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Description
Twenty-five percent of Americans are first- or second-generation immigrants (US Census, 2012). Thus, it is likely that many Americans identify with at least two cultures, that of the mainstream United States culture, and their ethnic culture from which they came, making them bicultural. However, current understanding of the impact of biculturalism on psychological functioning is quite limited in scope, as few studies have examined this association longitudinally or considered the moderating role of the cultural environment. The present study proposed to take a more comprehensive approach in understanding the consequences of biculturalism on psychological outcomes (i.e., depression, anxiety, and substance abuse symptoms) among Mexican American adolescents, as they belong to one of largest and fastest growing ethnic groups in the United States (US Census, 2013). The present study had two major goals. The first was to examine the influence of biculturalism on depression, anxiety, and substance abuse symptoms longitudinally over the course of two years. It was hypothesized that overall, biculturalism will lead to less depression, anxiety, and substance abuse symptoms. The results partially supported these predictions. For males, biculturalism was related to significantly fewer anxiety symptoms, but not for females. Further, no main effects of biculturalism were found for depression and substance abuse for males or females. The second goal of the study was to examine the potential moderating role of the cultural environment on the influence of biculturalism on mental health symptoms. It was hypothesized that bicultural individuals will exhibit less mental health symptoms in bicultural environments (person-environment fit) compared to more monocultural individuals (person-environment misfit). However, no differences are expected to ii emerge between bicultural and monocultural individuals in monocultural environments, as both groups should be well adapted in these settings. The results did not fully support these predictions. Though, biculturalism for male adolescents was related to significantly fewer anxiety symptoms in home environments where parents reported moderate degrees of biculturalism, and females' biculturalism was related to significantly fewer depression symptoms in neighborhood environments that were relatively bicultural; no effects of biculturalism were found in environments that were the most bicultural. The implications of the findings are discussed.
ContributorsBasilio, Camille D (Author) / Knight, George P. (Thesis advisor) / Kwan, Virginia S.Y. (Committee member) / Roosa, Mark W. (Committee member) / Gonzales, Nancy (Committee member) / Arizona State University (Publisher)
Created2014
Description
Recent reports have indicated that there are both mental health and educational disparities between Latino youth and their European American counterparts. Specifically, Latin youth are at a heightened risk for negative mental health outcomes in comparison to their non-Latino youth (e.g., Eaton et al., 2008). Further, 16.7% of Latino adolescents dropped out of high school compared to 5.3% of European American youth over the past several decades (1960-2011; U.S. Department of Education, 2013). Mexican American (M.A. youth in particular, have the lowest educational attainment among all Latino ethnic groups in the U.S. (U.S. Census Bureau, 2010). While these mental health and educational disparities have often been attributed to discrimination experiences that Latino youth encounter, there is also consistent empirical evidence linking discrimination with these maladjustment problems. These studies confirmed that discrimination directly related to depressive symptoms (e.g., Umana-Taylor et al., 2007), externalizing behaviors (Berkel et al., 2010), self-esteem (e.g., Zeiders et al., 2013), and academic outcomes (e.g., Umana-Taylor et al., 2012). Few studies to date have examined the underlying mechanisms (i.e., moderation and mediation) that help us to better understand resiliency paths for those Latino youth that display positive adjustment outcomes despite being faced with similar discrimination encounters that their maladjusted peers face. Therefore, the following two studies examined various mechanisms in which discrimination related to adjustment to better understand potential risk and resiliency processes in hopes of informing intervention research. Paper 1 explored cultural influences on the association between discrimination, active coping, and mental health outcomes in M.A. youth. Paper 2 examined how trajectories of discrimination across 5th, 7th, and 10th grades related to cultural values, externalizing behaviors, and academic outcomes in M.A. youth. Taken together, these studies provide a culturally informed overview of adjustment processes in M.A. adolescents who face discrimination in addition to identifying critical directions for future research in efforts to gaining a more contextualized and comprehensive understanding of the dynamic processes involved in discrimination and adjustment in M.A. youth.
ContributorsO'Donnell, Megan (Author) / Roosa, Mark W. (Thesis advisor) / Dumka, Larry (Committee member) / Gonzales, Nancy (Committee member) / Barrera, Manuel (Committee member) / Arizona State University (Publisher)
Created2014
Description
Mexican American adolescents report high rates of internalizing symptomatology and alcohol use. However, very little research has explored to what extent internalizing distress may contribute to alcohol use among this population. The current study utilized longitudinal data from a community sample of Mexican American adolescents (n=626, 51% female) to test a series of hypotheses about the role of internalizing distress on alcohol use and misuse. Specifically, this study used a bifactor modeling approach to investigate (1) whether different forms of internalizing distress are composed of common and unique components; (2) whether and to what extent such components confer risk for alcohol use; and (3) whether youth cultural orientation plays a role in these associations. Confirmatory factor analyses revealed that a bifactor model with a general factor and three specific factors (depressed mood, general worry, social anxiety) provided good fit to the data. The general distress factor was significantly associated with past month alcohol use but not binge drinking. However, these effects were conditional based on level of acculturation. Differential relations were found between the specific factors of internalizing distress and alcohol use. Depressed mood predicted past month alcohol use among girls; social anxiety negatively predicted past three month binge drinking among boys. Overall, results highlight the multidimensional nature of internalizing distress and suggest that both common and unique components of internalizing distress may be relevant to the etiology of alcohol use among Mexican-American adolescents. Findings underscore the importance of considering cultural orientation as a moderating factor when investigating substance use among Hispanic youth. Implications for future research examining the etiological relevance of the internalizing pathway to alcohol use among Hispanic adolescents are discussed.
ContributorsNichter, Brandon (Author) / Gonzales, Nancy (Thesis advisor) / Chassin, Laurie (Committee member) / Barrera, Manuel (Committee member) / Tein, Jenn (Committee member) / Arizona State University (Publisher)
Created2018
Description
The rates of anxiety, depression, and attempted suicide for transgender individuals are extremely elevated relative to the general population. Yet, little research has been conducted about the transgender population regarding social transition (an individual presenting as their authentic/true gender, one different than the gender they were assigned at birth, in the context of everyday life) and parental acceptance. Both of which have been shown to impact the mental health of transgender individuals. The purposes of this study were: (1) To characterize a sample of transgender adults on their age of awareness of their authentic gender identity and their age of social transition. (2) Examine whether age of social transition, (3) parental acceptance, and (4) the gap in time between age of awareness and age of social transition (awareness-transition gap) were related to mental health. (5) Examine whether parental acceptance was related to age of social transition or to awareness-transition gap. (6) Examine whether age of social transition or awareness-transition gap interact with parental acceptance as correlates of mental health. The sample consisted of 115 transgender adults, ages 18 to 64. Measures were separated into 7 subheadings: demographics, transgender
on-cisgender identity, age of awareness, age of social transition, primary caregiver acceptance, secondary caregiver acceptance, and mental health. Hypotheses were partially supported for age of social transition with mental health, parental acceptance with mental health, and awareness-transition gap with parental acceptance. This study investigated under studied concepts of social transition and parental acceptance that appear to have an effect on the mental health of transgender adults.
on-cisgender identity, age of awareness, age of social transition, primary caregiver acceptance, secondary caregiver acceptance, and mental health. Hypotheses were partially supported for age of social transition with mental health, parental acceptance with mental health, and awareness-transition gap with parental acceptance. This study investigated under studied concepts of social transition and parental acceptance that appear to have an effect on the mental health of transgender adults.
ContributorsRosenberg, Beth Ann (Author) / Gonzales, Nancy (Thesis director) / Saenz, Delia (Committee member) / Davis, Mary (Committee member) / Department of Psychology (Contributor) / Sanford School of Social and Family Dynamics (Contributor) / College of Public Service and Community Solutions (Contributor) / Barrett, The Honors College (Contributor)
Created2018-05
Description
Although discrimination is implicated in ethnic health disparities, social support may buffer against its negative effects on health. This study investigated whether prenatal maternal discrimination and social support would predict postpartum cortisol in low-income Hispanic women and infants. Among infants whose mothers reported high discrimination, low maternal social support was associated with high infant cortisol (ß= -0.293, p= 0.03). This provides evidence for the social buffering hypothesis.
ContributorsJewell, Shannon Linda (Author) / Luecken, Linda (Thesis director) / Presson, Clark (Committee member) / Gonzales, Nancy (Committee member) / Barrett, The Honors College (Contributor) / T. Denny Sanford School of Social and Family Dynamics (Contributor) / Department of Psychology (Contributor)
Created2013-05
Description
Declaration of Conflicts: This project has no conflicts of interest to declare.
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
Context: This project was completed at a federally qualified primary healthcare clinic in Phoenix, Arizona that served patients of all age groups, but primarily cared for the Hispanic population providing primary care, preventative services, family planning, two lab technicians, one promoter, two medical assistant supervisors, five front desk staff, one chief administrative officer, one chief financial officer, two medical directoers who were also providers at the clinic.
Problem and Analysis Assessment: During my clinical rotations, I saw the burden a missed patient appointment had not only on the patients themselves, but also on the clinic, providers, and the staff. It caused delay in treatment for patients, and it did not allow other patients that wanted to be seen to be seen. It also increased unnecessary costs and wasted provider time. Thereafter, I met with some of the leadership team and one of the medical directors to determine a solution to reduce the number of missed appointments that were occurring. An educational session was kept to discuss the findings of this problem to the providers and the staff and when surveys were handed out to the patients, providers, and staff to assess their satisfaction with the old scheduling system versus the new scheduling system, they were also provided with a cover letter discussing the project.
Intervention: In order for improvements in care to occur, a system process change including the way patients are scheduled must occur. In this case, an open-access scheduling system (OAS) was implemented. OAS allows a patient to schedule an appointment on the 'same-day' or the 'next-day' to be seen. One provider at each of the clinics, each day of the week was available for 'same-day' appointments from 1300-1600. The providers were still available for scheduled appointments using the previous scheduling method. Walk-ins were still accepted, and were scheduled based on patient provider preference; however, if an appointment was not available for their preferred provider, they were typically seen with the provider that was the 'same-day' provider for that day.
Strategy for change: Since patients were only allowed to schedule appointments one month in advance, only one month was needed to implement this process change. A recommendation for the future would be to clearly identify the patient encounter type, and label it as a same-day appointment, as this would be helpful when gathering and extracting data for this type of patient group specifically.
Measurement of Improvement: Over a three-month period, a data collection plan was used to determine the number of Mas over a three-month period before and after implementation of this change. Satisfaction scores were measured using likert scales for patients, provider, and staff, and a dichotomous scale was used to determine the likelihood of emergency room or urgent care use. A comparison was done to measure revenue during the same time frame. During the three months, a clinically significant decrease in MAs was seen (<0.52%), with an increase in revenue by 41%. Additionally, a statistically significant increase in patient, provider and staff satisfaction was also noted when compared to the old scheduling system, as >68% of all patients, providers and staff reported feeling either very satisfied or extremely satisfied with the new scheduling system. Additionally, patients also reported that they were less likely to visit an emergency room(88%) or urgent care (90%) since they were able to be seen the same-day or the next-day by a provider.
Effects of changes: An incidental finding occurred during this study - where 877 more patients were seen in the three months during the implementation of this project, compared to the three months prior; which likely resulted in a 41% increase in revenue. Additionally this project, allowed patients that wanted to be seen on the same day, to be seen, and it decreased unnecessary costs associated with emergency room or urgent care visits. Some of the limitations involved included the current political environment, appointment slots that were previously 15 minutes in length (in 2016), increased to 20 minutes in length (in 2017), a language barrier was noted for the patient surveys since English was not the first language for many of the patients who completed the survey (although documents were translated), and the surveys used were not reliable instrument given that a reliable instrument in previous studies could not be found.
Lessons learnt: In order to have accuracy of the survey results, it is best for the author of the study to hand out and provide scripture for the survey so that complete data is received from the surveyors.
Messages for others: Begin by making a small process change where only one provider allows for the open-access scheduling so that the entire office is not affected by it, and if results begin to look promising then it can be expanded. Additionally, correct labeling of patients as 'same-day' is also important so that additional data can be gathered when needed regarding the 'same-day' patients.
Patient/Family/Guardian Involvement: Patients who benefited from the new scheduling system (open-access scheduling) were asked to fill out a survey that asked them to disclose some demographic data and asked them to determine their satisfaction with the new vs old scheduling system and their likelihood of visiting an emergency room or urgent care.
Ethics Approval: Arizona State University Institutional Review Board (IRB) Received: September 2017
ContributorsPatel, Dimple (Author) / Thrall, Charlotte (Thesis advisor) / Glover, Johannah-Uriri (Thesis advisor)
Created2018-05-02
Description
Implementation challenges associated with low community effectiveness rates include low levels of client responsiveness to the intervention, less than ideal intervention fidelity, and low levels of provider quality of intervention delivery. The literature is mixed on how group leader fidelity/quality of delivery are associated with client responsiveness, and research on adolescents and ethnoracially diverse clients is particularly lacking. The current study examined group leader fidelity and quality of delivery as predictors of adolescent in-session group responsiveness to the first session of the Bridges intervention which is a universal, family-based, substance use prevention program delivered in Title I middle schools. Participants consisted of 325 adolescents across 30 intervention groups. Three separate observational coding teams coded group leader fidelity, group leader quality of delivery, and adolescent in-session group responsiveness to the program. Overall percentage of fidelity met was calculated. Next, two confirmatory factor analysis models were conducted on the responsiveness and quality of delivery data of session 1, and factor scores were extracted. Hierarchical linear regression was then conducted to predict adolescent responsiveness with group leader fidelity in step 1 and group leader quality of delivery in step 2. There were no significant associations between predictor variables and adolescent in-session group responsiveness. Findings suggest that group leader implementation constructs do not appear to account for a significant amount of the variance in adolescent group responsiveness during the first session. Future research should examine other variables that are relevant in influencing adolescent program engagement with larger sample sizes.
ContributorsKuckertz, Mary J (Author) / Gonzales, Nancy (Thesis advisor) / Mauricio, Anne (Committee member) / Anderson, Samantha (Committee member) / Arizona State University (Publisher)
Created2022
Description
Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their DM needs. Evidence suggests that using a culturally-tailored approach to DM education can uniquely improve health outcomes in this population. The purpose of this evidence-based practice (EBP) project was to improve glycemic control in a medically underserved Hispanic community through a culturally-tailored DM education program.
Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.
Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).
Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.
Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).
Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
ContributorsBrown, Fionnuala S. (Author) / Thrall, Charlotte (Thesis advisor)
Created2018-04-23