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.

SCHOOL DISTRICT GOVERNANCE AND KNOWLEDGE-FIT IN DECISION RIGHTS: HOW DISTRICTS RECRUIT AND HIRE SCHOOL LIBRARIANS

This study examines the organizational structures and decision-making processes used by school districts to recruit and hire school librarians. For students to acquire the information and technology literacy education they need, school libraries must be staffed with qualified individuals who can fulfill the librarian’s role as leader, teacher, instructional partner, information specialist, and program administrator. Principals are typically given decision rights for hiring staff, including school librarians. Research shows that principals have limited knowledge of the skills and abilities of the school librarian or the specific needs and functions of the library program. Research also indicates that those with specific knowledge of school library programs, namely school district library supervisors, are only consulted on recruiting and hiring about half the time. School districts entrust library supervisors with responsibilities such as professional development of school librarians only after they are hired. This study uses a theoretical lens from research on IT governance, which focuses on the use of knowledge-fit in applying decision rights in an organization. This framework is appropriate because of its incorporation of a specialist with a specific knowledge set in determining the placement of input and decision rights in the decision-making processes. The method used in this research was a multiple-case study design using five school districts as cases, varying by the involvement of the supervisors and other individuals in the hiring process. The data collected from each school district were interviews about the district’s recruiting and hiring practices with principals, an individual in HR, library supervisors, and recently hired school librarians. Data analysis was conducted through iterative coding from themes in the research questions, with continuous adjustments as new themes developed. Results from the study indicate that governance framework is applicable to evaluating the decision-making processes used in recruiting and hiring school librarians. However, a district’s use of governance did not consistently use knowledge-fit in the determination of input and decision rights. In the hiring process, governance was more likely to be based on placing decision rights at a certain level of the district hierarchy rather than the location of specific knowledge, most often resulting in site-based governance for decision rights at the school-building level. The governance of the recruiting process was most affected by the shortage or surplus of candidates available to the district to fill positions. Districts struggling with a shortage of candidates typically placed governance for the decision-making process on recruiting at the district level, giving the library supervisor more opportunity for input and collaboration with human resources. In districts that use site-based governance and that place all input and decision rights at the building level, some principals use their autonomy to eliminate the school library position in the allotment phase or hire librarians that, while certified through testing, do not have the same level of expertise as those who achieve certification through LIS programs. The principals in districts who use site-based governance for decision rights but call on the library supervisor for advisement stated how valuable they found the supervisor’s expertise in evaluating candidates for hire. In no district was a principal or school required to involve the library supervisor in the hiring of school librarians. With a better understanding of the tasks involved, the effect of district governance on decision-making, and the use of knowledge to assign input and decision rights, it is possible to look at how all of these factors affect the outcome in the quality of the hire. A next step is to look at the hiring process that school librarians went through and connect those with the measurable outcomes of hiring: school librarian success, retention, and attrition; the quality of school library program services, outreach, and involvement in a school; and the perceptions of the success of the school librarian and the library program as seen from students, teachers, administrators, parents, and other community stakeholders.

Crises and Crisis Generations: International Conflict and Military Participation in Politics

Why do states facing high levels of international threat sometimes have militaries that are heavily involved in politics and at other times relatively apolitical, professional militaries? I argue that the answer to this puzzle lies in a state's history of 'acute' international crises rather than its 'chronic' threat environment. Major international crises lead to professionalization and de-politicization of militaries in both the short- and long-term. International crises underscore the need for the military to defend the state and highlight military deficiencies in this regard. Accordingly, major international crises lead to military professionalization and withdrawal from politics in order to increase military effectiveness. This effect persists years, and decades, later due to generational shifts in the officer corps. As the "Crisis Generation" of officers become generals, they bring with them a preference for professionalization and de-politicization. They guide the military towards abstention from politics. I test this theory using a new global dataset on military officers in national governing bodies from 1964-2008 and find strong support for the theory. Major international crises lead to two waves of military withdrawal from government, years apart. Further statistical analysis finds that this effect is most strongly felt in the non-security areas of governing, while in some cases, international crises may lead to militaries increasing their involvement in security policy-making. Further, international crises that end poorly for a state — i.e., defeats or stalemates — are found to drive more rapid waves of military withdrawal from government. The statistical analysis is supported by a case illustration of civil-military relations in the People's Republic of China, which demonstrates that the crisis of the Korean War (1950-53) led to two waves of military professionalization and de-politicization, decades apart. The first occurred immediately after the war. The second wave, occurring in the 1980s, involved wholesale military withdrawal from governing bodies, which was made possible by the ascent of the "Crisis Generation" of officers in the military, who had served as junior officers in the Korean War, decades prior.