The relationship between health literacy and indicators of informed decision making for colorectal cancer screening among African Americans

African Americans are disproportionately affected by colorectal cancer (CRC) incidence and mortality. CRC early detection leads to better treatment outcomes and, depending on the screening test, can prevent the development of CRC. African Americans, however, are screened less often than Whites. Aspects of decision making (e.g., decisional conflict, decision self-efficacy) can impact decision making outcomes and may be influenced by social determinants of health, including health literacy. However the relationship between social determinants of health and indicators of decision making in this population is not fully understood. Additionally, individuals have a choice between different CRC screening tests and an individual’s desire to use a particular screening test may be associated with social determinants of health such as health literacy. This study aimed to examine the relationship between social determinants of health and indicators of decision making for CRC screening among African Americans. A total of 111 participants completed a baseline and 14-month follow-up survey assessing decisional conflict, decision self-efficacy, decisional preference (shared versus informed decision making), and CRC test preference. Health literacy was negatively associated with decisional conflict and positively associated with decision self-efficacy (ps < .05). Individuals who were unemployed or working part-time had significantly greater decisional conflict than individuals working full-time (ps < .05). Individuals with a first-degree family history of CRC had significantly lower decision self-efficacy than individuals without a family history (p < .05). Women were significantly more likely to prefer making a shared decision rather than an informed decision compared to men (p < .05). Lastly, previous CRC screening behavior was significantly associated with CRC test preference (e.g., individuals previously screened using colonoscopy were significantly more likely to prefer colonoscopy for their next screening test; ps < .05). These findings begin to identify social determinants of health (e.g., health literacy, employment) that are related to indicators of decision making for CRC among African Americans. Furthermore, these findings suggest further research is needed to better understand these relationships to help with the future development and improvement of interventions targeting decision making outcomes for CRC screening in this population.

INFORMATION TECHNOLOGY PROJECTS IN NONPROFIT UNIVERSITY: A PROJECT GOVERNANCE PERSPECTIVE

The universities rely on the Information Technology (IT) projects to support and enhance their core strategic objectives of teaching, research, and administration. The researcher’s literature review found that the level of IT funding and resources in the universities is not adequate to meet the IT demands. The universities received more IT project requests than they could execute. As such, universities must selectively fund the IT projects. The objectives of the IT projects in the universities vary. An IT project which benefits the teaching functions may not benefit the administrative functions. As such, the selection of an IT project is challenging in the universities. To aid with the IT decision making, many universities in the United States of America (USA) have formed the IT Governance (ITG) processes. ITG is an IT decision making and accountability framework whose purpose is to align the IT efforts in an organization with its strategic objectives, realize the value of the IT investments, meet the expected performance criteria, and manage the risks and the resources (Weil & Ross, 2004). ITG in the universities is relatively new, and it is not well known how the ITG processes are aiding the nonprofit universities in selecting the right IT projects, and managing the performance of these IT projects. This research adds to the body of knowledge regarding the IT project selection under the governance structure, the maturity of the IT projects, and the IT project performance in the nonprofit universities. The case study research methodology was chosen for this exploratory research. The convenience sampling was done to choose the cases from two large, research universities with decentralized colleges, and two small, centralized universities. The data were collected on nine IT projects from these four universities using the interviews and the university documents. The multi-case analysis was complemented by the Qualitative Comparative Analysis (QCA) to systematically analyze how the IT conditions lead to an outcome. This research found that the IT projects were selected in the centralized universities in a more informed manner. ITG was more authoritative in the small centralized universities; the ITG committees were formed by including the key decision makers, the decision-making roles, and responsibilities were better defined, and the frequency of ITG communication was higher. In the centralized universities, the business units and colleges brought the IT requests to ITG committees; which in turn prioritized the IT requests and allocated the funds and the resources to the IT projects. ITG committee members in the centralized universities had a higher awareness of the university-wide IT needs, and the IT projects tended to align with the strategic objectives. On the other hand, the decentralized colleges and business units in the large universities were influential and often bypassed the ITG processes. The decentralized units often chose the “pet” IT projects, and executed them within a silo, without bringing them to the attention of the ITG committees. While these IT projects met the departmental objectives, they did not always align with the university’s strategic objectives. This research found that the IT project maturity in the university could be increased by following the project management methodologies. The IT project management maturity was found higher in the IT projects executed by the centralized university, where a full-time project manager was assigned to manage the project, and the project manager had a higher expertise in the project management. The IT project executed under the guidance of the Project Management Office (PMO) has exhibited a higher project management maturity, as the PMO set the standards and controls for the project. The IT projects managed by the decentralized colleges by a part-time project manager with lower project management expertise have exhibited a lower project management maturity. The IT projects in the decentralized colleges were often managed by the business, or technical leads, who often lacked the project management expertise. This research found that higher the IT project management maturity, the better is the project performance. The IT projects with a higher maturity had a lower project delay, lower number of missed requirements, and lower number of IT system errors. This research found that the quality of IT decision in the university could be improved by centralizing the IT decision-making processes. The IT project management maturity could be improved by following the project management methodologies. The stakeholder management and communication were found critical for the success of the IT projects in the university. It is hoped that the findings from this research would help the university leaders make the strategic IT decisions, and the university’s IT project managers make the IT project decisions.

Pathways to adulthood and their precursors: Roles of gender and race

Research on the transition to adulthood dates back nearly four decades, but a growing body of research has taken a new approach by investigating multiple demographic markers in the transition to adulthood simultaneously. Using the life course perspective, this dissertation is built on the literature by first examining contemporary young adults’ pathways to adulthood from ages 18 to 30 and their differences by gender. Data for this study were drawn from the National Longitudinal Survey of Youth 1997; the final sample included 2,185 men and 2,086 women. The college-educated single workers pathway, the college-educated married working parents pathway, and the high-school-educated single parents pathway were identified in both genders. For men, the study also identified the high-school-educated single workers pathway and the high-school-educated married working parents pathway. For women, the study also identified the high-school-educated workers pathway and the high-school-educated married parents pathway. Not only did the definitions of some pathways differ by gender, but even in the pathways with the same definition, gender differences were found in the probabilities of being married, of being a parent, or of being employed full-time. Based on the pathways to adulthood identified, this research examined the family and adolescent precursors and whether race moderates the associations between family structure experiences and young adults’ pathways to adulthood. Parental education, family structure, GPA, delinquency, early sexual activity, and race/ethnicity were the family and adolescent precursors that distinguished among pathways taken by the youth. Two interactions between race and family structure/instability were identified. The positive association between growing up in a single-parent family and the odds of taking the high-school-educated single workers pathway compared to the college-educated married working parents pathway was weaker for Black males than for White males. The positive association between family instability and the odds of taking the college-educated single workers pathway compared to the college-educated married working parents pathway was weaker for Black females than for White females. This dissertation accounted for changes in the multiple statuses related to becoming an adult by following contemporary young adults for 12 years. More research on contemporary young adults’ pathways to adulthood and subgroup differences in the effects of precursors are recommended. Limitations and implications of this study are discussed.