The relationship between spirituality, knowledge and tuberculosis (TB) medication adherence among African Americans and Haitians

Tuberculosis (TB) is an infectious disease and nonadherence to medication can lead to new cases, multi-drug resistant TB, or potential death. Additionally, healthcare professionals and individuals with TB’s knowledge of the disease and medication adherence are crucial for successful completion of medication therapy. Patient education is one of the most important aspects of care provided in healthcare settings (CDC, 1994). TB tends to disproportionately affect minority and economically disadvantaged patient populations. The purpose of this mixed method study was to explore the relationship between spirituality, knowledge, and TB medication adherence among African Americans and Haitians. The primary research question was: What is the relationship between spirituality, knowledge and TB medication adherence among African Americans and Haitians? Quantitative data were gathered from 33 questionnaires and analyzed by two ANOVAs and four chi square analyses. The null hypothesis was not rejected; there was not a statistically significant relationship between spirituality and TB medication adherence (p =.208) among the study’s African Americans and Haitians. Qualitative data concerning participants’ knowledge of TB, gathered from 16 individual interviews further informed this analysis. Secondary research questions examined the role of spirituality, knowledge of TB and medication adherence among African Americans and Haitians. Four common themes emerged across both groups to answer the secondary research questions. Interviews revealed the themes: (a) God is in control, (b) stigmatization of TB, (c) lack of knowledge, and (d) fear of death. The theme lack of knowledge about TB was found to contribute to stigmatization of TB patients. However, in this study stigma and lack of knowledge were related to initial denial of symptoms and delayed diagnosis, but not found to be related to TB medication adherence. This study could help adult educators and health educators enhance their educational interventions, develop a better understanding of adult learning, resulting in early diagnosis and treatment ultimately decreasing transmission of TB, drug resistance, and potential death. Educators should be aware that TB patients’ spirituality may be an important part of how they cope with having TB. A larger scale study, conducted at multiple locations should be conducted to extend the findings of this small scale exploratory study. Further studies should be done to better determine what patient, healthcare provider and health care system factors might mediate relationships that may exist between lack of knowledge of TB, stigma and TB medication adherence.

An investigation of multiple pathways of developmental intervention change

Convergence among treatment, prevention, and developmental intervention approaches has led to the recognition of the need for evaluation models and research designs that employ a full range of evaluation information to provide an empirical basis for enhancing the efficiency, efficacy, and effectiveness of prevention and positive development interventions. This study reports an investigation of a positive youth development program using an Outcome Mediation Cascade (OMC) evaluation model, an integrated model for evaluating the empirical intersection between intervention and developmental processes. The Changing Lives Program (CLP) is a community supported positive youth development intervention implemented in a practice setting as a selective/indicated program for multi-ethnic, multi-problem at risk youth in urban alternative high schools. This study used a Relational Data Analysis integration of quantitative and qualitative data analysis strategies, including the use of both fixed and free response measures and a structural equation modeling approach, to construct and evaluate the hypothesized OMC model. Findings indicated that the hypothesized model fit the data (χ2 (7) = 6.991, p = .43; RMSEA = .00; CFI = 1.00; WRMR = .459). Findings also provided preliminary evidence consistent with the hypothesis that in addition to having effects on targeted positive outcomes, PYD interventions are likely to have progressive cascading effects on untargeted problem outcomes that operate through effects on positive outcomes. Furthermore, the general pattern of findings suggested the need to use methods capable of capturing both quantitative and qualitative change in order to increase the likelihood of identifying more complete theory informed empirically supported models of developmental intervention change processes.

Placing immigrant incorporation: Identity, trust, and civic engagement in Little Havana

Immigrant incorporation in the United States has been a topic of concern and debate since the founding of the nation. Scholars have studied many aspects of the phenomenon, including economic, political, social, and spatial. The most influential paradigm of immigrant incorporation in the US has been, and continues to be, assimilation, and the most important place in and scale at which incorporation occurs is the neighborhood. This dissertation captures both of these integral aspects of immigrant incorporation through its consideration of three dimensions of assimilation – identity, trust, and civic engagement – among Latin American immigrants and American-born Latinos in Little Havana, a predominantly immigrant neighborhood in Miami, Florida. Data discussed in the dissertation were gathered through surveys and interviews as part of a National Science Foundation-funded study carried out in 2005-2006. The combination of quantitative and qualitative data allows for a nuanced understanding of how immigrant incorporation is occurring locally during the first decade of the twentieth century. Findings reveal that overall Latin American immigrants and their American-born offspring appear to be becoming American with regard to their ethnic and racial identities quickly, evidenced through the salience and active employment of panethnic labels, while at the same time they are actively reshaping the identificational structure. The Latino population, however, is not monolithic and is cleaved by diversity within the group, including country of origin and socioeconomic status. These same factors impede group cohesion in terms of trust and its correlate, community. Nevertheless, the historically dominant ancestry group in Little Havana – Cubans – has been able to reach notable levels of trust and build and conserve a more solid sense of community than non-Cuban residents. With respect to civic engagement, neighborhood residents generally participate at rates lower than the overall US population and ethnic subpopulations. This is not the case for political engagement, however, where self-reported voting registration and turnout in Little Havana surpasses that of most benchmarked populations. The empirical evidence presented in this dissertation on the case of Latinos in Little Havana challenges the ways that identity, trust, and civic engagement are conceptualized and theorized, especially among immigrants to the US.

Navigating racial boundaries: The one-drop rule and mixed-race Jamaicans in South Florida

Like many West Indians, mixed-race Jamaican immigrants enter the United States with fluid notions about race and racial identifications that reflect socio-political events in their home country and that conflict with the more rigid constructions of race they encounter in the U.S. This dissertation explores the experiences of racially mixed Jamaicans in South Florida and the impact of those experiences on their racial self-characterizations through the boundary-work theoretical framework. Specifically, the study examines the impact of participants’ exposure to the one-drop rule in the U.S., by which racial identification has been historically determined by the existence or non-existence of black forebears. Employing qualitative data collected through both focus group and face-to-face semi-structured interviews, the study analyzes mixed-race Jamaicans’ encounters in the U.S. with racial boundaries, and the boundary-work that reinforces them, as well their response to these encounters. Through their stories, the dissertation examines participants’ efforts to navigate racial boundaries through choices of various racial identifications. Further, it discusses the ways in which structural forces and individual agency have interacted in the formation of these identifications. The study finds that in spite of participants’ expressed preference for non-racialism, and despite their objections to rigid racial categories, in seeking to carve out alternative identities, they are participating in the boundary-making of which they are so critical.^

A developmental intervention science outreach research approach to promoting positive youth development

Recent intervention efforts in promoting positive identity in troubled adolescents have begun to draw on the potential for an integration of the self-construction and self-discovery perspectives in conceptualizing identity processes, as well as the integration of quantitative and qualitative data analytic strategies. This study reports an investigation of the Changing Lives Program (CLP), using an Outcome Mediation (OM) evaluation model, an integrated model for evaluating targets of intervention, while theoretically including a Self-Transformative Model of Identity Development (STM), a proposed integration of self-discovery and self-construction identity processes. This study also used a Relational Data Analysis (RDA) integration of quantitative and qualitative analysis strategies and a structural equation modeling approach (SEM), to construct and evaluate the hypothesized OM/STM model. The CLP is a community supported positive youth development intervention, targeting multi-problem youth in alternative high schools in the Miami Dade County Public Schools (M-DCPS). The 259 participants for this study were drawn from the CLP’s archival data file. The model evaluated in this study utilized three indices of core identity processes (1) personal expressiveness, (2) identity conflict resolution, and (3) informational identity style that were conceptualized as mediators of the effects of participation in the CLP on change in two qualitative outcome indices of participants’ sense of self and identity. Findings indicated the model fit the data (χ2 (10) = 3.638, p = .96; RMSEA = .00; CFI = 1.00; WRMR = .299). The pattern of findings supported the utilization of the STM in conceptualizing identity processes and provided support for the OM design. The findings also suggested the need for methods capable of detecting and rendering unique sample specific free response data to increase the likelihood of identifying emergent core developmental research concepts and constructs in studies of intervention/developmental change over time in ways not possible using fixed response methods alone.

Not getting by: Poverty management and homelessness in Miami

Urban inequality has emerged as one of the dominant themes of modern life and globalization. More than three million people experienced homelessness in the United States last year; in Miami-Dade, more than 15,000 individuals were homeless. Surviving extreme poverty, and exiting or avoiding homelessness, involves negotiating a complex mix of public and private assistance. However, a range of factors influence what types of help are available and how they can be accessed. Frequently, larger social structures determine which resource are available, leaving many choices entirely out of the individual's control. For single men, who are ineligible for many benefits, homelessness can be difficult to avoid and even harder to exit. My study seeks to better understand how adult, minority men living in extreme poverty in Miami-Dade negotiate their daily survival. Specific research questions address: Do black and Hispanic men who are homeless or at risk of homelessness have different personal characteristics and different experiences in avoiding or exiting homelessness? How does Miami's response to extreme poverty/homelessness, including availability of public benefits and public and private service organizations, either maximize or constrain the choices available to this population? And, what is the actual experience of single, adult men who are homeless or at risk of homelessness, in negotiating their daily survival? A mixed methods approach combines quantitative survey data from 7,605 homeless men, with qualitative data from 54 semi-structured interviews incorporating the visual ethnography techniques of Photo Elicitation Interviewing. Results show the differences experienced by black and Hispanic men who are poor and homeless in Miami. Findings also highlight how the community's official and unofficial responses to homelessness intersect with the actual experiences of the persons targeted by the policies and programs, challenging preconceived notions regarding the lives of persons living in extreme poverty. It adds to the existing body of literature by focusing on the urban Miami context, emphasizing disparities amongst racial and ethnic groups. Findings are intended to provide an empirically grounded thesis that humanizes the subjects and illuminates their personal experiences, helping to inform public policy around the needs of extremely poor populations.

Selection and passage of county land preservation voter referendum: The role of government

County jurisdictions in America are increasingly exercising self-government in the provision of public community services through the context of second order federalism. In states exercising this form of contemporary governance, county governments with "reformed" policy-making structures and professional management practices, have begun to rival or surpass municipalities in the delivery of local services with regional implications such as environmental protection (Benton 2002, 2003; Marando and Reeves, 1993). ^ The voter referendum, a form of direct democracy, is an important component of county land preservation and environmental protection governmental policies. The recent growth and success of land preservation voter referendums nationwide reflects an increase in citizen participation in government and their desire to protect vacant land and its natural environment from threats of over-development, urbanization and sprawl, loss of open space and farmland, deterioration of ecosystems, and inadequate park and recreational amenities. ^ The study's design employs a sequential, mixed method. First, a quantitative approach employs the Heckman two-step model. It is fitted with variables for the non-random sample of 227 voter referendum counties and all non-voter referendum counties in the U.S. from 1988 to 2009. Second, the qualitative data collected from the in-depth investigation of three South Florida county case studies with twelve public administrator interviews is transformed for integration with the quantitative findings. The purpose of the qualitative method is to complement, explain and enrich the statistical analysis of county demographic, socio-economic, terrain, regional, governance and government, political preference, environmentalism, and referendum-specific factors. ^ The research finds that government factors are significant in terms of the success of land preservation voter referendums; more specifically, the presence of self-government authority (home rule charter), a reformed structure (county administrator/manager or elected executive), and environmental interest groups. In addition, this study concludes that successful counties are often located coastal, exhibit population and housing growth, and have older and more educated citizens who vote democratic in presidential elections. The analysis of case study documents and public administrator interviews finds that pragmatic considerations of timing, local politics and networking of regional stakeholders are also important features of success. Further research is suggested utilizing additional public participation, local government and public administration factors.^

Achievement motivation attributes of international students attending a *postsecondary institution

The purpose of this study was to identify and compare the causal attributes of achievement motivation for academic success possessed by international students to those causal attributes of achievement motivation by other legal immigrant student groups attending a postsecondary institution. In this study, F-1 international students have obtained permission from the federal Department of Immigration and Naturalization Services to attend Miami-Dade Community College in Miami, Florida. There were two additional groups of students selected to participate in this study: Permanent Resident students and Others comprised of asylees, refugees and paroles, which are specific categories of legal immigrant students.^ From the observations of the investigator, international students were more successful at the institution as compared to the other two student groups as measured by such variables as Grade Point Average, Number of Credits Earned and Honors Day awards. By identifying these attributes of achievement motivation, additional curricula, support services and activities can be developed to meet the needs of these highly motivated students.^ Incorporating the theories of McClelland and Weiner in the theoretical framework of the study, both quantitative and qualitative data were collected from 150 subjects using the Measurement of Achievement Motivation Questionnaire and the Guided Biography Interview as data collection instruments. Statistical analyses on the data collected from the three groups of foreign born students at the institution indicated differences in these identified attributes and their effects on academic success.^ Results indicated that F-1 international students at Miami-Dade Community College were highly motivated to achieve, possessed different causal attributes of achievement motivation and displayed their need for achievement in different activities and in different ways as compared to the Permanent Resident and Other student groups. Further investigation on the importance of residency status as an influencing factor of achievement motivation is suggested. ^

Waking the sleeping giant: Beliefs of Brazilian and *American teachers concerning liberation curriculum

The school curriculum is a matter mandated by the educational system rather than determined by the school stakeholders of a community, as Freire (1993) suggests. At the present time, one significant vision of school is challenging the current order of curriculum practice. It focuses on school as a liberating agency grounded on the belief that the abilities to access information and to think critically about it will educate an individual capable of making independent decisions. This dissertation investigates teacher's beliefs concerning curriculum. It was assumed that there is a discrepancy between what has been the position proposed by critical theorists including Freire (1998a, 1993); Apple (1979); Giroux (1998), and the position on curriculum which school systems are typically advancing. ^ There were four purposes of this study. The major purpose of this study was to determine whether or not Brazilian and American Teachers believe that a school curriculum based on Freirean principles could be implemented in the schools in which they worked. Also, this study sought to determine the differences found between teachers' beliefs in the Brazilian and American contexts. Another purpose was to determine how Brazilian and American teachers justify their beliefs and actions when these may represent conflicting values. Finally, this study sought to determine if these teachers believe that the curriculum is in need of change or if they accept the current curriculum as adequate. This study consisted of quantitative and qualitative data collection through multiple methods involving surveys and interviews. The study involved 171 teachers (88 Brazilian and 83 American) from multiple settings with the majority working for public systems. Overall, it seems that Brazilian and American teachers believe that a curriculum based on Freirean principles of education can be implemented in their schools, if ongoing education is provided. The majority of Brazilian teachers believe a curriculum change is necessary while half of the American teachers believe a curriculum change is needed and the other half seems to believe curriculum is adequate. Teachers explain that it is hard to implement a curriculum they believe to be most appropriate for students because the current curriculum is mandated by the school system or by national guidelines. The majority of Brazilian teachers and those American teachers who believed a curriculum change is necessary explained their rationale for change in terms of social justice, problem-solving, collective work, student-centered and context-based curriculum. American teachers, who believed that the curriculum is adequate, explained that they are satisfied with their student's achievements. They stated that their students are doing well on tests and are learning what is required. ^

Cultural perceptions of space and place in the South Florida *environment

Public opinion polls in the United States reveal that a great majority of Americans are aware and show concern about ecological issues and the need to preserve natural areas. In South Florida, natural resources have been subjected to enormous strain as the pressure to accommodate a growing population has led to rapid development. Suburbs have been built on areas that were once natural wetlands and farmlands, and the impact today shows a landscape where natural places have all but disappeared. This dissertation examines the intersection between the perceptions that individuals living in the South Florida region have with respect to the natural environment and local ecological problems with where their relationship to nature takes place. ^ The research is based upon both quantitative and qualitative data. The principal methodology used in this research is the ethnographic method, which employed the data gathering techniques of in-depth interviewing and participant observation. The objective of the qualitative portion of the study was to determine how people perceive and relate to their immediate environment. The quantitative portion of the study employed telephone survey data from the FIU/Florida Poll 2000. Data collected through this survey provided the basis to statistically test responses to the research questions. ^ The findings show that people in South Florida have a general idea of the relationship between the human population and the environment but very little knowledge of how they individually affect each other. The experience of private places and public spaces in everyday life permits people to compartmentalize cultural values and understandings of the natural world in separate cognitive schemas. The appreciation of the natural world has almost no connection to their personal sense of obligation to preserve the environment. That obligation is only felt in their home space even though the South Florida environment overall struggles desperately with water shortages, land encroachment, and a rapidly expanding human population whose activities continuously aggravate an already delicate natural balance. ^

The early development and pilot -testing of a case management intervention with victims of stalking: An evaluation study

This study evaluated the early development and pilot-testing of Project IMPACT, a case management intervention for victims of stalking. The Design and Development framework (Rothman & Thomas, 1994) was used as a guide for program development and evaluation. Nine research questions examined the processes and outcomes associated with program implementation. ^ The sample included all 36 clients who participated in Project IMPACT between February of 2000 and June of 2001, as well as the victim advocates who provided them with services. Quantitative and qualitative data were drawn from client case files, participant observation field notes and interview transcriptions. Quantitative data were entered into three databases where: (1) clients were the units of analysis (n = 36), (2) services were the units of analysis (n = 1146), and (3) goals were the units of analysis (n = 149). These data were analyzed using descriptive statistics, Pearson's Chi-square, Spearman's Rho, Phi, Cramer's V, Wilcoxon's Matched Pairs Signed-Ranked Test and McNemar's Test Statistic. Qualitative data were reduced via open, axial and selective coding methods. Grounded theory and case study frameworks were utilized to analyze these data. ^ Results showed that most clients noted an improved sense of well-being and safety, although residual symptoms of trauma remained for numerous individuals. Stalkers appeared to respond to criminal and civil justice-based interventions by reducing violent and threatening behaviors; however, covert behaviors continued. The study produced findings that provided preliminary support for the use of several intervention components including support services, psycho-education, safety planning, and boundary spanning. The psycho-education and safety planning in particular seemed to help clients cognitively reframe their perceptions of the stalking experience and gain a sense of increased safety and well-being. A 65% level of satisfactory goal achievement was observed overall, although goals involving justice-based organizations were associated with lower achievement. High service usage was related to low-income clients and those lacking in social support. Numerous inconsistencies in program implementation were found to be associated with the skills and experiences of victim advocates. Thus, recommendations were made to further refine, develop and evaluate the intervention. ^

A comparison of the teacher efficacy and performance of traditionally and alternatively certified first -year teachers

The purpose of this study was to compare the efficacy and performance evaluations of alternatively certified first-year teachers to traditionally certified first-year teachers. The participants were 25 first-year teachers in the Broward County Public School District (FL) who completed the Transition to Teaching alternative certification program and a comparison group of 32 first-year teachers in the same school district who completed a traditional university teacher preparation program. ^ The study was a mixed methods design (Creswell, 2003; Tashakkori & Teddlie, 1998). The quantitative data were collected during the 2002–2003 school year using the Teachers' Sense of Efficacy Scale (Tschannen-Moran & Hoy, 2001) and the Florida Performance Measurement System formative and summative instruments. The qualitative data consisted of focus group interviews that were conducted at the end of the 2002–2003 school year. ^ Data were analyzed using independent samples t tests to compare the means of the two populations on their efficacy scores and performance evaluations. Paired samples t tests and analysis of covariance (ANCOVA) were used to compare the efficacy scores for each certification type at the beginning of the school year to the efficacy scores at the end of the school year. A repeated measures analysis of variance (ANOVA) was used to compare the change in the efficacy scores of the teachers from the beginning of the school year to the end of the school year. Focus group interviews were conducted and transcribed, and the content was analyzed and categorized based on the four sources of self-efficacy described by Bandura (1986, 1997). ^ The results of this study revealed that no statistically significant differences existed between the two groups of teachers in their teacher efficacy or performance evaluations and that they reported similar sources of their efficacy. These findings add to the research base that supports alternative certification as a viable and effective pathway into teaching. ^

A determination of the effects of a ropes course on the self -esteem of undergraduate and graduate students

The purpose of this study was to evaluate the impact of the ropes course on the self-esteem of undergraduate and graduate students. The ropes course provides challenging experiential activities that facilitate personal confidence and group teamwork. The study relates to adult education, experiential education, and program evaluation within the context of hospitality and tourism management education. Quantitative data were based on the assessment of self-esteem through the completion of the Coopersmith Self-Esteem Inventory (SEI-C) modified for this study. Qualitative data were based on assessment of participants' reflective papers stating their perceptions of the ropes course. ^ The study compared a treatment group (31 undergraduate and 25 graduate students) which participated in the ropes course, and a control group (31 undergraduate and 25 graduate students) which did not participate. Both groups completed the pre- and post-treatment SEI-C at the same time intervals. The quantitative data were analyzed using a two-way repeated-measures analysis of variance (ANOVA). The qualitative data, comprised of reflective papers voluntarily written by 44 (79%) of the treatment group, were coded using four major themes reflecting the students' perceptions about the ropes course. ^ Scores on the pretest and posttest of the SEI-C were not significantly different for the two groups. The qualitative data showed a favorable impact of the ropes course. The discrepancy in the outcomes based on these two measures suggests that the SEI-C self-report paper-and-pencil instrument may not be sufficiently refined to evaluate the complex issue of self-esteem. The SEI-C, if used, should be supplemented by other evaluation measures, since the two measures may be evaluating different components of self-esteem. They may be also differentially affected by bias in scoring, or by statistical characteristics of reliability and validity. ^

Differential outcomes of two -way and transitional programs on English language learners at different entry levels

This study investigated the effects of two types of bilingual education programs (two-way and transitional) on the academic performance, attitudes, and metacognitive awareness of 5th grade students who entered kindergarten or first grade with different levels of English proficiency. The multi-stage sample consisted of students who had participated in each program for a period of at least five years. A mixed model design allowed for the collection of quantitative and qualitative data that were analyzed accordingly and integrated. ^ The findings indicated no significant differences between the two groups on measures of academic achievement in English. Significant differences were found in the number of semesters required for the students to become proficient English speakers. An important conclusion, based on these findings, was that the students enrolled in the two-way bilingual education (TWBE) programs learned English faster. Moreover, they maintained a high level of proficiency in Spanish, scoring significantly higher than the transitional bilingual education group on measures of Spanish reading ability.^ Questionnaire and interview data indicated that the students in the two-way bilingual education programs tended to use more Spanish for recreational purposes and tended to rate themselves as more proficient Spanish speakers than their peers. Conversely, the students enrolled in the transitional bilingual education programs tended to rate themselves as more proficient in English than their peers. ^ The level of English language proficiency upon entering school (five years later) was found to make a difference in academic achievement, as measured by standardized tests. Five years of schooling did not fully eliminate the gap in academic performance between students with different ESOL entry levels at kindergarten. However, entry level did not have an effect on attitudes towards bilingualism. ^ It is concluded that, although there was no significant difference between the two groups on measures of academic achievement in English, TWBE and transitional programs have differential effects. Students in the TWBE programs acquired oral language at a faster rate, developed literacy skills in their native language, and acquired more positive attitudes towards bilingualism. Theoretical, methodological, and policy implications of the findings are discussed. ^

Implementation of service -learning in higher education courses: Perceptions of faculty

This study examined the motivation of college and university faculty to implement service-learning into their traditional courses. The benefits derived by faculty, as well as those issues of maintenance, including supports and/or obstacles, were also investigated in relation to their impact on motivation. The focus was on generating theory from the emerging data. ^ Data were collected from interviews with 17 faculty teaching courses that included a component of service-learning. A maximum variation sampling of participants from six South Florida colleges and universities was utilized. Faculty participants represented a wide range of academic disciplines, faculty ranks, years of experience in teaching and using service-learning as well as gender and ethnic diversity. For data triangulation, a focus group with eight additional college faculty was conducted and documents, including course syllabi and institutional service-learning handbooks, collected during the interviews were examined. The interviews were transcribed and coded using traditional methods as well as with the assistance of the computerized assisted qualitative data analysis software, Atlas.ti. The data were organized into five major categories with themes and sub-themes emerging for each. ^ While intrinsic or personal factors along with extrinsic factors all serve to influence faculty motivation, the study's findings revealed that the primary factors influencing faculty motivation to adopt service-learning were those that were intrinsic or personal in nature. These factors included: (a) past experiences, (b) personal characteristics including the value of serving, (c) involvement with community service, (d) interactions and relationships with peers, (e) benefits to students, (f) benefits to teaching, and (g) perceived career benefits. Implications and recommendations from the study encompass suggestions for administrators in higher education institutions for supporting and encouraging faculty adoption of service-learning including a well developed infrastructure as well as incentives, particularly during the initial implementation period, rewards providing recognition for the academic nature of service-learning and support for the development of peer relationships among service-learning faculty. ^