Using a mixed design study to develop a breast screening intervention among Chinese women in the UK

Breast cancer is the most common cancer among Chinese women living in the UK. However the literature suggests that Chinese women are less likely to attend breast screening than white British women. No studies have been conducted to explore reasons for low attendance among this specific population. The purpose of this thesis was to understand the psycho-social factors related to breast cancer prevention and screening among Chinese women in the UK, and then to inform a breast screening intervention design. Three studies were conducted. The first was a systematic review of interventions to increase breast screening among Chinese women living in Western countries. The second and third studies used focus groups to explore Chinese women’s beliefs about breast cancer prevention and screening practices among older and younger generations. Finally, Intervention Mapping was used to synthesise the findings of the focus groups with those of the systematic review to design an empirical and theoretical evidence based breast screening intervention directed at Chinese women who are non-adherent to the NHS Breast Screening Programme. The qualitative findings revealed that older participants held a more holistic view of health maintenance, and had less knowledge about breast cancer and its causes than younger participants. They showed positive attitudes to breast screening and most had responded to receiving a mammography invitation. Language was a key barrier to older participants using medical care and obtaining health-related information. Younger participants expressed high dissatisfaction with health care in UK and showed a strong ‘neo-fatalistic’ view of breast cancer prevention, believing the main cause of breast cancer to be genetic predisposition. The synthesis of findings suggest that healthcare providers need to take Chinese cultural and language concerns, but also the differences between generations, into account when designing and implementing breast screening services and educational programmes which target Chinese women.

A generational analysis of survival strategies of Southern rural Black women

This study examines cross-generational survival strategies, among Southern Rural Black women. Through their oral histories, the currents that run through the lives of five women will be examined from a Black female's perspective. While the experiences are richly different across four generations, these women have provided for their families despite the triple discrimination of being female, poor, and Black. Three important survival resources are identified: kin, education, and religion. The mothering role emerged as a master status with special emphasis on the mother-daughter relationship. ^

Stigma and homeless women

Homelessness among women is an increasing phenomenon. Past research has established the characteristics and the numbers of the homeless thus establishing the heterogeneity of the group. The focus of this work is to examine common experiences and explain how homeless women interpret their circumstances. Erving Goffman's classic work on stigma is combined with the meaning of home and its connection with personal identity. A number of case studies are used to further develop and explain the implications of the homeless state upon the women. ^

Perceptions of family environment, body image and self-esteem of eating disordered and non-eating disordered women

This study explored the perceptions of family environment, body image and self esteem of women who suffer from anorexia nervosa, bulimia nervosa, and depression. Using a nonequivalent control group design, one hundred and fifty women with anorexia nervosa (n = 50), bulimia nervosa (n = 50), and depression (n = 50) were given the Family Environment Scale (FES) and the Eating Disorders Inventory-2 (EDI-2). The objectives of this study were to: (1) study how women with anorexia nervosa and bulimia nervosa perceive their family environment as measured by the FES; (2) compare and contrast perceptions of family environment of women with anorexia nervosa and bulimia nervosa with the control group; (3) compare and contrast perceived levels of self esteem and body image as measured by the EDI-2 of women with anorexia nervosa and bulimia nervosa with the control group; and (4) examine the perceived family environments of eating disordered and non-eating disordered women with regard to body image and self esteem. Results suggested, women who suffered from anorexia nervosa or bulimia nervosa scored significantly lower (p $<$.021) on the Expressiveness, Intellectual-Cultural Orientation, and Active-Recreational subscales of the FES. The results also indicated that women who suffered from bulimia nervosa scored significantly higher (p $<$.015) than women who suffered from anorexia nervosa on the Conflict and Independence subscales of the FES. The results of studying these three populations reflected that women who suffered from anorexia nervosa scored significantly different (p $<$.000) than women who suffered from bulimia nervosa on many of the subscales of the EDI-2. The findings of the study confirmed that women who suffered from anorexia nervosa or bulimia nervosa scored significantly different (p $<$.000) on the subscales of the EDI-2 compared to women who suffered from depression. It was also confirmed that a relationship does exist between perceptions of body image and self esteem and perceptions of family environment amongst women with anorexia nervosa and bulimia nervosa as compared to depressed women. The findings of the study indicated that women who suffered from anorexia nervosa tended to: be less expressive and independent; handle conflict less openly; have a greater drive for thinness; have greater body dissatisfaction; be more perfectionistic; and struggle more intensely with fears around maturity and social insecurity than did women who suffered from bulimia nervosa or depression. In addition, the findings of the study also suggested that women who suffered from bulimia nervosa tended to: be raised in homes where openly expressed anger is permitted amongst family members; have a lesser drive for thinness; have less body dissatisfaction; be less perfectionistic; and not struggle as intensely with fears around maturity and social insecurity as do women who suffered from anorexia nervosa, but more than women who suffer from depression. Treatment implications that may assist community college professors and counselors in meeting the special needs of this special group of women were also discussed. (Abstract shortened by UMI.) ^

Women defending themselves: Cuban Romantic feminine voices (poetry and short stories)

Throughout history, women have played an important role in literature. Nevertheless, since Sappho's poetry until now, feminine voices have had to struggle for recognition of their works. ^ Before the nineteenth century, women were almost ignored in Spanish literature. Society kept them as “ángeles de la familia,” taking care of their homes, husbands, and children. Some of them, such as María de Zayas y Sotomayor in Spain and Sor Juana Inés de la Cruz in Mexico, complained about their situation in their writings. However, they expressed their fight not as a generation but as individuals. ^ In the nineteenth century, the ideas and ideals of Romanticism, were brought to Latin America from Europe. Cuba was among those countries where the new movement took roots. Initiated by Gertrudis Gómez de Avellaneda, a group of women began to participate in literary reunions, and to found newspapers and magazines where works authored by women, dedicated to feminist ideas, were published. They indeed through literature started to live out womanhood in order to intellectually leave the ideological prisons where society had been keeping them. ^ This study scans the literary works of all Romantic women writers in Cuba. It specifically analyzes poetry and short stories, and investigates how these authors expressed themselves in their works against the patriarchal society, where they lived and wrote their books. An eclectic critical method has been used. ^ Findings were very revealing. Only three of the fourteen writers studied in my dissertation had been previously mentioned by major critics. Most of them had been ignored. However, the greatest discovery was that they prompted something new: For the first time they projected themselves as a group, as a collective consciousness, and this fact established a difference with former women writers in Cuban literature before Romanticism. In other words, they produced a “Renaissance” in Cuba's literature. In spite of how they lived between 1820 and 1900, their struggles for women's rights have linked them to our current times. ^

The health and nutritional status of multiethnic perimenopausal women

An integrated, dual-phase study design assessed the health and nutritional status and practices of African-American (A-A), Caribbean (A-C), and white non-Hispanic (W-A) women during perimenopause (40–55 years). During Phase I, four focus groups (n = 37) of male and female participants discussed the health and social implications of perimenopause. A conceptual framework for the main study (Phase II) was developed from the focus groups' findings, in concert with the main study's specific aims and objectives. ^ The main study, a cross-sectional survey, quantitatively assessed the health and nutritional status of a convenience sample of 109 women (25 A-A, 31 A-C and 53 W-A), who met specific eligibility criteria. Using seven instruments, sociodemographic, dietary, medical, reproductive health, health practice and anthropometric data were collected. ^ The groups were of comparable age, education, and socioeconomic status (SES). Despite these similarities, statistically significant interethnic nutritional status differences were found. Significantly more total energy and energy from fat were consumed by A-A than W-A and A-C women. Also, significantly more A-A and A-C than W-A women were overweight or obese with android-type weight patterning. ^ Overall, iron and calcium Recommended Dietary Allowances (RDA's) were not met by 35% and 68% of participants, respectively. Iron deficiency anemia was reported by 29% of participants while 33% reported heavier menstrual bleeding. Coupled with suboptimal iron intakes, this is likely to present a serious public health problem. Similarly, increased bone demineralization characteristic of perimenopause, coupled with suboptimal calcium intakes could precipitate another public health problem, osteoporosis. ^ Participants had different expectations about the role of medical care during perimenopause. Significantly more white (57%) than black (38% [A-A and AC]) women sought medical attention for symptoms. Whereas Hormone Replacement Therapy (HRT) was prescribed for 25% of them, only 13% were compliant at enrollment. ^ The trends and statistically significant findings of this study have huge public health policy implications. It is imperative that appropriate policies are formulated to ensure that America's ethnically diverse perimenopausal women have ready access to culturally appropriate care. This would optimize their health outcomes, and enhance their quality of life and productive capacities at this critical juncture of their lives. ^

Generational change among women in rural Valencia

The demise of Generalissimo Francisco Franco in 1975 and the subsequent democratization of Spain and its inclusion in the European Community have profoundly altered the patriarchal traditions of Spanish society. This study focused on the changes that women in Moixent, a rural village in Valencia, Spain, have experienced as a result of this liberalization of government policies, modernization, and economic development. ^ The purpose of this research was to illuminate the changing lives of two generations of women and their families in rural Valencia. The qualitative research techniques of participant observation, in-depth interviewing, and narrative analysis were used to present the different frames of reference of the two generations. Young working women in this rural community have come to rely on the help and support of their mothers in their attempts to work outside the home and improve their standard of living. As they enter Spain's modernizing economy their consumption patterns increasingly mimic those promoted by the global media, and especially television. As these young women take jobs outside the home they are having fewer children and dramatically altering the nation's demographic profile. ^ The older generation of women, who lived through decades of deprivation during the Spanish Civil War and Franco's long regime, support their daughters' new independence by assuming the arduous tasks of providing informal day care for their grandchildren and performing a variety of unpaid services for their daughters, including shopping, cooking, and housecleaning. This older generation of grandmothers is assuming a more difficult and demanding workload in what otherwise would be their retirement years. Hence they are the true enablers of their daughters' economic progress and modern patterns of consumption. ^ Other influences from the outside world have altered family farming practices. The participation of women in the harvests has declined, and most harvesting is now done by migrant foreign workers. As young women enter the workforce grandmothers strive to impart traditional values to their grandchildren, in the face of a rapidly changing world. ^

Women graduates' academic resilience and their personal strategies for doctoral success

This study explores women's perceptions of what made them successful doctoral students and what strategies they used to cope and succeed in the academic environment of an off-campus program in South Florida. The study's theoretical framework was built on Bandura's (1997) theory regarding ways self-efficacy influences choices made and effort expended; and Gilligan (1982), Belenky et al. (1986) and other feminists' theories concerning how women learn. ^ The study included data obtained from individual, semi-structured interviews with 10 participants, documents spanning the 10 years of the program and interviews with founding faculty members. For each, academic resilience was built on (a) viewing that working on the degree was personally fulfilling; (b) believing she possessed a strong sense of academic confidence; (c) priding herself on having self discipline; (d) seeing herself as a role model; and (e) being motivated by a personal or career goal. ^ Strategies the participants used to overcome roadblocks included (a) time management—finding time for personal, professional, and academic duties; (b) focus—making the dissertation a priority; (c) collaboration—utilizing both personal and programmatic assistance; (d) and advocacy—acting on their individual needs. ^ Results of the study indicated that the program at the satellite campus provided structural resources that satisfied basic needs and strengthened the students' self-efficacy. This helped them become successful doctoral graduates. The women had personal fortitude and strong self-efficacy to complete the doctoral journey. They understood that their success was primarily based on the support they received from people: families, peers, and their major professors. Participants suggested that successful women students ascertain whether they have time and resources to devote to an extended study, an understanding family, and the resilience to overcome roadblocks along the way. ^

Translating international norms: Filters to women's rights in Lebanon

In 1979 the United Nations passed the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), an international bill of rights for women. Much scholarship has focused on the degree to which states have adopted these new international gender norms, but have paid little attention to the fact that norms change in the processes of implementation. This dissertation focuses on that process assessing the translation of international gender equality norm in Lebanon.^ The study traces global gender equality norms as they are translated into a complex context characterized by a political structure that divides powers according to confessional groups, a social structure that empowers men as heads of families, and a geopolitical structure that opposes a secular West to the Muslim East. Through a comparison of three campaigns – the campaign to combat violence against women, the campaign to change personal status codes, and the campaign to give women equal rights to pass on their nationality – the study traces different ways in which norms are translated as activists negotiate the structures that make up the Lebanese context. Through ethnographic research, the process of norm translation was found to produce various filters, i.e., constellations of arguments put forward by activists as they seek to match international norms to the local context. The dissertation identifies six such filters and finds that these filters often have created faithless translations of international norms.^

Women and development in Senegal: Microcredit and household well being

The challenging living conditions of many Senegalese families, and the absence of a providing spouse, have led women to covet new economic opportunities, such as microcredit loans. These loans offer Senegalese women the possibility to financially support their households and become active participants in their economies by starting or sustaining their micro businesses. The study takes place in Grand-Yoff, an overpopulated peri-urban area of the Senegalese capital city Dakar, where most people face daily survival issues. This research examines the impact of microcredit activities in the household of Senegalese female loan recipients in Grand-Yoff by examining socioeconomic indicators, in particular outcomes of health, education and nutrition.^ The research total sample is constituted of 166 female participants who engage in microcredit activities. The research combines both qualitative and quantitative methods. Data for the study were gathered through interviews, surveys, participant observation, focus-groups with the study participants and some of their household members, and document analysis.^ While some women in the study make steady profits from their business activities, others struggle to make ends meet from their businesses’ meager or unreliable profits. Some study participants who are impoverished have no choice but to invest their loans directly into their households’ dire needs, hence missing their business prerogative. Many women in the study end up in a vicious cycle of debt by defaulting on their loans or making late payments because they do not have the required household and socioeconomic conditions to take advantage of these loans. Therefore, microcredit does not make a significant impact in the households of the poorest female participants. The study finds that microcredit improves the household well-being - especially nutrition, health and education - of the participants who have acquired significant social capital such as a providing spouse, formal education, training, business experience, and belonging to business or social networks.^ The study finds that microcredit’s household impact is intimately tied to the female borrowers’ household conditions and social capital. It is recommended that microcredit services and programs offer their female clients assistance and additional basic services, financial guidance, lower interest rates, and flexible repayment schedules. ^

A study of the differences among African -American, Hispanic, and Anglo women on the perceived barriers and strategies to career advancement in public school administration

Women have been traditionally excluded from the ranks of principals and district administrators in public school systems throughout the country. Traditionally, Anglo women have been more successful than African American and Hispanic women in breaking down the barriers that impede their ascension to the top. The purpose of this study was to ascertain how African American, Hispanic, and Anglo higher-level female administrators perceive the barriers that hinder their progress, the effects of the barriers, and the strategies to overcome the barriers. ^ Two hundred, sixty female administrators employed with Miami-Dade County Public Schools and serving in the role of principal or higher were mailed a questionnaire consisting of 49 questions centering on personal and professional characteristics, perceptions of barriers, perceived effects of barriers, and strategies to overcome the barriers. One hundred, seventy-five questionnaires were returned. To analyze the respondents' personal and professional characteristics, cross tabulations were conducted on the demographic information and on the strategies. ANOVA was conducted on the barriers and the effects of the barriers by ethnic groups. Tukey's test for post-hoc comparisons was utilized to identify groups with means significantly divergent from those of other ethnicities. ^ The data revealed that Hispanic female higher-level administrators who returned the questionnaire were more likely to be married and have children as compared to Anglo and African American female administrators. When addressing the barriers to career success, African American females had a higher mean score on 14 of the 17 barriers to career success as compared to the other ethnic groups. Hispanic female administrators proved to be more successful in utilizing the strategies to overcome career barriers. The strategy, forming a “New Girl Network,” was the least utilized with 79 of the respondents reporting that they had never used it. ^ It is concluded that there is strong need for female administrators to network, mentor, and support one another. Also, it is imperative that the success of particular groups in certain areas is shared with others. ^

Identity, purpose, and well-being among emerging adult Hispanic women

Few studies apply the Eriksonian model of identity formation to cross-cultural samples (3), even though issues of ethnicity and culture may inform a Hispanic woman's self-concept (Phinney, 1996). Hispanic women may also be influenced by traditional gender role behaviors such as passivity or dependence that are outlined by marianismo (Stevens, 1973). A recent study of a multiethnic sample of emerging adult women and men found that purpose commitment mediated the effects of identity commitment on hope and life satisfaction (Burrow & Hill, 2011). The current research consists of two studies that replicate and expand upon the work of Burrow and Hill (2011). Study I replicated the work of Burrow and Hill (2011) among a sample of emerging adult Hispanic women, in order to assess the extent to which the original findings would replicate in a culturally distinct sample. Study II examined the role of marianismo, ethnic identity, and acculturation on identity commitment among emerging adult Hispanic women. Both studies utilized a sample of 532 female undergraduate psychology students, age 18 to 25, who self-identified as Hispanic and submitted data via online surveys. Both studies used self-report, quantitative data, which was analyzed using structural equation modeling. Results from Study I indicated good model fit and replicated the findings from Burrow and Hill (2011). Specifically, the direct effect of identity commitment on hope was fully contingent upon an individual's level of purpose commitment, while the effect of identity commitment on life satisfaction was not contingent upon an individual's level of purpose commitment. Results from Study II indicated that marianismo, Spanish proficiency, familiarity with Latino culture, and familiarity with American culture demonstrated statistically significant direct effects on identity commitment among emerging adult Hispanic women. Results indicated cultural convergence regarding the association of an individual's identity with well-being through a sense of purpose. Findings also revealed the role of cultural factors in the extent to which Hispanic women commit to a personal identity. Future studies should employ mixed method research designs as a means to better ascertain implications of findings. ^

Parental and cultural influences on Hispanic college women's verbal intimate partner violence victimization: An examination of within group differences

Prior research has shown that college women in the United States are experiencing significantly high rates of verbal intimate partner violence (IPV); estimates indicate that approximately 20-30% of college women experience verbal IPV victimization (e.g., Hines, 2007; Muñoz-Rivas, Graña, O'Leary, & González, 2009). Verbal IPV is associated with physical consequences, such as chronic pain and migraine headaches, and psychological implications, including anxiety, depression, suicidal ideation, and substance use (Coker et al., 2002). However, few studies have examined verbal IPV in college populations, and none have focused on Hispanic college women who are members of the largest minority population on college campuses today (Pew Research Center, 2013), and experience higher rates of IPV victimization (Ingram, 2007). The current dissertation sought to address these gaps by examining the influence of familial conflict strategies on Hispanic college women's verbal IPV victimization. Further, within group differences were explored, with specific attention paid to the role of acculturation and gender role beliefs. A total of 906 from two Hispanic Serving Institutions (HSI) in the southeastern (N=502) and southwestern (N=404) United States participated in the three part study. Study one examined the influence of parental conflict strategies on Hispanic women's verbal IPV victimization in current romantic relationships. Consistent with previous research, results indicated that parental use of verbal violence influenced verbal IPV victimization in the current romantic relationship. A unidirectional effect of paternal use of verbal aggression towards the participant on maternal verbal aggression towards the participant was also found. Study two examined the influence of parental conflict strategies, acculturation, and gender role beliefs on victimization. Acculturation and gender role beliefs were found to not have an influence on participants' verbal IPV victimization. Study three examined within-group differences using Study two's model. Differences were found between the southeastern and southwestern participants; gender role beliefs increased rates of verbal IPV victimization in the southeastern population. The current dissertation fills a gap in the literature on IPV experiences in Hispanic college populations, the importance of examining verbal IPV trends, and highlights importance differing cultural influences within populations traditionally viewed as homogenous. The implications for future research are discussed.^

"I’m complicit and I’m ambivalent and that’s crazy":care-less spaces for women in the academy

This paper is about three working class women academics in their 40s, who are at different phases in their career. I take a reflexive, feminist, (Reay 2000, 2004, Ribbens and Edwards 1998) life story approach (Plummer, 2001) in order to understand their particular narratives about identity, complicity, relationships and discomfort within the academy, and then how they inhabit care-less spaces. However unique their narratives, I am able to explore an aspect of higher education – women and their working relationships – through a lens of care-less spaces, and argue that care-less-ness in the academy, can create and reproduce animosity and collusion. Notably, this is damaging for intellectual pursuits, knowledge production and markedly, the identity of woman academics. In introducing this work, I first contextualise women in the academy and define the term care-less spaces, then move onto discuss feminist methods. I then explore and critique in some detail, the substantive findings under the headings of ‘complicity and ‘faking’ it’ and ‘publishing and collaboration’. The final section concludes the paper by drawing on Herring’s (2013) legal premise, in the context of care ethics, as a way to interrogate particular care-less spaces within higher education.

Identity, Purpose, and Well-Being Among Emerging Adult Hispanic Women

Few studies apply the Eriksonian model of identity formation to cross-cultural samples (3), even though issues of ethnicity and culture may inform a Hispanic woman’s self-concept (Phinney, 1996). Hispanic women may also be influenced by traditional gender role behaviors such as passivity or dependence that are outlined by marianismo (Stevens, 1973). A recent study of a multiethnic sample of emerging adult women and men found that purpose commitment mediated the effects of identity commitment on hope and life satisfaction (Burrow & Hill, 2011). The current research consists of two studies that replicate and expand upon the work of Burrow and Hill (2011). Study I replicated the work of Burrow and Hill (2011) among a sample of emerging adult Hispanic women, in order to assess the extent to which the original findings would replicate in a culturally distinct sample. Study II examined the role of marianismo, ethnic identity, and acculturation on identity commitment among emerging adult Hispanic women. Both studies utilized a sample of 532 female undergraduate psychology students, age 18 to 25, who self-identified as Hispanic and submitted data via online surveys. Both studies used self-report, quantitative data, which was analyzed using structural equation modeling. Results from Study I indicated good model fit and replicated the findings from Burrow and Hill (2011). Specifically, the direct effect of identity commitment on hope was fully contingent upon an individual’s level of purpose commitment, while the effect of identity commitment on life satisfaction was not contingent upon an individual’s level of purpose commitment. Results from Study II indicated that marianismo, Spanish proficiency, familiarity with Latino culture, and familiarity with American culture demonstrated statistically significant direct effects on identity commitment among emerging adult Hispanic women. Results indicated cultural convergence regarding the association of an individual’s identity with well-being through a sense of purpose. Findings also revealed the role of cultural factors in the extent to which Hispanic women commit to a personal identity. Future studies should employ mixed method research designs as a means to better ascertain implications of findings.