Purpose: This dissertation describes the discourses of asthma management disparities (AMD) used by African American adolescents in King County and Washington State Asthma Planning (WSAP) stakeholders.
Methods: Data for this study combined: 1) texts from 12 focus groups of African American adolescents with asthma (N=20) who engaged in a Photovoice activity; 2) texts of a WSAP (N=13) meeting; text of the draft asthma plan for Washington state; and 3) observation notes of a discussion between adolescent and WSAP stakeholders in reviewing the results of the Photovoice activity. A critical discourse analysis methodology was used in analyzing the data. An ecological framework of discursive-topics of AMD was used to shape the results by individual/family, healthcare, community, and sociocultural systems.
Findings: There were four main findings, 1) adolescents introduced discourse topics were of “a permanent fix,” “moving,” and school exposures (to stairs, athletics, and nutritional resources), 2) WSAP stakeholders discourse topics were minimized using arguments of “measurement,” “core values,” and “too much detail,” 3) multilevel discourses did not occur for WSAP stakeholders, and 4) shared topics between adolescents and WSAP stakeholders were in four areas: self-management skills, healthcare communication, inadequate housing, and outdoor air pollution.
Discussion: New discourse topics identified by adolescents warrant further investigation in regards to school inequalities and asthma management. Adolescents resisted the dominant discourses of “asthma control” by introducing and demanding “a permanent fix” to AMD. State planning programs may be institutionally limiting how racism and other social justice topics are addressed for AMD. Discourses favoring the identification of disadvantaged groups limit the effectiveness of measurement efforts. The WSAP stakeholder arguments of measurement, core-values, and too much detail could be used by advocates to push for a greater focus on AMD. This study shows the significance of studying discourses of WSAP stakeholders and adolescents concurrently to identify policy solutions to disparities.
|Advisor:||Boutain, Doris M.|
|School:||University of Washington|
|School Location:||United States -- Washington|
|Source:||DAI-B 73/07(E), Dissertation Abstracts International|
|Subjects:||Nursing, Public health, Health care management|
|Keywords:||Adolescents, African-Americans, Asthma, Health disparities|
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