Buffering Effects of Job and Personal Resources on the Health and Well-Being of Care Workers:

Thesis advisor: Erika L. SabbathThe care industry is encountering a critical demand for care workers in the formal and informal sectors. As a result, the healthcare industry is strained from the increasing shortage of workers and capacity in facilities. Moreover, there is a desire among the aged to age in place, thus, care provided in the home and community is also on the rise. The requisite for care workers in the U.S. suggests that this population is vulnerable to job and personal demands in the workplace that are associated with negative health outcomes such as poor sleep and burnout. The purpose of this three-paper dissertation is to evaluate the moderating effects of job and personal resources on the health and well-being of nurses and patient care associates (PCAs) in the formal sector and Filipina care workers in the informal sector. The first two papers used the Boston Hospital Health Workers Study, a longitudinal study that was established in 2006 to examine the working organization and condition, behaviors, and health outcomes among healthcare workers from two large hospitals in the same health system in Boston. The first paper (N=845) used a mixed methods approach and used logistic regression analysis to examine the association of discrimination and short sleep and interaction terms to assess the buffering effect of people-oriented culture between discrimination and short sleep. The qualitative section used a combination of grounded theory and thematic analysis of interviews of unit nurse directors (N=16) to gain an in-depth understanding of how discrimination transpires in the workplace and the resources available to address discrimination and poor sleep among care workers. The second paper (N=874) evaluated the association of job and personal demands and burnout using logistic regression. Interaction terms were implemented to assess the buffering effect of workplace flexibility between job and personal demands and burnout. The third paper used semi-structured interviews of Filipina care workers in New England (N=14). A combination of grounded theory and thematic analysis were used to analyze the qualitative data. In Paper 1, findings showed that people-oriented culture did not buffer the relationship of discrimination and short sleep. However, people-oriented culture slightly attenuated the association of discrimination and odds of short sleep. Qualitative findings illuminated that discrimination transpired among co-workers in relation to their job titles and while numerous job resources are available, these resources do not necessarily address discrimination and promotion of inclusivity. In the second paper, workplace flexibility moderated the relationship between married healthcare workers without children and odds of burnout. Moreover, there are significant associations between active (high demand, high control) and high strained (high demand, low control) workers with perceived low workplace flexibility and odds of burnout. In the third paper, qualitative findings highlighted that Filipina care workers are tasked with multiple job responsibilities that are associated with abuse and injuries and personal demands of providing financial care to their family and saving face from divulging difficult experiences. While job resources like job contracts are helpful in lowering the likelihood of abuse, lack of government oversight facilitated violence in the workplace. Filipina care workers found support through community organizations and advocating for themselves and other fellow care workers. Findings from this study suggest that organizational policies and practices play a role in attenuating poor health outcomes among care workers but not all experience these policies and practices equally. Barriers such as not acknowledging discrimination directly and providing specific resources to discrimination, differing control in the workplace because of job title and racial and gender identities, and reporting abuse and violence in the workplace outweighing the cost of the demand to provide the needs for family members prevent care workers from being able to fully benefit from these policies and practices. Nevertheless, while structural changes take time, unit managers in formal settings and employers in informal settings can address these inequities in their specific settings to improve the health and well-being of care workers. This dissertation will assist the field of social work to advocate for federal, state-level, local, and organizational policies to be implemented in the workplace that will adjust to the needs of healthcare and domestic workers. Furthermore, the study can also inform future interventions to integrate effective organizational policies that reduce poor sleep quality and burnout among care workers.Thesis (PhD) — Boston College, 2020.Submitted to: Boston College. Graduate School of Social Work.Discipline: Social Work

Changing Attitudes towards Hepatitis B among Asian Americans: From Saving Face to Getting Serious

Background: Asian Americans have the highest prevalence of hepatitis B virus (HBV) in the US. The San Francisco Hep B Free (SFHBF) campaign aimed to increase awareness and access to HBV education and services among Asian Americans in San Francisco. Purpose: We sought to examine attitudes and knowledge among Asian Americans regarding HBV at baseline (2009) and benefits of the SFHBF outreach campaign four years later (2013). Methods: Four focus groups were conducted (n=45) in 2009, followed by in-depth interviews (n=40) in 2013. Results: In 2009, many participants were misinformed about HBV symptoms and transmission. They also reported stigma associated with HBV, which hindered Asian Americans from discussing the disease and seeking services. The 2013 interviews revealed that SFHBF had contributed towards awareness of HBV screenings and vaccinations, and also instilled acute seriousness that HBV could affect them directly. Conclusion: The in-depth interviews conducted in 2013 illustrated that there was less concern about “saving face,” but a shift to a level of seriousness associated with HBV. Future efforts among Asian Americans should continue to focus on self-efficacy regarding HBV prevention, including screening and vaccination

A call to healing: Black Lives Matter movement as a framework for addressing the health and wellness of Black women

The Black Lives Matter (BLM) movement re-centered and illuminated the disparities facing the Black population as a result of systemic racism in the United States (U.S.). Notably, BLM also highlighted and uplifted issues facing Black women. Numerous studies have demonstrated that Black women are at-risk for cardiovascular disease, maternal and infant mortality, breast cancer, and mental health symptoms. This paper seeks to argue that the BLM movement is a critical site for radical transformation for raising critical consciousness. In focusing on the well-being of Black people, BLM puts forth a framework of healing justice that employs an anti-racist, intersectional, holistic, and culturally and politically appropriate informed therapeutic approach. This framework addresses the historical and contemporary trauma that Black people have and continue to experience in the U.S. This paper asserts that this framework can cultivate a space of vulnerability for Black women to heal and to continue to develop resilience for liberation and self-determination. </p

A call to healing: Black Lives Matter movement as a framework for addressing the health and wellness of Black women

The Black Lives Matter (BLM) movement re-centered and illuminated the disparities facing the Black population as a result of systemic racism in the United States (U.S.). Notably, BLM also highlighted and uplifted issues facing Black women. Numerous studies have demonstrated that Black women are at-risk for cardiovascular disease, maternal and infant mortality, breast cancer, and mental health symptoms. This paper seeks to argue that the BLM movement is a critical site for radical transformation for raising critical consciousness. In focusing on the well-being of Black people, BLM puts forth a framework of healing justice that employs an anti-racist, intersectional, holistic, and culturally and politically appropriate informed therapeutic approach. This framework addresses the historical and contemporary trauma that Black people have and continue to experience in the U.S. This paper asserts that this framework can cultivate a space of vulnerability for Black women to heal and to continue to develop resilience for liberation and self-determination.

Associations with E-cigarette use among Asian American and Pacific Islander young adults in California

With attention to the rapidly growing market of electronic nicotine delivery systems (ENDS/e-cigarettes) and the fastest growing US ethnic minority group, the current study explored associations between awareness, perceived risks, and use of ENDS among Asian American and Pacific Islander (AAPI) young adults.AAPI young adults (ages 18–25) in California were recruited via social media, college classes, listservs for AAPI-serving non-profits, and snowball sampling to complete an anonymous survey between 2014 and 2015.The sample (N = 501) was 57% women, 15% LGBTQIA; with a mean age of 21; 26% foreign-born; identifying as Filipino (29%), Chinese (24%), Vietnamese (14%), mixed-AAPI heritage (13%), or 21% other. Nearly half the sample (44%) reported ever ENDS use; 11% were current users. Current ENDS use was twofold greater for: Filipino and Vietnamese compared to Chinese respondents; men versus women; LGBTQIA-identified respondents; those vocationally trained; and employed. Awareness of ENDS from peers/friends was most common and was associated with ever though not current ENDS use. Most respondents perceived ENDS as harmful (62%); low compared to high risk perception was associated with a three-fold greater likelihood of ever use and six-fold greater likelihood of current use. Popular flavors were fruit (49%, e.g., lychee, taro) and candy/sweets (26%). Current users viewed ENDS as a healthier alternative or quit aid for conventional cigarettes (42%); recreation/social use (33%) also was common.Findings indicate ENDS visibility among AAPI young adults in California with affinity for flavors and many engaging in trial and current use for harm reduction and recreational/social aims. Keywords: Electronic cigarette, Asian American, Pacific Islander, Flavors, Risk perception, Young adult

"I don't have to explain, people understand": Acceptability and Cultural Relevance of a Mobile Health Lifestyle Intervention for Filipinos with Type 2 Diabetes.

BackgroundFilipino Americans have the highest risk for obesity-related type 2 diabetes and related complications compared with all major Asian American subgroups. Identifying effective interventions to improve Filipino health outcomes are needed to reduce this health disparity.ObjectiveTo assess the acceptability and cultural relevance of the PilAm Go4Health program - a culturally adapted mobile health weight-loss lifestyle intervention including virtual social networking for Filipino Americans with type 2 diabetes.Design setting participantsQualitative semi-structured post-program interviews explored perceptions of 45 Filipino Americans with type 2 diabetes in Northern California regarding their perceptions of the acceptability and cultural relevance of PilAm Go4Health. Participants' mean age was 57.6 years. Sixty-seven interviews were recorded, transcribed, and thematically analyzed by four independent coders.ResultsOver half (n=26, 57.8%) of the respondents found that a culturally tailored intervention program enhanced their engagement. All (n=45) of the respondents felt that mobile health technology promoted their self-efficacy. A majority of the respondents (n=29, 64.4%) expressed that they progressed from despair to self-efficacy as a result of their participation in the intervention. More than one-fourth of the participants (n=13, 28.8%) discussed that the intervention needed further cultural tailoring.ConclusionsOverall, PilAm Go4Health - a mobile health weight-loss lifestyle intervention - was acceptable and culturally relevant for Filipino Americans with type 2 diabetes. Findings may help inform clinician and researchers on effective intervention strategies for diabetes self-management when designing interventions for diverse populations

“I don’t have to explain, people understand”: Acceptability and Cultural Relevance of a Mobile Health Lifestyle Intervention for Filipinos with Type 2 Diabetes

BackgroundFilipino Americans have the highest risk for obesity-related type 2 diabetes and related complications compared with all major Asian American subgroups. Identifying effective interventions to improve Filipino health outcomes are needed to reduce this health disparity.ObjectiveTo assess the acceptability and cultural relevance of the PilAm Go4Health program - a culturally adapted mobile health weight-loss lifestyle intervention including virtual social networking for Filipino Americans with type 2 diabetes.Design setting participantsQualitative semi-structured post-program interviews explored perceptions of 45 Filipino Americans with type 2 diabetes in Northern California regarding their perceptions of the acceptability and cultural relevance of PilAm Go4Health. Participants' mean age was 57.6 years. Sixty-seven interviews were recorded, transcribed, and thematically analyzed by four independent coders.ResultsOver half (n=26, 57.8%) of the respondents found that a culturally tailored intervention program enhanced their engagement. All (n=45) of the respondents felt that mobile health technology promoted their self-efficacy. A majority of the respondents (n=29, 64.4%) expressed that they progressed from despair to self-efficacy as a result of their participation in the intervention. More than one-fourth of the participants (n=13, 28.8%) discussed that the intervention needed further cultural tailoring.ConclusionsOverall, PilAm Go4Health - a mobile health weight-loss lifestyle intervention - was acceptable and culturally relevant for Filipino Americans with type 2 diabetes. Findings may help inform clinician and researchers on effective intervention strategies for diabetes self-management when designing interventions for diverse populations

"I don't have to explain, people understand": Acceptability and Cultural Relevance of a Mobile Health Lifestyle Intervention for Filipinos with Type 2 Diabetes.

BackgroundFilipino Americans have the highest risk for obesity-related type 2 diabetes and related complications compared with all major Asian American subgroups. Identifying effective interventions to improve Filipino health outcomes are needed to reduce this health disparity.ObjectiveTo assess the acceptability and cultural relevance of the PilAm Go4Health program - a culturally adapted mobile health weight-loss lifestyle intervention including virtual social networking for Filipino Americans with type 2 diabetes.Design setting participantsQualitative semi-structured post-program interviews explored perceptions of 45 Filipino Americans with type 2 diabetes in Northern California regarding their perceptions of the acceptability and cultural relevance of PilAm Go4Health. Participants' mean age was 57.6 years. Sixty-seven interviews were recorded, transcribed, and thematically analyzed by four independent coders.ResultsOver half (n=26, 57.8%) of the respondents found that a culturally tailored intervention program enhanced their engagement. All (n=45) of the respondents felt that mobile health technology promoted their self-efficacy. A majority of the respondents (n=29, 64.4%) expressed that they progressed from despair to self-efficacy as a result of their participation in the intervention. More than one-fourth of the participants (n=13, 28.8%) discussed that the intervention needed further cultural tailoring.ConclusionsOverall, PilAm Go4Health - a mobile health weight-loss lifestyle intervention - was acceptable and culturally relevant for Filipino Americans with type 2 diabetes. Findings may help inform clinician and researchers on effective intervention strategies for diabetes self-management when designing interventions for diverse populations

Job and family demands and burnout among healthcare workers: The moderating role of workplace flexibility

Burnout is a growing problem among healthcare workers. Whereas there are numerous predictors of burnout, this article explores the compounding effects of job and family demands among nurses and Patient Care Associates (PCA). This study used the 2018 survey data of the Boston Hospital Health Workers Study (BHWHS) to assess the relationship of job and family demands, workplace flexibility, and burnout (N = 874). In addition, it aimed to evaluate the moderating effect of workplace flexibility and job and family demands on burnout. Results of the study demonstrate that active and high strained healthcare workers are associated with higher odds of experiencing burnout as well as workers who reported perceived low workplace flexibility. In addition, workplace flexibility is associated with reduced odds of experiencing burnout. Workplace flexibility moderated the relationship of childless married healthcare workers and burnout. The study shows that workplace flexibility plays a critical role in potentially reducing odds of burnout in the healthcare worker population. Assessing the perception and accessibility to workplace flexibility among workers is imperative to improve worker well-being and the quality of care provided to patients especially the current effects to worker's health during a pandemic