Theses and Dissertations School of Social Work
http://hdl.handle.net/10713/67
2024-03-24T15:20:09ZMoving Beyond ‘A white Man’s Thing’: A Case Study of Urban Kenyan Youth Mental Health
http://hdl.handle.net/10713/21575
Moving Beyond ‘A white Man’s Thing’: A Case Study of Urban Kenyan Youth Mental Health
Katerere-Virima, Thuli
Background: Kenya is a lower middle-income country located in Eastern Africa with a population of over 54 million people and a median age of 20 (World Bank, 2020). Competing health emergencies, a healthcare infrastructure ill-prepared for crisis, and inconsistent framing of mental health in culturally relevant terms have all created a gap between mental health need and services in Kenya (Meyer & Ndetei, 2016). This study explores how 15–24-year-olds in Nairobi, Mombasa and Kisumu counties define their mental health and which resources and barriers impact their engagement with mental health services. This study was designed to contribute to the ongoing REACH-MH (Reaching, Engaging Adolescent and youth adults for Care Continuum in Health-Mental Health) project.
Methods: I used an inductive approach to answer two research questions: 1) How do adolescents/young people (AYP) define their mental health? and 2) How do relevant stakeholders describe resources and barriers to AYP mental health? For this case study focused on LVCT Health’s One2One program, I used five sources of data: in-depth qualitative interviews with One2One hotline counsellors; One2One hotline data; youth focus group transcripts; stakeholder meeting notes; and government document review of the Mental Health Taskforce Report of 2020 and the Mental Health Amendment Act of 2022.
Findings: Five themes emerged from the data regarding the universality of “stress” as a concern for youth, the common conflation of mental health and mental illness, and recommendations for youth-friendly provision of mental healthcare. Overwhelmingly, study participants defined “mental health” in ways that captured broader social determinants of health, along with descriptions of “emotional, psychological and social wellbeing”. Barriers to mental health included cost and a lack of trust in mental health professionals, while youth’s capacity for coping and knowledge of the few, but existent, community services available were reported as facilitating factors.
Conclusions: Though challenges abound, also numerous are the strengths and resources possessed by Kenya’s people who continue to solve problems and utilize ways old and new to strive toward a uniquely Kenyan conceptualization of mental health.
University of Maryland Baltimore, School of Social Work, Ph.D. 2023.
2023-01-01T00:00:00ZAttitudes Toward Medical Aid in Dying in a National Sample of Hospice Clinicians
http://hdl.handle.net/10713/21353
Attitudes Toward Medical Aid in Dying in a National Sample of Hospice Clinicians
Becker, Todd D.; Becker, Todd
As of this writing, medical aid in dying (MAID) is available in 11 U.S. states and the District of Columbia, with further expansion projected. Legal protections for conscientious objection foreground clinician attitudes as substantial barriers or facilitators to MAID access for interested patients. Although upward of roughly three quarters of patients who use MAID are enrolled in hospice care, little is known about hospice clinicians’ attitudes toward MAID. The purpose of this three-paper dissertation was to examine attitudes toward MAID in a national sample of hospice clinicians. Participants were recruited from national hospice and palliative care membership associations representing the four core disciplines of the hospice interdisciplinary group (i.e., medicine, nursing, social work, chaplaincy) to complete a one-time, self-administered survey.
Paper 1 examined the preliminary psychometric properties of a modified version of the only empirically evaluated scale on attitudes toward MAID. Confirmatory factor analysis results indicated that the Attitudes Toward Medical Aid in Dying Scale demonstrated factorial validity. Construct validity was established through correlation analyses targeting convergent validity (vis-à-vis a researcher-constructed measure of attitudes toward MAID) and discriminant validity (vis-à-vis a researcher-constructed measure of attitudes toward euthanasia and a scale assessing religiosity). High congeneric reliability estimates supported internal consistency reliability. Despite the favorability of these statistical results, conceptual mismatches between scale items and the U.S. practice context as defined by state laws caution against wider scale use. Further psychometric development is warranted.
Paper 2 explored institutional factors tied to the hospice context of care as correlates of MAID attitudes. Using a 3-point version of Paper 1’s ordinal convergent validity item, results of a partial proportional odds model indicated that professional experience working in a state where MAID was legal and increased orientation toward patient-centeredness were both significantly associated with higher odds of more supportive MAID attitudes across each threshold of the dependent variable. Increased commitment to the hospice philosophy of care also was significantly associated with higher odds of more supportive MAID attitudes. Accounting for differing slopes across dependent variable thresholds, however, this association reached statistical significance only when estimating the odds of being in a category above the midpoint response option (neither support nor oppose). Findings support the assessment of ecological factors that drive hospice ethos and functioning when exploring attitudes toward MAID.
Paper 3 explored attitudes toward being physically present throughout MAID in a hypothetical patient scenario governed by certain safeguards. The 74% of participants who indicated willingness to be present did so based on feelings of personally derived support for MAID, definitions of quality clinical care, and values from their professional training. This broad support, however, was conditioned by boundary setting though which participants described specific conditions required for their participation. In contrast, 15% of participants were unwilling to be present. These attitudes were attributed to objections to the concept of MAID, objections to participation in MAID, and perceptions that MAID is misaligned with health care. Merely 11% of participants were unsure, relating their hesitation to feelings of ambivalence and a lack of experience with MAID. The tensions that participants across samples reported experiencing with themselves, their profession, and broader society reflect a need for greater professional guidance on the safe and effective provision of MAID.
University of Maryland, Baltimore, School of Social Work, Ph.D., 2023
2023-01-01T00:00:00ZPush Factors, Moving, and Mental Health Among Older Adults: The Moderating Effects of Indicators of Social Support
http://hdl.handle.net/10713/20660
Push Factors, Moving, and Mental Health Among Older Adults: The Moderating Effects of Indicators of Social Support
Cheon, Ji Hyang
Due to their inclination to age in place, older adults can experience stress when push factors require them to leave their current residence. Consequently, older adults who are moved because of such factors may be susceptible to adverse effects on their mental health. This study aimed to (1) identify the push factors affecting the moving of older adults, (2) investigate whether the relationship between push factors and mental health is mediated by moving, and (3) examine the moderating role of indicators of social support on the relationship between moving and the mental health of older adults. I conducted analyses of a sample of 4,856 community-dwelling older adults using secondary data derived from Rounds 6 and 7 of the National Health and Aging Trends Study. I used logistic regression and structural equation modeling to test aims. The findings revealed that older adults who had been hospitalized and were renters demonstrated a higher propensity to move and that those who were Medicare beneficiaries were less likely to move. Several health issues were associated with lower well-being and higher depression. Renters reported lower well-being, and Medicaid beneficiaries reported higher depression. Housing interior conditions were also associated with depression and well-being. However, the study produced no evidence that social support moderated the relationship between relocation and mental health in older adults. These findings can inform targeted interventions and policy development to improve the mental health of at-risk older adults who may face push factors such as health problems, limited income, and poor housing conditions.
University of Maryland, Baltimore, School of Social Work, Ph.D., 2023
2023-01-01T00:00:00ZOral Histories of Black Women Advocates in the Civil Rights Era: Illuminating Perspectives of Black Healing, Wellness and Spirituality
http://hdl.handle.net/10713/20634
Oral Histories of Black Women Advocates in the Civil Rights Era: Illuminating Perspectives of Black Healing, Wellness and Spirituality
Murray-Browne, Shawna
African American women have been the backbone of the African American community since their ancestors were forcefully brought to what is now known as the United States. While this remains a fact, the nuances of Black womanhood and its relationship to public and private advocacy have been largely ignored, dismissed, and/or unable to be captured by social work researchers. When the focus shifts to Black women narratives, too often what follows are insights in alignment with dominant Eurocentric frameworks, focusing chiefly on experiences that are palatable to those disinterested in acknowledging the legacy of racism and oppression. As a result, there is a dearth of knowledge exploring the wisdom borne from generations of advocacy executed by Black women as a source of survival and fulfillment. This leaves modern-day Black women advocates without a roadmap for combatting race-based trauma, and the practitioners that serve Black women reliant on harmful so-called “best practices” that defy Black cultural values. Much research conducted about Black women activists is less focused on their personal experiences and more on their perspectives about what they have contributed to society. While these insights are valuable, without the full picture of Black women’s lives, pathology and dehumanization are perpetuated. This study explains findings from a secondary data analysis of oral history interviews archived in the Radcliffe Institute’s Schlesinger Library, Black Women Oral History Project, collected from 1976 to 1981. By applying an anti-colonial Womanist conceptual framework, this study centers on the everyday experiences of six African American woman advocates during the civil rights era. Perspectives around concepts of mental health, healing, spirituality, and religion are illuminated. Utilizing the Womanist Triad of Concern, concerned with the human-human relationship, the human-spirit relationship, and the human-nature relationship, I discuss how sustenance, sacrifice, and solidarity are seen throughout the themes: connection and protection. Employing a reflexive thematic analysis, this study sought to amplify oral history as an anti-colonial methodology to interrupt harmful, dominant narratives in history. As a spiritually guided, African American woman advocate, I engaged in collaboration and meaning-making of the oral histories and this informed the sensemaking around the implications for contemporary change-making Black women, as well as recommendations for future research, policy, and decolonial social work practice.
University of Baltimore, Maryland, School of Social Work, Ph.D., 2023
2023-01-01T00:00:00Z