Background: In Navajo (Diné) populations, the two main forms of medicine that people use include traditional Diné medicine and Western medicine. Traditional medicine can be understood primarily through the concept of maintaining Hózhó or “balance”, while Western medicine is defined through the use of scientific evidence-based techniques and research. The reasons and barriers to using each form of medicine respectively are varied depending on aspects such as accessibility, familiarity, trust, or cost. Overall, there is a current lack of community viewpoints in regards to past examples of the intersection between traditional and Western medicine. This thesis examines reasons behind why Diné individuals use traditional Diné medicine and Western medicine respectively, and their viewpoints on the potential intersection. Methods: An anonymous online survey was distributed via snowball sampling from November 2023 to February 2024 after obtaining ASU IRB approval. It consisted of questions focused on demographics, use of traditional medicine, use of Western medicine, and opinion on the intersection between traditional and Western medicine. Statistical analysis and emerging themes were then performed and noted respectively. Results: There were a total of 15 responses to the online survey. A majority of participants previously used traditional medicine (80%), while all had previously used Western medicine (100%). There was a similar level of satisfaction and perceived efficiency for each, averages ranging from 3.8 to 4.0 respectively on a scale of 1 to 5. Many respondents used traditional medicine for more cultural and spiritual/mental health reasons, while many used Western medicine for more physical health reasons. Cost was the main barrier for each. Participants showed overall positive receptibility to potential intersections, but there was some hesitance in regards to scenarios where Western providers recommended traditional medicine use. Conclusion: Many reasons and barriers behind participant use of traditional and Western medicine were reflective of what was found in the literature review. The overall frequency of use, satisfaction, and efficiency can be further understood by a majority of participants living outside the Navajo Nation for long periods of time. The use of traditional medicine also made participants feel more connected to their culture, which can also contribute to the high levels of satisfaction/efficiency for traditional medicine. Interestingly, cost was found to be the primary barrier of each, which indicates room for growth in both respective fields to increase patient use. There was overall positive receptiveness to a possible intersection for delivery methods of medicine which indicates an overall desire to maintain Hózhó and holistic health, however the type of questions and recommendations made by respective providers needs to be done with care. This type of intersection should continue to be explored through community driven discussion and creativity in future studies.

This thesis project was inspired by healthcare disparities between rural and urban communities. This topic was operationalized in this paper through a comparison of dental care access in rural and urban areas of both Panama and Arizona. The significance and origin of the research were first introduced, followed by a literature review to establish baseline care access information in each of the locations. The methods of the research conducted include on-site observational data collection as well as patient interviews and conversations summarized by thematic analysis. Data showed different primary barriers to care in each location with an emphasis on geographic and policy variables. The results were discussed in terms of the factors identified as contributing to the disparities in access between the rural and urban communities in each location, and further, through a comparison of these disparities and their root causes, between Panama and Arizona. Recommendations were detailed for steps to continue this study and expand its scope, as well as suggested measures to minimize the access disparities faced by rural communities.

This study considered three main aims of (1) developing and validating a tool to measure parental perceived child mental health (MH) stigma, (2) determining whether perceived stigma levels corresponded in any way to parental identities, and (3) producing a decision-making process flow identifying where barriers such as perceived child MH stigma may affect families dealing with child MH issues. Recruitment of parents/guardians (18 years or older) with children (under the age of 18 years) was done through convenience and respondent-driven sampling in Phoenix, Arizona. A 44-prompt MH stigma tool was developed and validated (N=65, Cronbach's alpha 0.89) prior to utilizing (N=623) it to measure levels of perceived child MH stigma in the community. Analysis of variance showed potential significant (p<.005) interactions among education, income, and race/ethnicity (white, non-Hispanic/Latinx and Hispanic/Latinx) and levels of stigma. Specifically, higher education and lower income among the Hispanic/Latinx population in Phoenix showed a greater likelihood for higher levels of perceived child MH stigma. Factor analysis yielded three underlying factors of this stigma: interaction with MH, discrimination, and positive aspects. Content and thematic analysis of free response questions in the survey conveyed parents talk about MH diagnoses differently between general MH and child MH (e.g., child MH included ADD/ADHD while general MH included anxiety and schizophrenia). Fifteen, one hour-long, semi-structured interviews were completed, transcribed, and analyzed using narrative analysis to develop a parental decision-making process flow. The resulting flow showed parents went through informal methods of accessing MH care (e.g., research, awareness of MH issue) prior to formal methods such as seeking medical experts or school support. While the study was able to address these three aims, a significant shift in the landscape of MH occurred with the COVID-19 pandemic, increasing child MH risk and decreasing care access. This study developed a tool and set of methods that may be applied to identify changes in perceived child MH stigma and in how parents make decisions to access child MH care.

The purpose of this study is to analyze what barriers of care exist within the Senor de los Milagros community in Trujillo, Peru and how these barriers to care can identify shortcomings in the public healthcare system. This study is a collaboration of field research and outside literature. The research conducted was done via structured interviews with 15 participants, all promotoras (mothers of the community) and their husbands in the Senor de los Milagros community of Trujillo, Peru. Summaries and quotes from these interviews were uploaded and quantified to identify common barriers to care derived from socioeconomic and cultural determinants . Although this was on the main focus of the study, observations and conversations with healthcare staff and patients showed that the two most specific barriers found when data was analyzed were the wait times of public sector facilities and quality of care within these facilities. These barriers to care did not stop the promotoras from seeking care at MINSA facilities, but it does pose the questions as to how it affects healthcare-seeking behaviors and if this affects long-term healthcare outcomes.

Evolutionary and economic theories of fertility variation argue that novel subsistence opportunities associated with market economies shape reproduction in ways that both increase parental investment per child and lower overall fertility. I use demographic and ethnographic data from Guatemala as a case study to illustrate how ethnic inequalities in accessing market opportunities have shaped demographic variation and the perceptions of parental investments. I then discuss two projects that use secondary data sets to address issues of conceptualizing and operationalizing market opportunities in national and cross-population comparative work. The first argues that social relationships are critical means of accessing market opportunities, and uses Guatemala household stocks of certain forms of relational wealth are associated with greater parental investments in education. The second focuses on a methodological issue in how common measures of wealth in comparative demographic studies conflate economic capacity with market opportunities, and how this conceptual confusion biases our interpretations of the observed links between wealth and fertility over the course of the demographic transition.

ABSTRACT
Overview: There has been very little research done into the topic of mental illness in general, and Alzheimer’s Disease specifically, in Guatemala. The existing research accounts for prevalence of mental illness in Guatemala with an estimated prevalence of a mental illness of 27.8% (Guatemalan Government, 2009). Alzheimer’s Disease is less well researched.

Research Question: This research addresses this gap in knowledge by focusing on the stigma felt toward people who had Alzheimer’s Disease and Related Dementia (ADRD) by the people of Guatemala.

Participants: One-hundred twenty-four individuals over the age of 18 were recruited for participation. Participants were recruited through opportunity samples in artisan markets in Antigua.

Procedures: Participants completed a survey including demographic questions, the Dementia Attitudes Scale (O’Connor & McFadden 2010), as well as open-ended questions regarding the causes, symptoms, and treatments for Alzheimer’s. The study was conducted from July 2, 2018 to August 2, 2018.

Results: The average DAS score of 100.31± 14.01 found in this study is similar to results from other studies conducted in the United States (O'Connor & McFadden, 2010). Factor analysis did not verify the existence of sub-scales in the survey, as found in previous studies. The free-response questions indicated that many people may believe that ADRD is an inherited disease or one that is caused by factors outside of their control.

Conclusions: The high DAS score of 100.31± 14.01 matches other studies that used the DAS. Scores of 103.51± 13.43 (Scerri & Scerri, 2013) were reported in other studies and interpreted as positive as it relates to stigma. This points to a low stigma level in Guatemala. The failure to verify the sub-scales leads to the conclusion that although scales are validated in western nations, they may not be culturally portable. The DAS scale may not be measuring the same thing in this sample’s population versus previous studies sample populations.

Advancements in both the medical field and public health have substantially minimized the detrimental impact of infectious diseases. Health education and disease prevention remains a vital tool to maintain and propagate this success. In order to determine the relationship between knowledge of disease and reported preventative behavior 180 participants amongst the ASU student population were surveyed about their knowledge and prevention behavior for 10 infectious diseases. Of the 180 participants only 138 were completed surveys and used for analysis. No correlation was found between knowledge or perceived risk and preventative measures within the total sample of 138 respondents, however there was a correlation found within Lyme disease and Giardia exposure to information and prevention. Additionally, a cultural consensus analysis was used to compare the data of 17 US-born and 17 foreign-born participants to analyze patterns of variation and agreement on disease education based on national origins. Cultural consensus analysis showed a strong model of agreement among all participants as well as within the US-born and foreign-born student groups. There was a model of agreement within the questions pertaining to transmission and symptoms. There was not however a model of agreement within treatment questions. The findings suggest that accurate knowledge on infectious diseases may be less impactful on preventative behavior than social expectations.

Globally, suicide is the second leading cause of death, and accounts for about 800,000 deaths per year worldwide (WHO, 2013). The majority of these deaths occur in low and middle-income countries (LMIC), yet the research and documentation of suicide is heavily skewed to higher income countries where more systematic reporting of suicide occurs, along with a larger existing evidence base. Nepal is one LMIC where the speculated burden of suicide is high, with a predicted suicide rate of 7th highest in the world. Using both public-health and ethnographic approaches, the current study contributes to the discussion about suicide in Nepal. The primary goal of this research study is to understand the similarities and differences in perceived drivers for suicide for men and women in Nepal. Interviews conducted in Kathmandu and Jumla, Nepal were transcribed, and free lists which described drivers for suicide for men and women were extracted from the narratives. Thematic codes were then created to classify narrative responses into a cultural domain. The most salient codes listed by males and females for drivers for male/female suicide were analyzed and further contextualized using interview dialogue. Findings reveal social and relational drivers of suicide as the most salient for both genders, suggesting that suicide is not an individual act, but something that is caused by the broader, social environment. Additionally, perceptions of the reasons for suicide vary between gender. Perceived drivers for suicide for males are more often correlated with financial burden and the responsibilities tied to being the source of income and prosperity in a highly patriarchal society. Violence and inequality are perceived to be among the main drivers for female suicide. Findings contribute to the ethnographic research of suicide and the suicide literature in Nepal, and generate a better understanding of how reasons for suicide differ among males and females.