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Applying the 3D Model of Culturally Congruent Care to Address Prolonged Grief Disorder: An Embedded Mixed-Methods Study
Get PDFPopulation health is a relatively new concept that is integral to primary care. It requires healthcare providers to think differently about health issues and solutions by considering the individual, family, and community. Moreover, Prolonged grief disorder (PGD), also a newly introduced diagnostic condition in DSM-5-TR, is a persistent and pervasive response that affects beyond an individual's cultural, social, and religious norms and significantly impacts crucial areas (personal, family, and occupation) of functioning. Moreover, when PGD-bereaved familial caregivers are treated using Internet-based cognitive behavioral therapy (ICBT), gold standard retention has remained a significant issue among multicultural populations despite the steady rise in culturally adapted ICBT interventions. Therefore, to resolve this issue and build the trust gap between the healthcare provider and the participant dyad, I propose to develop a “Wave of Hope” framework by applying the 3D mode of culturally congruent care model. Thus, this dissertation involves a mixed-method approach to identify individual-level domains and integrate them into the existing framework using a cultural humility lens, which will act as a source to improving retention in the existing interventions. This research will create insights to guide future empirical work in this area. The specific aims are to:1. identify gaps in retention strategies in PGD effectiveness studies among familial caregivers.2. comprehensively explore the culturally relevant grief experiences of (racially/ethnically) diverse bereaving caregivers.3. identify individual-level cultural domains that can help enhance the retention of ICBT for PGD and integrate them into the existing 3-D model of Culturally Congruent care.Doctor of Philosoph
COMBATING FOOD INSECURITY AMONG COLLEGE STUDENTS AT UNC: DEVELOPING A SOCIAL MARKETING INTERVENTION TO PROMOTE SNAP USE.
Get PDFFood insecurity (FI) presents a significant public health challenge in the United States that disproportionately affects college students, among whom approximately 32.2% experience FI, exceeding the national average (21%). This issue not only negatively impacts nutrition intake but also contributes to the development of chronic health conditions and is well understood to undermine academic success and mental well-being. Despite the effectiveness of the Supplemental Nutrition Assistance Program (SNAP,) the largest US-federal nutrition assistance program, in addressing FI; college students often underutilize it due to barriers such as lack of awareness, stigma, and complex application processes. Increasing SNAP participation among students is crucial for improving food security, health, and well-being, creating a need for targeted interventions to promote SNAP use amongst food insecure college students.This study aimed to explore undergraduate students' experiences with food insecurity and perceptions of the SNAP program through qualitative focus groups, highlighting challenges in accessing SNAP benefits and the need for more visible campus resources, and then to develop and pretest an intervention designed to enhance self-efficacy among students navigating the North Carolina SNAP application process. Informed by Social Marketing principles and Social Cognitive Theory, the intervention addresses identified barriers and promotes strategies tailored to student's specific needs, as revealed in phase one focus group insights.The focus groups revealed key themes, including the effects of food insecurity on students' well-being and academics as well as barriers and facilitators to accessing SNAP. Students expressed a need for more explicit resources and university support to address food insecurity effectively.Following the focus groups, our research applied the Social Cognitive Theory to the Social Marketing framework to develop an intervention to increase students' self-efficacy in navigating SNAP applications. Pre-tested with food-insecure undergraduate students at UNC-CH, the intervention clarified the SNAP application process and enhanced understanding of eligibility criteria. Feedback obtained from students emphasized preferences for online delivery and suggested improvements in recruitment strategies and outreach methods using university resources.This study deepened the understanding of food insecurity among UNC-Chapel Hill undergraduate students and their perceptions of SNAP benefits. Findings highlighted multifaceted factors contributing to food insecurity across personal, interpersonal, organizational, and environmental levels, impacting students' academic, mental, and physical well-being. The intervention received positive feedback for its clarity and effectiveness in addressing concerns, with implications for future research and campus policy to support food-insecure college students.Doctor of Philosoph
Harm and Benefit
Get PDFHarm and benefit are crucial to our everyday decisions about what to do, and yet their nature and significance is obscure. In this dissertation, I identify what we want from an account of harm and benefit, and I defend a new account on the grounds that it gives us what we want. Along the way, I review and refine existing challenges of preemption and overdetermination, and I develop new challenges regarding difference-making and indeterminacy. I argue that these challenges arise from failing to distinguish between relevant alternatives, and this diagnosis leads me to search for an account that distinguishes between relevant alternatives. What ultimately emerges is a unified perspective on the nature and significance of harm and benefitDoctor of Philosoph
AN EXPLORATION OF OPPORTUNITY CULTURE® MODELS IN A RURAL MIDDLE SCHOOL
Get PDFK-12 schools are currently facing twin crises of staffing shortages and decreasing student outcomes. These challenges are magnified in many rural districts. As a result, districts are increasingly turning to third-party organizations to provide technical expertise in strategic staffing designs to ensure all students receive high-quality instruction despite teacher shortages. Public Impact® is an organization dedicated to improving education through innovative strategies and research-based solutions. One of its flagship initiatives is the Opportunity Culture® model, which is designed to extend the reach of excellent teachers, create sustainable career pathways for teacher-leaders, and provide job-embedded professional development to support all educators. These models aim to improve student learning outcomes, enhance teacher retention, and ensure equitable access to effective teaching for all students. This study examined, in detail, the first year of OC™ implementation in a rural middle school in the Southern United States. By using interviews and document analysis, the study investigated perceptions of these models during the first year. Through the application of the Active Implementation Framework implementation drivers, the researcher examined how the school was able to leverage three key implementation drivers – competency development, organizational supports, and leadership – in the first year of using new staffing models.Doctor of Educatio
Risk Reduction and Risk Transfer to Manage Hydrometeorological Financial Risk for Hydropower Across Geographic Scales
Get PDFHydropower is the primary source of electricity for many countries and the leading source of renewable energy worldwide. However, while hydropower offers predictable hourly electricity generation that complements intermittent energy sources, it is susceptible to droughts, which can severely reduce hydropower supply on a seasonal-to-annual scale. During droughts, hydropower suppliers must grapple with reductions in generation and, correspondingly, revenues. These losses may be compounded by increases in costs if suppliers are forced to turn to more expensive sources of electricity to meet contractual obligations for electricity delivery. Left unmanaged, this financial risk can result in the diversion of public funds to offset losses and/or to credit rating downgrades, which can lead to higher costs of borrowing and increased long-term costs. Existing research has characterized the hydrometeorological financial risk facing hydropower suppliers and explored the potential of various risk management strategies, such as new water storage capacity and index insurance contracts linking weather conditions to payouts. Nonetheless, there remain significant knowledge gaps, several of which are addressed here. These include: (i) an understanding of how the costs of integrated risk management strategies are distributed across stakeholders; (ii) the value of the operational flexibility of transboundary infrastructure in reducing risk, and; (iii) the advantages of pooling risk globally via national-level index insurance contracts. With respect to (i), two utility-level financial risk management strategies are compared to evaluate the costs, and distribution thereof, associated with a government-supported strategy versus an independently managed approach employing a newly developed index insurance instrument. With regard to (ii), a transboundary water resource agreement is evaluated in terms of its ability to manage risk, with attention to how the limited operational flexibility of existing infrastructure impacts its financial value to the parties involved. Finally, in (iii) the potential for a risk pool of hydropower-dependent countries with (mostly) uncorrelated drought risks is explored as a means to reduce the costs of insurance at the global scale. In an era when hydropower’s strategic importance in the global energy portfolio continues to grow, these analyses contribute insights useful for managing the hydrometeorological financial risk faced by hydropower-dependent suppliers and countries alike.Doctor of Philosoph
Lawyers Setting the Menu: The Effects of Litigation Risk on Employer-Sponsored Retirement Plans
Get PDFAmerican households increasingly rely on employer-sponsored defined contribution plans to save for retirement. I show that litigation risk is an important factor that impacts these plans. Using a new database of over 35,000 plans covering more than $5 trillion in assets, I show that employers respond to increased litigation risk by excluding options from plan menus. Reduced choice decreases employees' retirement wealth by up to 14% for mean-variance optimizing investors. Additional results based on observed choices from over 2 million employees show that reduced choice is associated with 3% lower balances on average.Doctor of Philosoph
CONFESSION AND AUTHORITY NEGOTIATING VOICE, IDENTITY, AND POWER IN EARLY MODERN WOMEN'S AUTOBIOGRAPHY
Get PDFPietist women of the sixteenth and seventeenth centuries authored a remarkable number of confessional autobiographies, providing rich insight into how marginalized groups utilized writing to challenge prevailing social and religious norms. In this dissertation, I analyze how the defining characteristics of confession—completeness, compulsion, transformation, and self-reflection—intersect with those of autobiography—subjective narration, curated presentation, and voluntariness—to create a potent medium for personal and communal negotiation. Confession integrates the individual into a broader community, whereas autobiography highlights the uniqueness of the author's experience. I argue that Pietist women strategically adopted Augustine’s foundational approach to confession and autobiography not to reinforce but to critique societal expectations, thereby consciously crafting a chosen self for their readers. Central to this process is mediation and negotiation, both with their audiences for greater autonomy of voice and between conflicting religious, social, and personal expectations, through which each author transforms admissions of guilt into acts of empowerment. Chapter 1, "Augustine’s Confessional Mediation: Establishing Universal Doctrine through Personal Experience," analyzes Augustine’s Confessions as a rhetorical model that combines personal narrative with doctrinal authority. Augustine’s reflective dialogue with God profoundly influenced subsequent religious autobiographers—including Pietist women, who, unlike Augustine, wrote from positions outside traditional ecclesiastical authority. Chapter 2, "Negotiating Faith and Authority: Claiming Narrative Control through Confession in Anna Maria van Schurman’s Euklēría," demonstrates how van Schurman’s confessional stance appears to align with Labadist communal expectations while simultaneously preserving her personal convictions. Her strategic merging of confession and autobiography enables her to navigate conflicting demands and establish narrative autonomy. Chapter 3, "A Confession to an Unconventional God: Subverting Traditional Christian Norms through Prophetic Confession in Anna Vetter’s Autobiography," examines how Vetter uses her detailed accounts of early sins and subsequent spiritual transformation to frame herself as God’s chosen spokesperson. In doing so, she legitimizes her authority to preach within a context deeply skeptical of female spiritual leadership. Chapter 4, "Confession as Resistance: Subverting Accusation to Define Identity and Community in Eleonora Petersen’s Autobiography," highlights Petersen’s reinterpretation of external accusations as self-defined confessions, thereby reinforcing her place within radical Pietist circles. Her confessional narrative emphasizes innocence, establishing credibility and enabling her to advocate for unconventional theological positions. Doctor of Philosoph
Interpretive Front-of-Package Labels: Assessing and Addressing Unintended Contributions to Weight Stigma
Get PDFIntroduction. Weight stigma has numerous harmful effects, but public health interventions often overlook and may even contribute to such stigma. Interpretive front-of-package labeling (FOPL) of foods and beverages is a policy-level intervention gaining traction globally. Seeking to influence individual behavior, interpretive FOPLs may inadvertently reinforce perceptions of personal responsibility for body weight, thus contributing to weight stigma. However, this possible effect remains largely unexplored. This dissertation investigates the possible effects of interpretive FOPLs on weight stigma and strategies to mitigate this effect. Methods. This dissertation uses experimental and observational methods to investigate the relationship between exposure to interpretive FOPLs and weight stigma. The first study constituted a randomized between-within-subjects experiment with US adults examining how different FOPLs impact weight stigmatization, whether weight-neutral content reduces stigmatization, and potential trade-offs between stigmatization and effectiveness. The second study examined whether evolutionary psychology-based mechanisms explain the effects of FOPLs on explicit weight bias. The third study examined associations between self-reported awareness and use of FOPLs and attribution of blame for body weight among Mexican adults and Mexican and Chilean youth. Results. In the first study, nutrient warning labels performed best at maximizing effectiveness and minimizing stigmatization. Additionally, removing references to obesity from health warnings labels reduced stigmatization without meaningfully reducing effectiveness. In the second study, none of the mechanisms examined mediated the effects of FOPLs on explicit weight bias. In the third study, FOPL awareness was not associated with attribution of blame for body weight, but FOPL use was associated with higher attribution of blame among Mexican adults and with lower attribution of blame among Mexican and Chilean youth. Conclusions. This dissertation suggests that interpretive FOPLs’ content and design are important for managing their contributions to weight stigma. Nutrient warning labels, the most common type of mandatory FOPL, seem generally unlikely to contribute to weight stigma, although differences by label design merit attention. Health warning labels that reference obesity may contribute to weight stigma, but contributions may be mitigated by omitting such references. Overall, policy makers have promising options for designing FOPLs that do not reinforce weight stigma while remaining effective at influencing behavior.Doctor of Philosoph
BUILDING LOYALTY THROUGH POLICY: AN EXPLORATION OF HOW SCHOOL DISTRICTS IDENTIFY PROBLEMS
Get PDFAbstractThis qualitative case study examined how Durham Public Schools (DPS) identified problems and developed policy solutions through the "Growing Together" initiative, which aimed to revise student assignment policies and redraw school boundaries. Using publicly accessible data from 2018-2023, including Board of Education meeting transcripts, community engagement records, and district documents, the study explored the district's problem identification process, stakeholder involvement, and policy development approach. The research utilized Kingdon's Multiple Streams Framework to analyze how problems were framed and solutions proposed. Findings revealed that DPS employed various community engagement strategies and worked with third-party organizations to identify issues related to efficiency, capacity, growth, and equity. The district proposed a revised student assignment policy using a regional access model to address these concerns. While DPS emphasized community engagement, the study found limitations in transparency and inclusivity of the process. The research highlights tensions between efficiency and equity goals, as well as disparities in how community feedback was incorporated into policy decisions. Implications for educational policymakers include the need for clearer definitions of equity, more inclusive engagement practices, and greater transparency in decision-making processes. This study contributes to the understanding of how school districts navigate complex policy changes in response to demographic shifts and community growth, offering insights for other districts facing similar challenges.Doctor of Educatio
THE SOURCES OF ACCELERATOR HETEROGENEITY: THREE ESSAYS ON ACCELERATOR PARTICIPANTS AND GEOGRAPHY
Get PDFThis dissertation examines the dynamic interplay among accelerators, their participants, and places, with a particular focus on their heterogeneous nature, cohort-based program design, and the geography of program participants. By integrating a systematic literature review with empirical analyses, this dissertation provides a comprehensive understanding of accelerator dynamics and their implications for regional economic development and startup growth. Chapter Two reviews the accelerator literature in response to the increasing recognition of heterogeneity across accelerators. By introducing a new analytic framework that maps prior research onto a conceptual space defined by focal independent and dependent variables, this chapter systematically identifies critical research gaps remaining in understanding the roles of accelerator managers and peers, the influence of non-learning support mechanisms, and the broader relationship between accelerators and their environments. Chapter Three explores the role of peer networks in accelerator cohorts. Leveraging a hand-collected dataset on 329 startups across 30 Techstars accelerator cohorts, this chapter examines how the networks of cohort peers—shaped by their prior work experiences and geographic diversity—affect startups’ access to funding. The findings indicate that peer networks significantly enhance startups’ fundraising success in the immediate post-accelerator period, underscoring the importance of cohort composition. Chapter Four investigates the locational trajectories of startups in accelerators, examining how startups relocate for acceleration and where they move post-program. Focusing on the 291 U.S. startups in Techstars accelerators during 2007-2013, this chapter explores the factors influencing startups’ mobility before and after accelerator participation. The findings reveal that over 40% of startups relocate to join Techstars. Startups that make connections with investors local to the accelerator region are likely to remain in the region, whereas those that fail to raise funding tend to relocate to established entrepreneurial hubs. These results emphasize the importance of local investors in retaining high-potential startups in accelerators and fostering regional economic development.This dissertation advances accelerator research by addressing key gaps related to program heterogeneity, peer effects, and startup mobility. The findings contribute to a more nuanced understanding of accelerator dynamics and their role in shaping entrepreneurial ecosystems, offering practical insights for policymakers, accelerator managers, and entrepreneurs.Doctor of Philosoph