ-Me was determined to be feasible.

There were several important findings in the primary dissertation study. Employment and low disease severity were significant predictors of health-related QoL. Nonetheless, participants reported experiencing stigma from family, friends, and people in the workplace and school that impeded their access to the social support and financial resources needed to effectively self-manage. Self-management strategies were similar between the two countries with the exception of there being less opioid use and a greater focus on nutrition in Jamaica. Lastly, participants in both countries, regardless of demographic and clinical characteristics, reported perceiving stigma from healthcare settings. As a result, they altered their self-management in many ways including avoiding or delaying seeking care and pain management. Findings from this study will be used to generate hypotheses for future studies seeking to improve self-management and QoL of individuals with SCD in the presence of stigma.

Recent surveys show that the number of Americans who claim no affiliation with a church body has doubled in the last decade. In addition to the unaffiliated, those who are affiliated with a church body are spending less time in connection with that body. According to philosopher Charles Taylor, we have shifted the way we see the world from an uncontested reality, where truths are absolute, to one that is contested. At the same time, our corporate identity has become individualized. This shift has created a construct where individuals have the opportunity to challenge the traditional view of being, allowing the current shift from deism to atheism. Modern adults are no longer effected by the outside world, but rather, they are buffered and isolated from others, focusing on extreme individualism.

Social science research has shown that individuals experience lasting change through the dynamic power of small group relationships. If small groups are indeed vital to the transformation of individuals, Christian communities must begin to invest in true small group ministries in order to transform individuals. The Episcopal Church has failed to effectively connect and assimilate individuals into established communities, however, that trend can be turned around. Investing in integration programs and employing small group dynamics to achieve meaningful transformation in individuals can help the Episcopal Church stop its slow decline and begin to grow into the future, transforming more lives for Christ.