Suchergebnisse

INTRODUCTION: Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC. METHODS: Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations. RESULTS: The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender. CONCLUSION: The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.

Research on transgender and gender diverse (TGD) youth demonstrates the negative outcomes associated with trauma and oppression based on gender identity and expression. Related research illustrates how TGD youth are resilient in the face of oppression through individual (e.g., navigating difficult relationships, seeking mental health support) and community (e.g., access to community resources) factors. However, this research is limited by an understanding of resilience as overcoming challenges rather than exploring the possibly unique ways that TGD youth resist oppression as a form of resilience. This qualitative study utilized in-depth interviews with 19 TGD youth living in two Midwestern states, a region of the U.S. characterized by high levels of hostility and victimization toward TGD young people. Thematic analyses revealed the ways in which TGD youth engage in resistance strategies in the face of oppression. At an intrapersonal level, strategies included resisting oppressive narratives, affirming one's own gender, maintaining authenticity, and finding hope. At an interpersonal level, strategies were standing up for self and others, educating others, and avoiding hostility. Finally, at a community-level, TGD youth were engaging in activism and organizing and enhancing visibility and representation. Findings are discussed and implications are identified.