Graduates of the MACCP Program have completed the following thesis projects as part of their degree work. We invite you to review the abstracts, to get a more comprehensive view of the research our program supports. The authors can be reached through their LinkedIn pages.
Parkinson’s Dance!: A Meaning-Centered Analysis of the Emergence of Dance Therapy
Sofia Aba Jebel, MA (2011)
Objectives: The purpose of this study is to understand the experiences of dance advocates, instructors who engage in either dance therapy or dance in health related settings, and Parkinson’s dance students who participate in the Jewish Family & Children’s Center’s (JFCS) Dance for Parkinson’s program. The study is designed to collect narratives from participants, to gather meaning-based definitions of therapy and healing.
Methods: In order to collect data reflective of participant experiences, I participated in and observed dance classes held at the JFCS over six weeks. I conducted qualitative interviews with dance advocates, instructors and students. Dance students were all recruited from JFCS Dance for Parkinson’s program, whereas the advocates and dance instructors were recruited from both JFCS and Boston dance therapy networks.
Results: The data collected from the study reveal that participants’ explanatory models of illness and health are complex and multi-dimensional. Similarly, the unique dynamics of dance indicate that it functions as a viable intervention to address the complex and multidimensional aspects of Parkinson’s disease (PD). Dance students heal through dance because dancing is fun, liberating and provides a social context that Parkinson’s Disease would otherwise remove.
Conclusions: The professionalization of dance therapy has resulted in the specific appropriation of the term, requiring a certified dance therapist to be present. Dance students are affected by the narrow use of the term “dance therapy” and offer conflicting statements about the beneficial nature of dance; sometimes therapeutic, sometimes not. As a creative art therapy, programs like Dance for Parkinson’s have a long future ahead as long as they are not subject to qualification by the biomedical community.
“You Know a Girl When You See One”: Experiences of Surgeons Who Perform Gender Affirmation/Reassignment Surgery
Robert J. Christian, MS (2014)
Most recent research on gender affirmation/reassignment surgery focuses on discrimination and health disparities faced by the transgender community, and on perspectives and identity constructions of patients transitioning from one gender presentation to another. However, few studies address perspectives and experiences of the surgeons performing these operations. This exploratory study examines narratives of some of these surgeons in order to understand how they entered this particular practice, and how they perceive and classify these procedures. This study also aims to show the affect these procedures have on these surgeons and their discipline, and how these surgeons navigate the complex relationships between patients, healthcare providers, and surgeons, in the context of social values and popular media perspectives in the United States.
Experiences and Barriers to Engagement of Low Income Urban Minority Expectant Fathers
Cristina M. Crespo, MA (2011)
Expectant fathers‘ experiences of their partners‘ pregnancy and their own transition to parenthood has not been significantly researched across demographic differences to include low-income African American, Haitian Latino men in an urban environment. This is a qualitative case study of a health center in Boston, Massachusetts that examines what men in this category expect, perceive and experience during the prenatal process and what, in turn, the health professionals who interact with them expect and perceive. Research participants include men who are engaged in the prenatal process and healthcare professionals who interact with expectant couples at the chosen health center. This study focuses on a population scarcely addressed in the literature of fatherhood and who has historically experienced low levels of paternal engagement. As an in-depth grounded theory analysis of the experiences and opinions of expectant fathers and health professionals, this study reveals the pervasive influence of an idealized trope of American fatherhood which, in actuality, is often inaccessible to low income minority expectant fathers. The social barriers to involvement are discussed and clinical recommendations to improve paternal engagement are suggested.
“It’s About Having a Fertile Mind”: A Meaning-Centered Analysis of Hypnosis for Infertility
Meghen M. De Santa, MA (2011)
Objectives: This study examines the use of hypnosis for fertility and reproductive health in the United States. I present practitioners’ views on the nature and causes of infertility, and on its treatment in both biomedicine and hypnotherapy. I discuss the social and cultural significance of hypnosis as an alternative and complementary therapy for infertility.
Methods: I used anthropological research methods, including interviews, surveys, and participant observation, to gather the narratives of HypnoFertilityÒ consultants in the U.S. I invited all 208 consultants certified through the HypnoFertilityÒ Foundation, Inc. to participate in an interview and/or anonymous online survey, and to extend the same invitation to their current and former clients, as appropriate. In addition, I participated in a Fertility and Birth by HypnosisÒ training course with a Foundation-certified trainer.
Results: The data I collected for this study is based on in-depth, semiformal interviews with 15 HypnoFertilityÒ consultants, and the survey responses of 18 consultants and five clients. Detailed field notes document my interactions with participants, and my experience as a participant in the Fertility and Birth by HypnosisÒ training program.
Conclusions: The use of hypnosis for fertility has social and moral significance for its practitioners. The definition of infertility according to consultants differs markedly from biomedical definitions in its inclusion of social, emotional, and spiritual factors that contribute to the condition. Hypnotherapists feel that the medicalization of fertility can obscure patients’ self-knowledge and intuitive reproductive abilities. Gender-power disparities and shifts in family structure are said to be stressors that contribute to the degradation of clients’ self-healing abilities. Social critiques present within consultants’ narratives inform the significance of the practice as a complement to biomedical treatments for infertility.
Developing A Dialogue Between Refugee Patients and Their Healthcare Providers About Traditional Medicine Usage: Why Context Matters
Kristina H. Fenn, MA (2012)
Traditional medicine use is common and diverse among patients in the United States. Many do not tell healthcare providers about their traditional medicine use or remedies nor do healthcare providers typically have the time to ask. This creates a barrier to the care received because the patient and healthcare provider do not communicate fully about treatment options. The goal of this study was to increase communication about traditional and integrative medicine by putting together a survey following the analysis of these ethnographic interviews.
Working within the Boston Center for Refugee Health and Human Rights at Boston Medical Center, I interviewed refugee and asylum seeking patients and their healthcare providers about traditional medicine use. This included a demographic survey and qualitative, open ended interviews. I formally interviewed 27 refugee and asylum seeking patients and spoke with several healthcare providers throughout the study. The majority of interviewees were female (n=22) and from Africa (n=19), reflecting the demographic of patients throughout the clinic. Eighteen patients we interviewed reported using herbal remedies at some point in their lives, more than half (n=13) in the United States. Participants were much more open to discussing herbal medicine and religious healing than other types (e.g. ancestor worship).
Through this survey, I hope to increase health care practitioner’s awareness of these issues and help them effectively navigate this conversation topic. Demonstrated understanding of their patients’ views of disease and medicine will potentially help the patients feel more comfortable in the clinic. In addition, it will enable both sides to be as open as possible with one another about treatment pathways.
Delivering Diversity: Meanings of Cultural Competence Among Labor and Delivery Nurses in an Urban Hospital
Rebecca D. Garza, MS (2014)
Nursing theory has contributed significantly to discussions of so-called culturally competent biomedical healthcare delivery. This study explores how Labor and Delivery nurses at a large, urban teaching hospital negotiate the care of a hyperdiverse patient population and construct working understandings of competence. Archival research, semi-structured interviews and participant observation demonstrate that cultural competence is not a distinct concept, but rather functions as an ambiguous symbol used to discuss a variety of challenges with advocating for patients and delivering care in communities faced with issues of racism, immigration, low socioeconomic status, and multiple comorbidities.
We Have Not Been Here Before: Aging and Elderly Women With Intellectual Disabilities
Nechama W. Greenwood, MA (2013)
Background: Adults with intellectual disabilities (ID) face important health disparities, and are underrepresented in research. There is a particular lack of research from the perspective of members of this population. However, adults with ID are living longer than ever before, and, after a long history of institutionalization, are aging in the community. Aging adults with ID face important support gaps and challenges as pioneers in aging in the community. Aging women with ID are further marginalized by gender and age. This qualitative, participatory study explores lived experiences of aging and elderly women with intellectual disabilities.
Methods: In order to maximize voice for participants with ID, this study used qualitative, participatory methods including individual interviewing and Photo Voice, a participatory technique where participants are given cameras and become co-researchers on the project as they document their worlds.
Results: Important themes emerged including: The experience of aging with ID is a gendered phenomenon, anticipation of increased independence and community participation as a result of aging, community inclusion and the importance of relationships and belonging.
Discussion: While further research is needed to quantify the experiences described by participants, the importance of community inclusion and relationships suggests that policy level supports for aging in place and individualized planning with be important for this generation of adults with ID. This thesis concludes with recommendations as to how adults with ID can best be supported in achieving healthy aging from a systems perspective.
The Meaning of Diabetes
Stephanie L. Hill, MA (2012)
The purpose of this study is to understand the health beliefs and behaviors of Puerto Rican and El Salvadorian adults’ living with Type 2 diabetes in the Jamaica Plain neighborhood of Massachusetts. What explanatory models do Puerto Rican and El Salvadorian adults’ frame with regard to Type 2 diabetes mellitus? Which of the multiple etiologies and available treatments shape diabetes health beliefs, and how do these relate to the explanatory models of physicians, and how might they impact diabetes behaviors? I sought to gain understanding of these ideas by looking beyond the biomedical definition that may have been imprinted into their descriptions to examine these Puerto Rican and El Salvadorian adults’ point of view of diabetes. The research will aid health care professionals in understanding how Puerto Rican and El Salvadorian adults’ perceive and discuss diabetes prevention, etiologies, treatments, and aid in creating a care management plan for patients. This project is designed to learn about the views of diabetes causation and treatments for Puerto Ricans and El Salvadorians living with type 2 diabetes in the Jamaica Plain neighborhood.
Developing a Sense of Belonging: The Immigration Experience of Latin American Women in Boston
Vivian Laurens, MA (2012)
This thesis explores the experience of immigration of Latin American women living in Boston, and how they develop a sense of belonging and identity in American society. By looking into different aspects of participants’ lives (work, family life, community, healthcare), I examine various circumstances in which their sense of belonging is supported and those in which it is jeopardized. The primary site of recruitment for this study was a Baptist congregation, which serves the Latino population in the Boston area. I used qualitative data collection methods including, individual interviews with the women and participant observation at the congregation, to gather participants’ immigration stories. As an in-depth grounded theory analysis this study reveals the fluid nature of participant’s sense of belonging; it is ever-changing, it is always moving back and forth from insider to outsider, and it is constantly brought into question. As a result the immigration experience of participants is immersed within tensions between a cohesive and fragmented sense of belonging.
“Who Minus Who”: Suicide in Boston’s Ethiopian Community
Eva R. Melstrom, MS (2014)
This thesis examines suicide in Boston’s Ethiopian Community. The act of suicide and individual cases are explored through participant narratives. Narratives from family members and acquaintances of those who died by suicide are examined. I rely on in-depth (N=8) and follow-up interviews (N=7). Drawing heavily on culturally constructed notions of self, this thesis explores what it has meant for persons of the Ethiopian community to lose fellow members to suicide. Intersections of emotions, constructions of choice and agency, and idealized notions of self emerge as central themes. The body, in life and death, is situated as a vehicle for communicating dis-eased social relationships and unrealistic cultural expectations. Participants position their perceptions of the deceased in relation to popular preconceived notions of life in the United States and stresses encountered during and after the immigration process. Memory of Ethiopia, the United States, immigration, and the suicide are significant for understanding the rigidity of culturally authoritative truths.
This thesis emphasizes the progressive and beneficial methodology of an anthropological investigation into suicide. Understanding the reasons and acquiring specific knowledge about Ethiopian suicide in the United States can contribute to current conversations regarding immigrant suicide. Ultimately, this study aims to contribute to comprehensive prevention measures, which support every individual.
Pathways Into Care for Pediatric Asthma
Alexandra M. Palmer, MA (2012)
Studies have demonstrated that patients may not adhere to the treatment prescribed by the physician because their respective models of the disease are different. Studies have also demonstrated that the patient may feel inferior to the health care provider and not share his or her model with the doctor for fear of being perceived as ignorant. The interaction between the provider and patient is especially significant to asthma because asthma is a chronic condition that may require management for life. However, there is a gap in the social science literature for studies related to asthma. This thesis presents the way pediatric asthma health care providers and a sample of Boston Puerto Rican parents of children with asthma perceive asthma based on data collected through informal interviews. Puerto Ricans are one of the Latino subgroups who remain most at risk for asthma morbidity and are the most represented Latino subgroup in Boston. Research tends to generalize all of the Latino subgroups and it is important to consider each one separately in order to develop effective public health prevention and intervention strategies. Making each other aware of the other’s asthma model will provide an avenue to help the health care providers and Puerto Ricans work together through any differences to an agreed-upon management regimen for the child’s asthma. An understanding of why the health care provider is suggesting a particular treatment and why the patient is managing the disease in a particular way may help improve outcomes.
The Effects of Direct-To-Consumer Antidepressant Advertising on Doctor-Patient Relationships
Christine Soya, MA (2012)
Objective: This qualitative study looks at how doctors and patients feel direct-to-consumer antidepressant advertising affects the doctor-patient relationship.
Methods and Results: I conducted open-ended interviews with eight primary care physicians to understand their feelings about direct-to-consumer antidepressant advertising. I performed a content analysis of eight antidepressant and antidepressant add-on advertisements available on YouTube. I also collected and analyzed comments for each YouTube ad to represent the general public’s opinions. Using an ethnomedical framework, I looked at the many factors surrounding direct-to-consumer antidepressant advertising including: the object of concern (depression), the social practice of advertising, patients’ cultural specific concerns, doctors’ values, and managed care organizations (the institutional level).
Conclusions: My study points to both physician and societal perceptions of the current practice of direct-to-consumer antidepressant advertising, and its perceived risks or benefits to the doctor-patient relationship.
Virtual Lay Therapy: The Role of the Internet, Illness Narratives and Experiential Knowledge in Health Decision-Making
Meryl L. Kopy St. John, MA (2011)
This thesis describes and analyzes the culture and behavior of an online health community focused on female sexual and reproductive health. 263 participants were asked to describe the ways in which they utilized the community and how their health-seeking behaviors and interactions with medical professionals had altered since they had turned to the Internet to supplement their medical care. The women reported using the community not just for medical information, but in a search for empowerment and a medical space perceived as non-judgmental. Often, participants had been inspired to use the Internet to cope with or evade feelings of marginalization they received when engaging in professional care. Study participants described sophisticated methodologies for evaluating online information, and some then used this information in an attempt to transform and improve both their clinical encounters and their medical decision-making. Lay And experiential knowledge contributed by community participants was used to evaluate, and sometimes challenge, expert knowledge offered by medical professionals. The study has implications for a new era of medical pluralism in which individuals negotiate and combine traditional care avenues with a virtual form of lay therapy management. The thesis also reviews the history of both self- care and Internet communication, traditions whose legacies eventually led to modern communities like the one investigated here.
From Washing to Whitening: The Cosmetic Practices and Beauty Politics of Vietnamese-American Women in Boston
Eileen C. Sullivan, MA (2013)
This thesis examines perceptions of normative beauty ideals among Vietnamese-American women and the impact of these ideals on beauty seeking behaviors. I explore women’s lived experience of beauty via practices pursued and products consumed, and frame beauty work as a disciplinary practice, as well as an investment in embodied species of capital. I query how ideals of appearance relate to being Vietnamese within American culture and the critical role of appearance in affirming identity. The methods used were in-depth interviews (n=5), an open-ended response Internet survey (n=19), and a content analysis of a transnational Pond’s advertisement to which both Internet participants and in-depth interview participants contributed.
Becoming a Kidney Transplant Citizen: Kidney Transplantation, Race and Biological Citizenship
Masami Tabata, MA (2013)
I conducted a four-month ethnographic fieldwork study to document the stories of thirteen post-kidney-transplant minority patients and three nephrologists at Boston Medical Center. My research explores how patients’ interactions with health professionals, medical regimens, dialysis treatments, and adaptation to living with transplanted kidneys constantly shape their identities and perceptual worlds.
Patients’ narratives highlighted the emotional struggles they encountered along the path of End-Stage Renal Disease, which unfolded as distinct experiences influenced by their varied backgrounds. The majority of my patient-participants lived on the verge of poverty, and in some cases, their insurance status caused delays in their being registered on the transplant waiting list, making them endure a long wait. Some patients were afraid of wearing short sleeves because they thought the scars on their arms from dialysis treatment would lead others to think they were gangsters.
Instantiations of various theories emerged from the saturated data and narrative analysis, from Bourdieu’s concept of habitus with regard to the process of how patients alter their consciousness through interactions with medicine to Foucault’s ideas of power relations and technologies of the self that address the issues of agency and power that influence the formation of patients’ identities. The intersection of these theoretical frameworks led me to develop the critical medical anthropological-oriented concept of biological citizenship.
This paper examines 1) the ways in which “race” interacts with the theoretical concept of biological citizenship and 2) the ways in which socioeconomic status and race tailor a kidney transplant patient’s illness experience, and related discourse.
Sexual Orientation and Identity in Diabetes Health Care: The Experience of Type 2 Diabetes among Lesbian, Queer, and Women-Loving Women
Michelle Welch MS (2014)
This Master’s Thesis reports on the experiences of Type-2-Diabetes Lesbian, Queer, and Women-Loving Women. The thesis examines the impact of sexual orientation on experiences with diabetes, and how this chronic disease affects the way a woman views herself, her health, and her body image. Each participant presented her narrative and world views in regards to her diabetes health care and management, stress and trauma, and management of relationships. Through narrative analysis, I have revealed differing mechanisms of coping and explanatory models; the many women of this study selectively chose to be more open about her sexual orientation than her diabetes status.
“What Am I Supposed To Eat?”: Nutritional Messaging in an Inner-City Integrative Medicine Clinic
Heather M. White, MS (2014)
Public health has developed education campaigns based on nutritional messaging to alleviate illnesses related to food consumption. This thesis examines cultural factors affecting the accessibility of such messaging, such as economic status, ethnicity, role in the family, access to transportation and markets, and familiarity with the topics of messaging. I explore how these variables affect learning and applying new nutrition knowledge in an individual’s daily life. The methods used were semi-structured interviews (n=11) and participant observations conducted in an Integrative Medicine clinic at an urban hospital.
Covering Health: Healthworlds of First-Generation Chinese Immigrants in Boston Chinatown
Tong Xin, MS (2014)
This study examines the healthworlds of first-generation Chinese immigrants in Boston’s Chinatown. Through participant observation and interviews conducted within a local church and a local park community, three key issues emerged: how the space of Chinatown influences people’s post-immigration healthworld, the dynamics of community health supports and health challenges, and the daily health lives of these immigrant individuals within their respective families. Likewise, complex understandings of health coverage emerge that include not only health insurance, but also social forms of insurance. Community integration becomes not only a cultural tradition, but also how health resources and health support are linked and provided. This social form of insurance makes it possible for community members to reach out cultural and religious health resources and support in the context of everyday life.
All theses are available through ProQuest.