Ph.D. - Social Work
Permanent URI for this collectionhttps://hdl.handle.net/10125/1114
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Item type: Item , Post-Traumatic Growth in U.S. Veterans: A Multifaceted Examination of Racial and Ethnic Variations(University of Hawai'i at Manoa, 2024) Maldonado, Fary Antonio; Guo, Jing; Social WorkAbstract Background and Purpose: While many researchers have examined posttraumatic growth (PTG) in various contexts, exploring the influence of race/ethnicity on PTG in the U.S. military, veterans require more in-depth investigation. This study investigates racial and ethnic differences in PTG among trauma-exposed U.S. military veterans. The main research questions are: 1) How do PTG total and subscale scores differ by race/ethnicity (i.e., White, Black, Hispanic veterans) among trauma-exposed veterans? 2) Does race/ethnicity moderate the associations between PTG and factors associated with PTG (cumulative trauma exposure, PTSD, psychosocial and personality characteristics, coping strategy, social support, religiosity/spirituality) in trauma-exposed veterans?Methods: This study draws data from the nationally representative National Health and Resilience in Veterans Study (NHRVS). Focusing on trauma-exposed veterans, the study sample consisted of 3,071 non-Hispanic White veterans, 293 Hispanic veterans, and 259 Black veterans. This study uses descriptive and inferential statistics to examine the relationship between PTG and psychosocial and personality factors. Furthermore, this study addresses whether the relationship between PTG and psychosocial factors or personality characteristics varied depending on the racial/ethnic background of the veterans. Results: This study identifies significant racial and ethnic disparities in PTG outcomes. Key findings reveal that cumulative trauma exposure, PTSD severity, and psychosocial factors such as resilience and coping strategies are critical predictors of PTG, with notable variations across racial and ethnic groups. Black veterans, in particular, with fewer PTSD symptoms, have a stronger link between PTG and PTSD. The substantially higher PTG scores among Black veterans suggested unique strengths or coping mechanisms within this population. Potential explanations could include the historical resilience and cultural strengths cultivated within Black communities, such as a strong sense of community support, spirituality, and collective coping strategies. Additionally, experiences of historical adversity and systemic racism may have equipped Black veterans with enhanced coping skills and resilience, contributing to higher levels of PTG. Conclusions and Implications: The study's results underscore the importance of race and ethnicity as moderating factors in the relationship between trauma and PTG, challenging the one-size-fits-all approach in mental health interventions for veterans. By highlighting these differences, this research contributes to developing more tailored, culturally sensitive therapeutic strategies to enhance psychological recovery and growth in diverse veteran populations. The implications extend to clinical social work, emphasizing the need for customized interventions that address the unique experiences of minority veterans.Item type: Item , Productive Aging and Psychological Well-being of Older Adults in Rural Bangladesh(University of Hawai'i at Manoa, 2024) Hossain, Mohammad Didar; Hong, Seunghye; Social WorkBackground & Objectives: Promoting long and productive lives is one of the 14 grand challenges for social work to accomplish. Existing literature suggests that productive aging (PA) could be a protective factor for overall health and well-being in later life. Studying PA and relevant issues is critical to facilitating an age-friendly society where older adults remain comfortable and contribute significantly to the community. Researching patterns and factors that influence PA can help researchers and other stakeholders understand the mechanism of PA in older adults and its multifaceted impact on diverse outcomes, including psychological well-being (PWB). Having multiple implications, research has yet to investigate the nature of PA and its effect on the PWB of older adults in rural Bangladesh. Research Design: Guided by gaps in the literature, this dissertation study employed a multi-method design that included both qualitative and quantitative methods. Two studies were conducted concurrently to explore the comprehensive dimensions of PA and its effect on the PWB of older adults in rural areas under the eight administrative divisions of Bangladesh. In the qualitative part, a focused ethnographic study explored the perceptions, patterns, factors, opportunities, challenges, and overall impact of PA on PWB by utilizing in-depth interviews. Using a cross-sectional design, the quantitative part examined the association between factors such as socio-demographic or individual, health, social network, policy, and different types of PA engagements among 240 participants. The quantitative part examined the association between factors such as socio-demographic or individual, health, social network, policy, and different types of PA engagements paid or income-generating works, non-financial activities, caregiving, and volunteering) and the PWB outcome of older adults in rural Bangladesh. Findings: The qualitative study provided comprehensive findings regarding PA in rural areas of Bangladesh that included perceptions, patterns, attitudes, factors, challenges, benefits, and impact on the PWB of older adults. Under the six major themes, the result shows that PA is necessary for older adults in rural Bangladesh. Based on cultural norms, older adults feel obligated to and, for the most part, want to contribute to their families and communities. Gender norms, age, physical health, stereotypes, less social support, etc., influence the patterns and options for PA. Findings also showed that PA benefits the health and overall well-being of older adults in the challenging socio-economic contexts of rural Bangladesh. The quantitative results show that different social demographic, health, social network, and policy-related factors are statistically associated with the PA engagements of older adults. Further, the study utilized multiple linear regression models to test the effect of PA activities on PWB outcomes. The results show that paid work and volunteering had a significant statistical association with the PWB, whereas non-financial activities and caregiving had no significant association. Contributions: Recognizing the challenges related to the methodologies during the global pandemic, the two distinct studies of this dissertation contribute to aging research, policies, and practices to support marginalized and underprivileged older adults in rural Bangladesh and to promote their productive contributions and PWB. Further, this study provides insights into PA and mental health research and education in Bangladesh, South Asia, and developing countries worldwide. The findings would inform professionals, researchers, academics, policymakers, and individuals about the issues related to PA and its impact on PWB well-being of vulnerable older adults in rural settings while addressing the challenges of population aging locally and globally.Item type: Item , Sex/Gender Differences in Work and Pathways to Parenthood in Industrialized Economies(University of Hawaii at Manoa, 2023) Seo, Jin Young; Stotzer, Rebecca; Social WorkMany industrialized societies have below-replacement fertility rates and many of their governments have made fertility promotion an objective in their policy. South Korea, the context of two of my three studies, has the lowest fertility rate in the world. A deeper understanding of pathways into parenthood and parental leave policy from a South Korean context may provide insights as to how to address the problems of declining fertility and gender inequality in South Korea and other industrialized societies. Moreover, stubborn sex/gender differences in parental leave usage and labor force participation rates raise the question as to whether we might be overlooking some important element in our conceptualization of the work and parenting behaviors of men and women. Studies A, B, and C of my dissertation sought to answer these questions. Study A seeks to examine the association between socioeconomic status of men and women and their lifetime fertility or childlessness. This study used data from the Korean Longitudinal Study of Aging (KLoSA), Wave 1 collected in 2006. Results showed that, for men, education, employment, and income were significantly positively associated having a child/children, whereas no significant association was found among women. The findings imply that in South Korea, men who have difficulty bearing the normative expectation of financial responsibility of fatherhood tend not to have children. Study B is a theoretical discussion paper, where I applied a biological/evolutionary framework to understanding the sex/gender differences in parental leave and labor force participation behaviors. The refractory nature of gender gaps in parental leave and labor force participation statistics raises the question as to whether the current dominant conceptualization of gender gaps needs to be reexamined. Application of biological/evolutionary thinking reveals that it can contribute to explaining the stubborn nature of the sex differences in work and parenting behaviors. This paper illustrates how, and under what circumstances, the biological/evolutionary framework can be applicable in discussions around sex/gender gaps in work and parenting behaviors, with rudimentary policy idea examples, and can be helpful for thinking about what each society is willing to give up for sex/gender equality. Study C is a policy case study on parental leave in the context of South Korea. Based on the idea that policy making is a political process where values clash, this policy case study is an attempt to uncover the assumptions behind the arguments for two parental leave policy alternatives in South Korea. The data sources from which to infer values and assumptions were official documents and public comments on the National Assembly website. The data were analyzed using a constant comparison method. The findings can be summarized in three points. First, the narratives around parental leave were gendered. Second, there appeared to be competing narratives about fathers’ motivation for childrearing. Third, philosophical tensions between equality and individual choice were apparent in the discourse around parental leave policies. I anticipate that my dissertation makes a unique contribution to advancing knowledge about sex/gender differences in work and pathways to parenthood in industrialized economies. By elucidating the normative expectations of fatherhood, bringing to the foreground biological sex differences in work and parenting behaviors, and highlighting the narratives around parental leave policies that have been overlooked, the findings and discussions of these three studies provide implications for how South Korea and other industrialized societies around the world could approach the issues of low fertility and sex/gender differences in work and parenting behaviors.Item type: Item , Action Research To Start New Services And Expand Roles For Mongolian Older Adults(University of Hawaii at Manoa, 2022) Batzogs, Uyanga; Braun, Kathryn L.; Social WorkThe older adult group consists of 962 million people worldwide, representing 13% of the total world population. This number is projected to double by 2050 and triple by 2100, reaching three billion older adults. However, the number of older people in less developed countries is projected to increase by more than 250%, compared to only 71% in developed countries by 2050. Mongolia, a developing country with three million people, currently has a low percentage of senior citizens in its overall population (about 7%), yet this is projected to triple to about 19% of the population by 2050. This change is due, in part, to increasing life expectancy, from 48 years in 1960 to almost 70 years today. Yet, the retirement age in most sectors is unchanged, 60 years for men and 55 years for women. Thus, older Mongolians are spending more years in retirement, and many are struggling to find meaningful activities after retirement, including socialization and work opportunities. There is gap in the research about Mongolian older adult’s service development because these services and opportunities are limited. I helped to create some of the first senior services in Mongolia, using an action research framework, and this model should be examined for transferability to other low- and middle-income countries and for expanding services in Mongolia. My research question is “How can an action research strategy be useful in the development of new services, particularly senior centers and employment opportunities, and expand roles for Mongolian older adults?” The objective of my dissertation is to produce a single, holistic case study on the efforts of Quality Life NGO and Prost LLC to develop low-cost senior services in Mongolia by using the action research strategy. I described and compared the two pilot services developed under the initiative, examining their reach, effectiveness, adoption, implementation, and maintenance using RE-AIM framework, and examining roles adapted by older adults using these services. Developed first were senior centers for purposes of socialization, and the second were employment options including a laundry business that employs older adults. Both services are located in Ulaanbaatar, the capital city of Mongolia. I conducted a secondary analysis of existing data collected in 2015 and 2019 and collaborated with Quality Life NGO and Prost LLC to collect additional data in 2021 to document the planning, implementation, observation, and reflection phases of the action research model. Case study findings suggest that the Quality Life NGO and its partners contributed to expanding services and opportunities for Mongolian seniors. Findings also point out the challenges faced in developing and sustaining services in an under-resourced country facing rapid growth in its older-adult population. This case study may become a reference for public and private sector organizations in other developing countries that are preparing for a significant increase in their older adult population. The study provides a tangible example of solving a practical problem using the action research strategy.Item type: Item , Exploring the Dietary Experiences of Tongan Americans: Barriers and Facilitators to Healthy Dietary Behaviors(University of Hawaii at Manoa, 2020) Kaufusi, Victor Francis; Hong, Seunghye; Social WorkBackground and Significance: Over the past two decades, the quality of the Tongan-American diet has become of increasing concern to researchers, health professionals, and within the Tongan American communities. Schmidt (2007) found the dietary behaviors among Tongan-Americans consist of unhealthy foods including a high intake of sugar, salt, and fat. Yu et al. (2016) argued that the adoption of healthy dietary behaviors can help to reduce the disproportionate rate of diseases. Obesity rates have increased among this population in the last 20 years (Flegal et al., 2010; Panapasa et al., 2012) and obesity is now considered to be an epidemic among Tongan-Americans (Panapasa et al., 2012). According to the World Health Organization (2003), Tongans have the fifth-highest percentage of obese people in the world. In addition, the prevalence of diabetes among Tongan-American adults is also twice as high (21%) as compared to the U.S. population (10%) (Panapasa et al., 2012). These health disparities could be addressed by exploring the experiences with dietary behaviors among this population given the link between dietary behaviors and obesity and other chronic diseases such as diabetes. Purpose of Study: The purpose of this study is to better understand the dietary experiences and attitudes of Tongan Americans that contribute to the disproportionate rates of obesity and other chronic diseases in an effort to inform culturally tailored health strategies to address the high incidences. Methods: The study utilizes the principles of a grounded theoretical approach to understanding the lived experiences of Tongan American adults. The inductive nature of this exploratory qualitative study gives voice to participants' stories of how their behaviors around food and food preparation have evolved. The shift in dietary practices is among the underlying causes of the high rates of the chronic disease currently experienced by Tongan American adults. The methodology includes semi-structured interviews with 12 Tongan Americans (six men, six women). Findings: The findings indicate that there are complex behaviors involved with dietary behaviors. Thus, there were various nuances between the Tongan American dietary behaviors and the facilitators and barriers to adopting healthy dietary behaviors among Tongan American adults, including variables at the individual, environmental, sectoral, and socio-cultural levels, as the framework. In this study, the findings show that the barriers to healthy dietary behaviors include (1) home and physical environment, (2) convenience, (3) time management, (4) stress, (5) health literacy, and (6) the media; and the facilitators include (1) social support, (2) family meals, (3) meal planning and preparation, (4) individual health benefits, and (5) resiliency. Further findings suggest the importance of considering social, structural, and cultural contexts when engaging Tongan American populations and formulating preventive strategies. Therefore, research efforts and intervention initiatives aimed at preventing health disparities among Tongan Americans should be adaptable, innovative, multi-component, and multi-faceted, and should be culturally tailored to meet the needs of Tongan Americans.Item type: Item , Ho'ala Hou O Na Wahine Maoli: Reawakening of Native Hawaiian Women Exploring the Pathways to Post-traumatic Growth and Healing of formerly incarcerated Native Hawaiian female trauma survivors(University of Hawaii at Manoa, 2019) Martin, Tammy Kaho'olemana Kahalaopuna; Godinet, Meripa; Social WorkTrauma research has historically focused on the negative outcomes of adversity. Although trauma can have devastating effects, growth can also arise in one’s life through overcoming life’s challenges. Posttraumatic Growth (PTG), the positive psychological change and personal transformation that often occurs as a result of processing through trauma offers hope that individuals can and often do overcome adversity. To honor the 10 Native Hawaiian women’s leo (voices) and mo‘olelo (personal narratives), this study used semi-structured interviewing to: 1) better understand the pathways and processes to achieve PTG and healing across the life span for Native Hawaiian female trauma survivors who have been incarcerated across the life span; and 2) identify factors that contribute to healing and PTG for these women, including Native Hawaiian ethnic identity, class, gender, trauma, interpersonal violence, and incarceration. A grounded theory approach was employed along with Nohona Hawai‘i as a complimentary methodology that actualizes the Hawaiian epistemological and ontological viewpoints. The study found that pathways to healing are not linear, yet rather a process of a gradual ascension in conscious awakening as actions are taken, internal intellectualization occurs, insight is gained, release of hurt from the past occurs and reconnections are made to self, others, and culture. A three-phase dynamic conceptual model is presented to describe the interactive processes that occurred for the women in this study as they moved between Naʻaupō (“Night” mind ), Huliau (Time of Transformative Change), and Naʻauao (“Daylight” mind). Three major motivations to change were critical during the Huliau phase: ʻIʻini Hulihia (Desire to Overturn); ʻŌlelo Hoʻohiki (Conscious Commitment Ensures Accountability); and Hoʻomana (Being Spirit-Led versus Ego-Driven). Core factors that supported their overall transformation process include: a meaningful spiritual belief system, multiple trustworthy support networks, making conscious commitments to change, receiving and giving love, acceptance/recognition, forgiveness, cultural reclamation, education, and reflection time.