DR. RONALD E. MCNAIR
Ronald E. McNair, an engineer, scientist, and astronaut on the space shuttle
Challenger, was born on October 12, 1950 in Lake City, South Carolina.
McNair was the son of an auto mechanic. His perseverance in the face of poverty
and prejudice led him to complete his bachelor’s degree (magna cum laude) in
physics from North Carolina A&T State University in 1971. Five years later,
he earned a Ph.D. in physics from the Massachusetts Institute of Technology.
Dr. McNair was nationally recognized for his work in the field of laser physics
and received many honorary degrees, fellowships, and commendations. His achievements were not
limited to academia. He was a sixth degree black belt in karate and an accomplished saxophonist.
In 1978, Dr. McNair was selected for the NASA space program and was the second African American
to fly in space. His life ended tragically on January 28, 1986 when the Challenger space shuttle exploded
and crashed into the ocean, taking his life and the lives of six other astronauts.
The McNair Program at the University of St. Thomas is dedicated to preserving his legacy of scholarship
and commitment to excellence.
ACKNOWLEDGEMENTS
McNair Staff
McNair Faculty Mentors
Program Director/Principal Investigator
David F. Steele, Ph.D.
Assistant Director
Cynthia J. Fraction, MA
Graduate Assistants
Maleeha Abbas
Sarah Muenster-Blakley
Journal Production
Maleeha Abbas, Project Manager & Editor
Susan M. Moro, Layout & Design
Sarah Muenster-Blakley, Editor
Stephanie Stokman, Editor
Cynthia J. Fraction, Project Director
Kendra Garrett, Ph.D., University of St. Thomas
Jean Giebenhain, Ph.D.,University of St. Thomas
Ruthanne Kurth-Schai, Ph.D., Macalester College
Paul Lorah, Ph.D., University of St. Thomas
Christie Manning, Ph.D., Macalester College
Louis Mansky, Ph.D., University of Minnesota
TABLE OF CONTENTS
DO I MATTER, OR AM I JUST A NAME ON A CHART?
CANCER PATIENTS’ EXPERIENCES WITH HEALTH CARE PROFESSIONALS . . . . . . . . . . . . . . . . . 1
Oluwademilade Adediran ’13
ENHANCING EARLY CHILDHOOD EDUCATION FOR LOW-INCOME CHILDREN:
EXPLORING POSSIBILITIES FOR INCORPORATING MONTESSORI METHODS
WITHIN THE HEAD START PROGRAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Kesha Berg ’13
EXPLORING THE INFLUENCE OF HIV-1 RESISTANT CONFERRING MUTATIONS
ON ANTIRETROVIRAL DRUG RESISTANCE IN HIV-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Mondraya Howard ’13
WASTE(LESS): A PSYCHOLOGICAL APPROACH TOWARD REDUCING FOOD WASTE . . . . . . . . 47
Bridgette Kelly ’12
HEALTH CARE ACCESSIBILITY IN THE TWIN CITIES METROPOLITAN AREA
HMONG COMMUNITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Chia Lee ’13
A QUALITATIVE ANALYSIS OF TEACHERS’ PERCEPTION TOWARDS HMONG
AMERICAN STUDENTS’ ACADEMIC ACHIEVEMENT IN MINNESOTA . . . . . . . . . . . . . . . . . . . . . . 72
Mai-Eng Lee ’12
ABSTRACT
The purpose of the present study is to explore what female musicians, who were 1-5 years
post-treatment for breast cancer, had to say about their experience of mattering within
the context of their health care. According to Tucker, Dixon and Griddine (2010),
mattering is defined as “the experience of moving through life being noticed by and
feeling special to others who also matter to us” (p. 134). In 1890, William James
reflected on mattering by saying “one of the worst injustices in the world would be to
live life being unnoticed by others” (as cited in Tucker, Dixon & Griddine, 2010, p.
135). Although the concept of mattering has been around for more than a hundred
years, it has only recently been studied more systematically. Research related to
mattering has been applied to multiple subjects such as relationship fulfillment,
education, and workplace satisfaction (Kawamura & Brown, 2008; Connolly, 2002;
Tucker et al., 2010). The current study examines the experience of mattering within
a health care context. Common themes identified from 38 interview transcripts indicated
patients felt they did not matter when the doctors treated them as merely a cancer patient
and a name on a chart. This meant the doctors did not collaborate with the patients
and did not individualize their care. The results also state women disliked when they
were given their diagnosis over the phone by nurses who did not have sufficient
information. Patients felt they mattered when physicians seemed to care about their
livelihood. When doctors explained treatment options allowing for patient input, the
patient felt they mattered. Patients reported extreme approval of their doctors when they
received something such as a call from them to see how they were coping with treatments.
Further research with doctors is needed in order to understand how health care professions
perceive patients.
In the 19th Century the father of modern psychology, William James, stated
“one of the worst injustices in the world would be to live life being unnoticed
by others” (as cited in Tucker, Dixon, & Griddine, 2010, p. 135). Mattering,
as William James believed, is essential in order for an individual’s healthy
development (Tucker et al., 2010). Mattering to others in our lives is the
“experience of moving through life being noticed by and feeling special to
others who also matter to us” (Tucker et al., 2010, p. 135). It can also be
thought of, however, as a feeling that “we make a difference in the lives of
other people and that we are significant to the world around us” (France &
Finney, 2009, p.104).
Though the concept of mattering has been around since the 19th Century, it
has only begun to be studied systematically in recent years, being applied to
multiple subjects such as relationships, education, and workplace satisfaction.
For example, it has been found that college students are more likely to stay at
a particular college if they feel they matter to the institution (Tucker et al.,
2010). In addition, workers are more satisfied with their place of employment
if they feel like they matter to the company (Connolly, 2002). Kawamura and
Brown (2008) examined relationship satisfaction by looking at division of
housework data collected from homemakers and exploring how much women
perceived that they mattered to their husbands. The researchers measured how
much the women reported the division of housework to be equal. What was
DO I MATTER, OR AM I
JUST A NAME ON A
CHART? CANCER
PATIENTS’
EXPERIENCES WITH
HEALTH CARE
PROFESSIONALS
Oluwademilade Adediran ’13
University of St. Thomas
Mentor
Jean Giebenhain, Ph.D.
Professor of Psychology
University of St. Thomas
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UST McNair Scholars Program Research Journal
interesting about this study was the more wives reported
they mattered to their husbands, the more likely they were
to report the division of house work was equal, even if this
was not the case. In other words, work equality depended
upon how much the women felt they mattered to
husbands.
Mattering has also been shown to be a key factor in
mental health and wellness among adolescents (Rayle,
2005). A study conducted with high school students aimed
to show the link between mattering to significant others,
such as family, and the overall wellness of students. This
study defined wellness in terms of physical, emotional, and
psychological well-being. Students felt they mattered to
their families when they were assured they were significant,
viewed as important, depended on by their families, and
when their families were concerned with their fate and paid
attention to them. It was found that females felt they
mattered to their families more than males. Furthermore,
it was also reported that mattering significantly predicted
wellness for females. In other words, when females scored
high for mattering, they also scored high in wellness.
Though studies have looked at a wide range of topics
pertaining to mattering, little has been done in regards to
mattering in a health care context as relating to lifethreatening diseases.
Human beings are multi-cellular organisms composed
of structural and functional units called cells. Cells grow
and divide in a controlled way to produce more cells as they
are needed to keep the body healthy. When cells become
old or damaged, they die and are replaced with new cells.
This work of art called the body, though complex and aweinspiring, is not perfect. There are several diseases which
afflict the body without warning and threaten the life and
livelihood of the host. Oftentimes, in the division of cells,
something goes wrong and abnormal cells divide without
control and are able to invade other tissues. The most
common term for this abnormality is “cancer.” The
National Cancer Institute reports that there are over a
hundred types of cancers, among which the most common
to women is malignant neoplasms, or breast cancer.
According to the National Cancer Institute, there were
207,090 reported new cases of breast cancer in 2010 within
the United States alone. Modern advancements in medicine
have made it possible for more women to survive breast
cancer than ever before (Salonen et al., 2011). Using the
2
latest data available, survival rates for those diagnosed with
breast cancer are 89% after 5 years, 81% after 10 years, and
73% after 15 years. This is a significant increase in survival
rates compared to previous years (American Cancer Society,
2010). These increased survival rates indicate the need for
issues related to survivorship and long-term quality of life
to be added to overall treatment considerations (Kaiser et
al., 2009). If the patient matters, there could be a shift in
efforts to not only wipe out the cancer cells but to try and
preserve the livelihood of the patient after treatments are
over. Livelihood in this case refers to the patient’s ability
to return to their employment or the way in which they
make their income. Medical advances allow doctors to
provide more personalized care for their patients. During
treatment, oftentimes doctors become focused in their
work of eradicating the cancer cells they forget treatment,
at least in some aspects, should be based on requirements
defined by women with breast cancer (Landmark, bohler,
Loberg, & Wahl, 2008). Research suggests the women are
experts on their own lives and ideal doctors will listen to
them and try to find ways to preserve their livelihood post
treatment (Theisel, Schielein, & Splebl, 2010). The key
topic to preserving the life and livelihood of a patient is
whether or not the patient matters to the medical
professionals as an individual.
One such study that looked at the doctor-patient
interaction as a part of mattering did so by studying
interpersonal trust (Kaiser et al., 2009). The study looked
at breast cancer patients’ trust in several of their health care
providers. The study assessed breast cancer patients’ trust
in regular providers, diagnosing physicians, and their
cancer treatment team. In this study, patient trust was
associated with patient satisfaction and treatment
adherence. Findings suggest a trusting relationship with a
regular provider facilitated higher satisfaction with other
specialists (Kaiser et al., 2009). Though this study had
important findings, it does not explain why patients were
more likely to trust other specialists if they trusted their
primary doctor. Mattering could be one of the key
components of trust in a doctor-patient relationship. If a
patient feels they matter to their primary doctors, they
might trust them more. This trust could be carried over to
other specialists the doctor recommends.
Another qualitative study that assessed the relationship
between patients and doctors was conducted with 13
Psychology
individuals dying of cancer (Janssen & MacLeod, 2010).
Results indicated the patients felt they mattered to the
doctors when treated as more than a cancer patient.
Patients felt like more than just a cancer patient when
doctors sought to find “common ground” with their patients.
A common ground for the patients meant the doctors did
not only inform patients they have an illness, but sat with
them to answer any questions they might have. In some
cases, the patients would encourage the doctor to be livelier
by telling jokes. The patients remarked that this seemed
to make doctors feel more comfortable and in return they
seemed to be able to look past patients’ cancer to the
patients’ lives. The doctors who made patients feel like they
mattered were the ones who sat with the patients and
listened for extended periods of time, without trying to
rush off to another patient. A woman from the study said,
“Doctors should not just say this is a woman of 76 who’s got so
and so, past history of such and such. You heal a whole person.
We are not just a lump, an amorphous lump; we are body mind
and soul” (Janssen & MacLeod, 2010, pg. 252). Doctors
who were able to look into the patients lives were seen as
caring and made patients feel they mattered. These two
studies show ideal doctors are ones who valued or seemed
to value the interactions with their patients. Good doctorpatient interactions are essential to the concept of mattering
in a health care context.
Studies investigating what patients perceive as the ideal
doctor indicate patients want someone who is accessible,
takes their time, is friendly and congenial, shows
commitment and interest, is understanding and sensitive,
and is responsive to the needs of patients (Theisel et al.,
2010; O’Connor, 2011). Oftentimes, doctors lose sight of
the life and livelihood of the individual. Rarely do they
take into account patient considerations about how they
should be medically treated or what factors need to be
considered in order to reduce the negative impact on their
livelihood (Landmark et al., 2008). Part of mattering is
looking to see how treatments will affect the individual.
Do doctors take into account the patient’s life and
livelihood when treating the individual? Are treatments
specific to the individual or do doctors follow the same
protocols for all patients? Dibbelt, Schaidhammer,
Fleischer, and Greitemann, (2009) identify that the most
important variable in mattering as related to health care is
the ability for the doctor to let the patient decide what is
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Mattering
next. This study emphasized the need for the doctor to be
open to change and let the patients’ physical and emotional
conditions, as well as communication, dictate what
treatment should follow. In summary, when doctors sought
to build a relationship with the patients that involved more
than eradicating the cancer, the patients felt cared for, and
ultimately reporting they felt as if they mattered to the
doctor.
The present study on mattering seeks to improve upon
previous research in that it is conducted with a specific
group in order to see what the patients had to say about
their health care providers and identify factors of
specialized care that made breast cancer patients feel as if
they mattered. This study is also unique in that it focuses
on how doctors personalize care for patients. Uncovering
whether or not breast cancer patients felt they mattered to
their doctors is also an aim of this current research.
Mattering, in the context of this research, refers to the
“experience of moving through life being noticed by and
feeling special to others who also matter to us” (Tucker et
al., 2010, p. 135). Oftentimes it is not until a woman
moves into survivorship that she realizes her body is no
longer the same and her quality of life decreases (Salonen
et al., 2011; Sanson-Fisher et al., 2010). This change in
quality of life is problematic for musicians because of the
direct impact it has on their careers.
This current study is unique because it will use a special
participant pool comprised of musicians. Being a musician
constitutes a livelihood that hinges on the ability to play
an instrument or sing at a specific pitch. Breast cancer
treatments, including lumpectomies, lymph node removal,
mastectomies, radiation, and chemotherapy, often damage
physical functions such as lung capacity and upper body
strength which can interfere with an artist’s ability to make
music. Survivors can have long-term issues with pain,
neuropathy, and lymphodema, not to mention chronic
fatigue and a plethora of other side effects from treatments
(Fisher et al., 2010). Using musicians for this study is
critical because a condition such as lymphodema causes
swelling of the arms. For a woman who does not have to
use her arms at work, this might not be problematic.
However, musicians who play string instruments use their
arms for instrument support and sound production.
Musicians were used for this study based on the direct
affects cancer treatments can have on their livelihoods. In
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UST McNair Scholars Program Research Journal
the case of musicians, if a woman is a singer or plays a wind
instrument, lung scaring from radiation may diminish her
lung capacity necessary to perform at the level she once did.
Weaknesses as a result of lymph node removal, or injury
from ports or drains, may make horn or violin players
unable to hold their instruments for even short periods of
time.
Most musicians train for a lifetime to perfect their craft.
Music is often their way of life, and if treatments damage
their way of life, it is incredibly difficult to find another
means to make money and live. Medical specialists ought
to understand the musician’s strong feelings toward her
music. The patient should matter enough to doctors that
they take their time to find other viable treatments that
have less of an impact on the women’s ability to make
music. The purpose of mattering in this study is to answer
the question, if the patient matters to the doctor, and music
matters to the patient, will the patient’s music matter to
the doctor?
The research goals for this project are twofold. The first
is to explore what female musicians who had cancer say
about their experiences with their health care professionals,
particularly if these women felt as though they mattered.
In addition, it explores what behaviors from their doctors
made them feel like they mattered and which ones made
them feel like they didn’t matter. The second is to observe
if health care professionals took into account the women’s
livelihoods when prescribing treatments. (This research is
part of an ongoing study to access female musicians’
experiences with the health care system. This particular
study uses the existing interview transcripts conducted by
Drs. Jean Giebenhain and Sarah Schmalenberger, along
with Charles Gessert, M.D. and Lisa Starr, CNP.) To
achieve these goals, content analysis will be performed on
the interview transcripts of thirty-eight female musicians
who are one to five years post-treatment for breast cancer.
METHODS
I conducted content analysis (qualitative data analysis)
on existing coded interview transcripts of 38 female
musicians who were 1-5 years post-treatment for breast
cancer. These interviews were originally conducted as part
of an ongoing study by Drs. Giebenhain, Schmalenberger,
4
and Gessert, as well as Lisa Starr, CNP (For a fuller
discussion of the participant pool and original methods see:
Schmalenberger, Giebenhain, Starr, & Gessert, 2008). The
interviews were analyzed for themes particularly related to
mattering. The Nvivo 9 qualitative software package was
used to assist the analysis in order to identify themes
associated with what women had to say about their
experiences with health care professionals. Analysis
identified specific information related to behaviors health
care providers exhibited that contributed to whether
women felt as if they mattered or not.
RESULTS
NON-MATTERING BEHAVIORS
After reviewing the coded transcripts, there were themes
that emerged from the experiences of our participants.
Themes related to mattering are identified below:
Diagnosis delivered over the phone/Staff was not
knowledgeable or helpful.
There were several behaviors from healthcare
professionals that made the women feel they didn’t matter.
Patients experienced extreme dislike of their health care
professionals when they were informed of their diagnosis
over the phone. The women remarked the dislike came
from the way the message was delivered. The nurse or
technician who would make the call lacked compassion
when giving the women their diagnosis. They would
simply say the test results came in and the diagnosis is
cancer. They would then tell the women to schedule
surgery. In most instances when a diagnosis was delivered
poorly, the women were not able to schedule treatment for
weeks. Patients expressed extreme dislike of this system,
saying it was cold and forced them to sit with the news of
their diagnosis for weeks without support. They also
remarked that the nurses were not able to answer questions
and lacked information that was critical to them. An
example of these behaviors was encountered by a woman
who was diagnosed over the phone. She said “The first bad
thing about being told I had breast cancer was um, my doctor
didn’t even tell me, it was like a nurse I didn’t even know just
sort of called and said oh, um your result was positive and then,
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Psychology
I don’t know anything else, bye, hung up.” The patient then
called the nurse back to get some more explanation. She
explained the situation by saying “I called back, the nurse
goes, well we just got preliminary results, and we don’t know
anything else. I said why didn’t the doctor call me? The nurse
says oh well, it’s her day off, so she couldn’t call you.” As the
situation played out on the phone, the patient recalled
being told, “Why don’t you call the hospital and try to find out
something?” this patient was extremely dissatisfied with the
lack of empathy exhibited by this hospital. The fact the
doctor could not call herself was “jaw dropping” to the
patient.
Physician did not address side effects of treatments/ did not
collaborate with patients.
Patients who met with doctors to receive their diagnosis
reported the experience was negative when doctors simply
lectured and gave the medical aspects of the cancer. The
patients explained that when doctors focused on the
medical aspect of the cancer, they overlooked the women’s
opinions on how they should be treated. The patients felt
they did not matter when doctors did not answer questions
and failed to give information on what treatment would
mean for their livelihoods. There are several examples in
the transcripts of patients being given medications without
full explanations as to what the side effects could be. When
women researched the medications and came back with
questions, often times the response from the doctor was
negative. In one instance, a woman was prescribed Taxol,
an anti-cancer chemotherapy drug. The women researched
the drug and proceeded to talk to her doctor about her
findings. She said,
“When I talked to the doctor about the Taxol, he was so nonunderstanding, so uncompassionate about it. He’s like well,
just do it and, you know…I mean, he… I don’t feel that I
was respected for my fear or my decision on what this was
going to be, and, um, I felt that it was a valid fear, or a
valid… you know, um, question. And I just felt really
disconnected by the doctor with… you know, it’s like…
okay, well, um, if you want to live you going to do this, um,
without any understanding that what it was for me to live,
you know, what it… what it took for me as a human, as a
person, as an individual, um, you know… if I couldn’t have
my music, or if I couldn’t have… and for some other people
who are passionate about something if they don’t have that
in their lives anymore, how are they going to adjust and how
are they going to survive. Piano or my music to me is really
my coping mechanism for everything else that I do. And to
be left without it… and I don’t think that he had enough
understanding about that.”
This woman is one of the many patients who were not
understood when trying to articulate their fears about
medications.
Lack of concern for livelihood
Most women reported telling their doctors they were
musicians and asked how treatments would impact their
ability to play. The results show that when the doctors
focused on the cancer first and everything else second, the
women had a negative experience. These women would also
report that the doctors only cared about them as a cancer
patient and not as a whole person with a life outside of
cancer. The doctors who treated the women simply like a
cancer patient failed to individualize care that would allow
for the women to be able to play music at their current
level post treatment. One participant who sang for a living
was concerned about her ability to sing post treatment.
This woman, among others, reported some doctors did not
understand their lung capacity had been reduced after
treatment. Doctors who did not realize that certain
musicians, such as singers, had extraordinary lung capacity
when compared to a normal person only focused on healing
the patient as a normal person. When measured for lung
capacity, this woman was told she was at ideal levels for a
female, but not at the extraordinary level she once was.
This patient reported that doctors simply did not know
how musicians functioned. She said, “But [doctors] don’t
know, they don’t know what’s necessary for a singer to sing, they
don’t know how those parts work. Aa, aa, it’s like you know I
remember long ago going to an ear, nose, and throat specialist. He
did not understand musicians and he was one of those who was
more interested in getting off to his weekend trip so told me there
was nothing wrong with my voice when I couldn’t sing above an
F. This was my upper range; he said my speaking voice was just
fine so my singing voice should be fine.” Women felt they did
not matter to health care professionals when their concerns
were met with cynicism and doubt.
Did not assist patient with “survivorship”
Many patients also expressed a dislike of the attention
given to them post treatment. These patients explained
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UST McNair Scholars Program Research Journal
that for doctors, it was truly “Cancer first.” When
treatments were over and patients inquired as to what to
do in order to regain their physical capacity to make music,
they found doctors were nonresponsive. A patient who was
a violinist asked her doctors what she should do in order
to be able to hold her instrument for long periods of time.
She was given a sheet containing exercises, which included
crawling ones hand up a wall and moving a broomstick up
higher each day. The woman said “I wish they had said a
little bit more about what to do instead of just giving me this paper,
here do these exercises.” Several other patients experienced this
same situation, and remarked they would have liked more
attention paid to how they were going to regain their
physical capacity to make music.
agree, I’m glad that I kept playing and teaching.” This type of
encouragement made women feel as if the cancer was not
going to define who they were. Patients reported these
doctors were truly “human” and made them feel like they
were not just an accumulation of cancer cells but a whole
person with feelings. Doctors made patients feel like they
mattered when they treated the women respectfully and
looked at them as a person. A patient stated her doctor was
very nice to her and it “kind of makes you feel like I’m not like
old and ugly and cancerous because, you know, he was being so
nice to me.”The women explained the term “human” by
saying that these doctors understood how they were feeling
and were responsive to their needs. These doctors wanted
to heal the patient as a whole person and not just as
cancerous host.
MATTERING BEHAVIORS
Physical contact (if welcomed by patient).
Physician stayed away from medical jargon / medical team
was encouraging.
When doctors had patience and explained all possible
options to the patient, allowing the patient to make an
informed choice, the patient seemed satisfied. Doctors who
stayed away from medical jargon and strove to not
overwhelm the patient were seen as understanding. An
example of this comes from a woman who recalled what it
was like when she was diagnosed. She said, “They gave me a
book at the library, the book had information about what doctors
do when someone is diagnosed. It said they give you a bag with a
bunch of stuff in it like a satin pillow case, when your hair falls
out, and about, you know, the people that replaced your eyelashes
and stuff like that. This book actually scared the (*****) out of
me.” When the woman told her doctor her concerns, he
explained to her what she was reading in the book in nonmedical, plain terms. She said she was assured by the doctor
that he would explain each treatment procedure to her and
be there during the procedures in case she needed comfort.
Analysis showed this type of personal relationship between
both doctor and patient facilitated the thought the patient
mattered. The most desirable doctors were those who in
some cases would encourage the women to continue
playing their music. A woman recalled the help she
received from her health care professionals by saying “I got
a lot of psychological help from my doctor and my nurses, they were
cheering me on saying I was doing great and it was better for me
to keep making music than sit home and worry, which I really
6
Some patients found it helpful when the doctor would
make physical contact (e.g. hand on the shoulder) in order
to help them understand that they were not alone in the
ordeal. A patient explained, “He[ the doctor] never seemed aloof
or cold, or never even on the operating table, you know, when they’re
getting ready to give you all of those drugs, and you know, it’s the
hand on the shoulder and just those little things that they do that
just make you feel so human and not just another patient.” Some
patients, however, did not feel comfortable engaging in this
type of physical contact from doctors when they did not
know them well or were just meeting for the first time. A
patient remarked that she disliked contact with her doctor
by saying, “When I got into the office she was very patronizing.
She put her arm around me. I don’t know this lady. She puts her
arm around me and tells me I have cancer. It was hard to take it
all in with this woman draped over me.”
Interested in patients’ wellbeing
When doctors asked how treatments were affecting the
patient’s wellbeing, the patient felt they mattered. The
patients reported that it is absolutely essential a person find
a doctor who they not only trust because they are a good
doctor, but somebody they really wants to go and talk to.
It is also important they feel good just being in the doctor’s
presence. A patient stated she loved being in her doctor’s
presence. She went on to say “He was so kind and like he
would put his hand on my shoulder. You know, just he would touch
and um, like ask me questions that didn’t necessarily relate to the
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Psychology
diagnosis, but I just really felt like he cared about how this was
all affecting me as a person.” When doctors made the patient
comfortable, the patient seemed to trust and want to be in
the presence of the doctor.
Going above and beyond the call of duty
The ultimate behavior that made patients feel they
mattered to their healthcare professionals was when doctors
went above and beyond the call of duty. Patients reported
extreme approval of their doctors when they received a call
from them to see how they were coping with treatments.
The doctors who contacted patients made the participants
feel they mattered because those doctors put the patient
first. Among many examples, there are a few that stand
out. A woman stated that “my doctor would call me, like, um,
during the week after, you know, the surgery or something and just
say yeah, I’m just calling to see if you have any questions, how
are things going and I’m like oh my gosh my doctor is calling me
at 5:30 in the evening just to see how I am!” This patient
experienced satisfaction because this doctor did not have
to call her, but nevertheless, this doctor took time from his
day to make sure his patient was alright. Another example
of a doctor going beyond the call of duty occurred when a
patient told her doctor that she was a musician. The doctor
asked her if she would be willing to come and play her
music in the hospital. This gesture meant a great deal to
this woman because she was dealing with depression due
to the effects the breast cancer and the treatments were
having on her life and livelihood. She was happy because
she felt she mattered to the doctor and was able to give
back to others in her position by playing her music for
them. In summation, I believe women who experienced
these types of interactions felt as if their doctors were
saying “I know that being able to play your music matters
to you. You are my patient and you matter to me, therefore
your ability to play also matters to me.”
THE IMPACT
MATTERING
OF
DOCTOR-PATIENT
INTERACTIONS ON
From the analysis, it appears mattering occurs within a
twofold interaction. Those patients who came in with
questions and had researched what cancer medications can
do to the body felt prepared to interact with the doctor.
Women who either brought a friend to ask questions, or
researched and asked the doctor as many questions they
could felt they mattered when the doctor answered their
questions. A patient recalled her experience with her doctor
by saying “I brought a friend with me because in the midst of
this you need someone who will be a real advocate. This friend
who went with me, boy, she interrogated the doctor up one side and
down the other. She asked him questions like, how often have you
done a mastectomy. The doctor was patient and answered
everything.” Patients who came in with questions for the
doctor felt the doctor was competent and caring when he
or she answered the questions. The second portion of this
interaction process is that the doctor should respond to the
patient. The doctors who answered all the patient’s
questions were seen as caring and compassionate as well as
competent. A patient called her doctor as “caring” when
the doctor took the time to answer all of her queries. The
patient identified above went on to say “I could email her
and she would email me back within hours, ah, and she might
answer and say I am at a conference in China, you know, what
do you want to know? But she was just always there to answer
any questions that I had, no matter where she was. “When
patients and doctors achieved this ideal interaction, the
patient felt they mattered to the doctors as a person and
not just as a cancer patient.
Participant perception of “types of doctors”
Results from analysis show that patients perceive two
types of doctors and two types of patients. A patient put it
best by saying, “the first types of doctors are those who do not
seem like interaction with patients and simply want to prescribe
medication in order to treat whatever is afflicting the person.” The
second types of doctors, just like the first, prescribe
medication to the patient in attempt to heal and give the
individual their life back. The difference between these
doctors lies in the interaction component of the second
doctor. The second doctor is also concerned with the
patients’ livelihood during and after treatments and
therefore seeks to interact and understand how treatments
are affecting the individual.
Types of patients
Analysis showed there are also two types of patients. A
participant articulated what the two types of patients were
by saying “there are people who go to the doctor and they don’t
want to know anything and they just want to put their trust in
the doctor and be led and do what the doctor said and that’s maybe
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half. And then there are the patients who want to be participants
by talking one on one with the doctor and want all the information
that is possible and they want to be involved in the decision
making.” Analysis of the transcripts shows many women
saying what one patient said best, “there needs to be a match
on the doctors who are comfortable with each kind of patients.”
Most of the participants fit the criteria for the second
patient who wants to be involved in the care they receive
because they wanted to be able to perform their music after
treatments. Many of the women gave advice to future
patients by saying “If there is a mismatching of the right doctor
to the right patient, there will be conflict and the patient might
not feel cared for.” There are several examples of this
mismatching of patients to doctors, or instances where
patients did not feel comfortable with the doctors they had.
One particular example occurred with a woman who had
difficulty with her health care professionals. She recalled
and said “I had to deal with so many nonmedical people when
you went for radiation, there were like six people standing around,
you know. And here I’m lying down with my breast hanging down
being ready to get shot up and they were like wearing uniforms.
They looked almost like airline attendants. And I thought why
do they need all of these people around here.” This woman felt
uncomfortable with the situation in the operating room.
Though her doctors were in the room, she remarked she
did not feel as if she could talk to them due to the lack of
intimacy she felt.
Mattering in the long term/Survivorship
Analysis revealed many women looking for support and
a sense they mattered from their doctors after treatments
were over. Most women commented they found they
received the most attention when they were going through
the cancer treatments. When the treatments were over,
they recalled having problems adjusting to their damaged
bodies as relating to performing and making music. A
woman expressed her concern toward this topic by saying
she found doctors focus more on the short term (e.g.
getting rid of the cancer) than the long term (e.g. good
quality of life). She went on to say, “I don’t think medical
doctors understand holding an instrument for a solid hour, it’s not
easy. I suppose a way to make them understand is to relate it to
some sport. They might have a better understanding that it is very
difficult to hold an instrument after having lymph nodes taken
out.” Almost all of the women in this study remarked that
8
there needs to be more attention given to living with the
long term effects of cancer treatments. The women
remarked often they do not want to bother their medical
team when they come in for routine checkups because they
feel the doctors are often busy with other patients. The
doctors who truly made women feel like they mattered
were the ones who addressed these issues. A patient put
best what others were trying to articulate by saying,
“I felt like my all the medical care that I had was excellent.
I don’t find a lot of attention to long term care and how are
you are in the long run. I think doctors have a lot of time to
surround, mainly when I go to my oncologist appointment,
which I will in April, a few key questions will be asked
and they will get my ****bones and see**** and they will
check on the critical things and do I have cancer. There are
no signs that I have cancer. And sometimes my oncologist does
ask about my comfort level and I guess, I always kind of get
the idea, you know, they are busy dealing with people who
are dying from cancer, they are not all that concerned with
how am I doing in the long term. And I have never said
that I’m doing poorly. I have continued to pursue this soreness
and each time I go in I say well, you know, can you, to begin
with I wanted physical therapy and he was willing to, you
know, write a prescription for that and the massage is
helping so he took my massage person’s card, um, but I guess
I would hope for a little bit more attention to the long term
effects.”
CONSEQUENCES OF MATTERING
It is important to note that many women in this study
wanted to matter to their doctors. A patient recalled her
experience with her doctors by saying “I had to switch doctors
because they just didn’t seem to understand, you know. I wanted
someone who would understand and be able to tell me how these
treatments would affect my voice as a musician.” Many patients
echoed what this woman said by saying they preferred the
second type of doctor because it seemed this ideal doctor
cared about them as a patient as well as a person.
DISCUSSION
The aim of this research was to see if patients perceive
they matter to their health care providers. Patients stated
mattering to doctors was very important in receiving quality
care. Patients often switched doctors when they felt they
didn’t matter to their health care providers. The main
Psychology
finding from this study was doctors made patients feel like
they mattered when they took the time to talk, answered
questions, and view the patient as a person who wanted to
be able to have good quality of life after treatments. The
results also indicated women felt they were merely cancer
patients when they were given their diagnosis over the
phone and by nurses who did not have sufficient
information. Results from the current study coincide with
findings from previous research from Janssen & MacLeod,
(2010) which also found that patients dislike being treated
as only as their cancer and not as people.
This research also investigated whether or not patients
perceived whether doctors took their life and livelihood
into account when prescribing treatments. It seems some
doctors are still focused on the elimination of the cancer
and fail to look at long term effects of cancer treatments.
Some doctors failed to address the side effects of treatments,
which led to patient difficulty in regaining their livelihood
(Schmalenberger, S., Giebenhain, Gessert, & Starr, 2011;
Schmalenberger, Giebenhain, Starr, & Gessert, 2011). The
patients from this study remarked if the doctor could give
them back their lives but take away their means of
providing for themselves, their quality of life had been
greatly diminished. Being musicians is their passion,
identity, and way of life. These women have trained for a
lifetime to make music, and therefore cannot merely switch
professions.
Medical treatments are essentially universal and not
individualized. Doctors usually follow the same protocols.
In the present study, largely ignored? Or downplayed the
fact these women were musicians whose careers depend on
their finely tuned physical abilities. Results from this study
indicate when dealing with patients, they perceived the
doctor was concerned with the cancer to the exclusion of
anything else. Some doctors asked the patient how
treatments were affecting them, but the major focus was
on getting rid of the cancer, everything else came second.
Research indicates more women than ever are found to
survive breast cancer. This rise in survival rates can be
attributed to better methods of detection and intervention.
Because we are more likely to survive cancer today, it makes
sense that health care providers need to broaden their focus
to include individualized treatments to successfully
eliminate the cancer as well as minimize threats to patients’
Oluwademilade Adediran
Mattering
careers. This will help maintain the patients’ quality of life
after treatments are over.
Taking into consideration the concerns of the present
sample, recommendations for improved holistic health care
might include the following: in order for doctors to better
suit their patients and do no harm as the Hippocratic Oath
states, doctors could facilitate better communication with
patients. This could help patients perceive they matter as
people and are not just a name on a chart. Patients ought
to be able to tell their doctors they are a mechanic, surgeon,
professional athlete, or ballet dancer, and therefore must (if
at all possible) be able to do specific activities after
treatments have ended. Doctors ought to share with the
patient all possible treatment options, probabilities of
success, as well as the pros and cons of each treatment
option. This will ensure the patient has input about how
they would like to be treated. Furthermore, health care
professionals might consider creating a relationship that
conveys they care for the patient. The relationship need
only include specific characteristics which include: 1) the
doctor could listen to the patient and direct them to
resources which could give the woman further information
about treatment options; 2) the doctor could keep the lines
of communication open by making sure that meetings with
the patient last as long as they need to; 3) doctors ought to
take their time when meeting with each patient and not
try to hurry through the process. This patience exhibited
by the doctor could imply to the patient they can share
their thoughts.
The recommendations stated above were found to be
what the ideal doctor should engage in according to study
conducted by Theisel (2010). This “ideal” interaction does
not facilitate more work for the doctor who has many
patients to help, but helps him or her understand where
the patient is coming from. The complaints from the
women were not just that the doctor did not take his or
her time. It was that the doctor was not purposeful in the
use of his or her time. A patient explained “I see my surgeon,
oncologist, and radiation oncologist every couple of months. And I
have to tell you, when I go in for my treatment there, the visits get
quicker and quicker.” Practical constraints in the age of
managed care imply it is hard for a doctor to be able to give
each patient the attention they might deserve. Though this
is the case, doctors ought to make their patients feel they
matter by purposefully using the time they are allotted per
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patient. To address time constraints, the doctor could enlist
the help of other health care professionals such as nurses
and patient navigation advocates in order to make the
patient feel they matter. Research from Kaiser et al. (2009)
indicated the patient is more likely to trust the doctor if
they feel they matter. Much more than this, if the patient
feels they matter to the doctor, they are more likely to trust
other specialists the doctor recommends to them.
Health care providers, such as nurses or patient
navigation advocates, could perhaps also play a bigger role
in making the patient feel like they matter from the very
first phone call to the patient. If the woman must receive
the diagnosis over the phone, the nurse or doctor giving
the news ought to have information for the woman about
the illness, and possible treatment plans. The professional
could take into account the woman’s feelings on the subject
and not be cold in the delivery of the news. The health care
professional could attempt to schedule an informational
meeting with the woman as soon as possible, even if an
appointment with the physician is not possible within a
week. This will ensure women do not sit with news of their
cancer for weeks without information and support.
When interviewed, the post-breast cancer participants
in the current study had several suggestions for health care
professionals. A woman remarked she wants doctors to be
concerned with the quality of her life after treatments by
saying,
“I just feel like, um, the medical community needs to have a
little more understanding of what quality of life is for an
individual person, not just the treatment but the fact that,
You’re going to live, but are you going to live with good
quality or with just what you need to survive. Living and
surviving and, being successful are really different things to
everybody. You know what I mean. There are different
qualities and different aspects that have to go into all those
things. You know. You can live but if you’re not living the
quality of life or the success that you need for your life, then
it seems a lot pointless.”
Results from this study imply there needs to be more
attention to long term side effects from treatments, and
strategies to cope with and heal from those side effects. A
woman in this study remarked there have been
improvements, but there is still work to do. The woman
went on to say, [the medical center I go to] “has a newsletter
that goes out to patients that have had breast cancer and I have
10
seen more awareness developing in that of sort of like long term
kind of thing, you know, exercise classes or what are the effects
after you have had cancer 10, 5-10 years later. I have seen a little
bit more attention given to the issue rather than just talking about
it.” This study shows what many breast cancer patients are
sure to agree with: having breast cancer is not just
something someone has at some point in their life, it is
something the person has to deal with her entire life. Due
to this factor, doctors should give more attention to post
treatment or survivorship issues.
In order to address long-term survivorship issues, there
could be a specialist who provides occupational assessments
for patients. These exist in some breast centers today. The
specialist assesses the patient’s physical abilities prior to
any form of treatment in order to see what it is the patient
does for a living. For example, a patient might receive an
assessment that discovers he or she is a pianist. This would
be particularly helpful because the occupational assessment
specialist can pinpoint the muscles and ligaments in the
arms involved in playing piano. Doctors would receive this
information and would therefore be careful of these
locations, or perhaps pick other lymph nodes in the arms
to remove if possible. Better quality of life would be
reached if doctors are aware this patient needs to be able
to play the piano after treatment. They would be more
careful to place ports or drains in locations that would
facilitate less harm to the patient.
Another way to learn about survivorship issues would
be to create more survivor support groups. When women
were diagnosed in this study, they recalled being given
information about several focus groups that could help
them deal with the issues they were having adjusting to
life with cancer. There could be more groups focused on
the issues women have post-cancer treatments. These
groups ought not to be focused on simply stating
grievances women have, because many patients stated they
did not want to feel sorry for themselves, but they should
focus on support from other patients who have been
through what they were now undergoing (Johnson, 2010).
Doctors and other health care professionals should interact
with the patients in order to ascertain what women need
in terms of support. It could be the case that some women
want hard facts about survival rates and statistics while
some patients want to be in a group setting where they can
talk about the issues they are having. Interaction with
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Psychology
patients will help doctors understand the patient and their
needs, so they can direct patients to appropriate resources.
This research was conducted with only interviews from
patients and not health care providers. It would be
interesting for future research to acquire interviews from
doctors as well. This would provide an understanding
about how health care professionals view their interactions
with patients. In summation, the health care field, though
has made many advances, still needs to focus on individual
patients. Doctors could perhaps see patients as someone’s
father, mother, sister, or brother, and therefore understand
the patient as a whole matters. If the focus of health care
professionals shifts from not just curing a disease but to
also ensure the livelihoods of patients are protected,
patients might experience higher qualities of life. In
addition, if the patient matters to the doctor, it might be
easier for doctors to see the patient as a person, and
therefore the doctor will involve patients in making
decisions. If the patient matters to the doctor, then this
could imply the doctor will keep the patients’ interests in
mind. When the doctor says the diagnosis is cancer, it is a
challenge to not only to defeat the cancer but to return to
life after the treatments are over. Doctors ought to feel an
obligation, as stated by the Hippocratic Oath, to work to
integrate quality treatments into good quality of life for
patients.
In summation, this research identified two primary areas
that require attention from health care professionals. First,
there needs to be better interactions with the patient as was
also found in the study conducted by Kaiser (Kaiser et al.,
2009). Second, there ought to be more thought given to
long term effects of cancer treatments and the woman
should continue to matter over time. Though the next
steps of this research points to viewing health care
provider’s views on mattering, the more immediate step is
to focus on occupational assessments. As this study has
demonstrated, often times doctors do not take into account
the patients livelihood when prescribing treatments. Next
steps in research will not only look at health care providers
views on mattering, but also look at ways to implement
occupational assessments in more treatment centers.
REFERENCES
American Cancer Society. (2010). Survival rates for breast cancer
by stage. Retrieved from www.cancer.org/Cancer/
ProstateCancer/DetailedGuide/prostate-cancer-survival-rates
Connolly, K. M. (2002). Work: Meaning, mattering, and job
satisfaction. In D. S. Sandhu (Ed.), Counseling employees: A
multifaceted approach. (pp. 3-15) Alexandria, VA, US:
American Counseling Association.
Dibbelt, S., Schaidhammer, M., Fleischer, C., & Greitemann, B.
(2009). Patient–doctor interaction in rehabilitation: The
relationship between perceived interaction quality and longterm treatment results. Patient Education and Counseling,
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France, M. K., & Finney, S. J. (2009). What matters in the
measurement of mattering?: A construct validity study.
Measurement and Evaluation in Counseling and Development,
42(2), 104-120. doi:10.1177/0748175609336863
Janssen, A. L., & MacLeod, R. D. (2010). What can people
approaching death teach us about how to care? Patient
Education and Counseling, 81(2), 251-256. doi:10.1016/
j.pec.2010.02.009
Johnson, A. (2010) Informational Social Support: Female
Musicians Cope with Breast Cancer
Kaiser, K., Rauscher, G. H., Jacobs, E. A., Strenski, T. A.,
Ferrans, C. E., & Warnecke, R. B. (2011). The import of trust
in regular providers to trust in cancer physicians among
white, african american, and hispanic breast cancer patients.
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Kawamura, S., & Brown, S. L. (2010). Mattering and wives’
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j.ssresearch.2010.04.004
Landmark, B. T., bøhler, A., Loberg, K., & Wahl, A. K. (2008).
Women with newly diagnosed breast cancer and their
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norway. Journal of Clinical Nursing, 17(7), 192-200.
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National Cancer Institute. (2010). Survival statistics. Retrieved
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O’Connor, S. J. (2011). Listening to patients: The best way to
improve the quality of cancer care and survivorship. European
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Rayle, A. D. (2005). Adolescent gender differences in mattering
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doi:10.1016/j.adolescence.2004.10.009
Salonen, P., Kellokumpu Lehtinen, P., Tarkka, M., Koivisto, A.,
& Kaunonen, M. (2011). Changes in quality of life in patients
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with breast cancer. Journal of Clinical Nursing, 20(1-2), 255266. doi:10.1111/j.1365-2702.2010.03422.x
Sanson-Fisher, R., Bailey, L. J., Aranda, S., D’Este, C.,
Stojanovski, E., Sharkey, K., & Schofield, P. (2010). Quality
of life research: Is there a difference in output between the
major cancer types? European Journal of Cancer Care, 19(6),
714-720. doi:10.1111/j.1365-2354.2009.01158.x
Schmalenberger, S., Giebenhain, J.E., Gessert, C.E., & Starr, L.
(2011, July). The disabling affects of breast cancer treatment
on women musicians. Paper session presented at the
Minnesota Symposium in Disability Studies. Mpls, MN.
Schmalenberger S, Giebenhain J, Starr L, & Gessert C E. (2008).
The medical and occupational well-being of musicians after
breast cancer. American Journal of Clinical Oncology 31(5), 517.
Schmalenberger, S., Giebenhain, J.E., Starr, L., & Gessert, C.E.
(2011, July). Musician survivors: Breast cancer’s effect on
their livelihood. Paper session presented at the 29th Annual
Symposium of the Performing Arts Medicine Association.
Aspen, CO.
Theisel, S., Schielein, T., & Spleßl, H. (2010). Der „ideale“ arzt
aus sicht psychiatrischer patienten. [the “ideal” doctor from
the view of psychiatric patients.]. Psychiatrische Praxis, 37(6),
279-284. doi:10.1055/s-0030-1248403
Tucker, C., Dixon, A., & Griddine, K. (2010). Academically
successful African American male urban high school
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Professional School Counseling, 14(2), 135-145.
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IMPORTANT MATTERING QUOTES FROM PARTICIPANTS
Section one
Themes
The following quotes below are behaviors exhibited by healthcare
professionals patients felt were cold or aloof. The main finding in this section
was patients felt the doctors could have done more to make them feel more
comfortable and like they cared for their wellbeing outside of removing the
cancer. i.e. seeing how cancer treatment would affect their music playing
Quotes from patients
“Well, when we talked about the Taxol the doctor was so non-understanding, so
uncompassionate about it. “The doctor said if you want to live you got to do this,
Doctor did not consider the patient’s
without any understanding of what it was for me to live, you know, what it took for
whole life
me as a human, as a person, as an individual. If I couldn’t have my music, or if I
couldn’t have… and for some other people who are passionate about something if
Section one
they don’t have that in their lives anymore, how are they going to adjust and how
Doctors did not understand music was a are they going to survive. Because piano to me, or my music to me is really my
big part of the patient’s life:
coping mechanism for everything else that I do. And to be left without it I don’t
think that there’s enough understanding about that.”
“They [doctors] don’t know, they don’t know what’s necessary, they don’t know how
those parts work. Aa, aa. I remember long ago going to an ear, nose, and throat
specialist, um, who did not understand musicians and he was one of those who was
more interested in getting off to his weekend trip so told me there was nothing
wrong with my voice when I couldn’t sing above an F, you know, in my upper range.
He said my speaking voice was just fine so he thought.”
“The first thing that happened? They gave me a book at the library. What they do
when someone is newly diagnosed is they give you a bag with a bunch of stuff in it
like a satin pillow case, when your hair falls out, and you know, the people that
replaced your eyelashes and stuff like that. They give you a book which actually
scared the (*****) out of me.”
Doctors did not understand their patients
Section one
Lack of intimacy and sensitivity by staff:
“I got to tell you it’s like a parallel universe were I was treated. They kind of function
like the New York City Board of Ed in that they have so many nonmedical personnel
around there, the way the Board of Ed. It continues to astound me how many noneducation people they have there. Taking up space, taking up payroll, taking up
money. The hospital I went to was that way also. You know, you’d go outside and
you’d see all the uniforms out there standing around on a cigarette break and I’m
thinking this is a (*****) cancer hospital. I bet I mean I had to deal with so many
nonmedical people when you went for radiation, there were like six people standing
around, you know. And here I’m lying down with my breast hanging down being
ready to get shot up and they were like wearing uniforms. They looked almost like
airline attendants. And I thought why do they need all of these people around here.
You know, I mean maybe I should be grateful that these surroundings were pretty,
you know, like with flowers and nice painting and nice carpeting, but all I could
think of was, god dam, this is why they charge so much. You know, thank God I
had insurance because I know people who didn’t.”
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Listening
Section one
Doctors not listening
Delivery techniques
Section one
“You know, honest to God when I tell them [doctors] about problems I am having,
they look at me like I should just be grateful that I’m here instead of bringing up
the things that are real issues in keeping my life going. And I can understand that
because, you know, the oncologist has a crappy job, you know, I mean, they deal
with people and a large percentage of their client base, eventually die in a short
period of time. so, I think when somebody comes in who is still alive after 2 years
or 3 years and they are complaining about something like that they look at you like
you’re an ingrate, you know.”
“I said well you know… when the old ladies are passing me twice at the mall there’s
a real problem. So I went back to the oncologist who poo poed me and said, you
know, it’s in my mind, and you know, I’m, you know, I’m just you know bouncing
back or something like that. He pretty much blew me off.”
“Right. Um, the first thing was, the first bad thing being told you have you have
breast cancer was um my doctor didn’t even tell me it was like a nurse I didn’t even
know just sort of called and said oh, um your result was positive and then, I don’t
know anything else, bye, hung up.”
Poor diagnosis delivery and
technical help:
“Yea and so she goes, why don’t you call the hospital and try to find out something.
I was calling and they were going, we can’t tell you, its confidential, and I said yea
it’s about me but so they wouldn’t tell me anything and I called the nurse and said
have the doctor call me but she never did, which was jaw dropping. I switched
doctors after that. I refused to see her anymore.”
section two
The following quotes below, are behaviors exhibited by healthcare
professionals which made patients feel doctors care about them more than a
cancer patient. There are also recommendations given by patients. The
patients stated that if these criteria were met, they would feel more
comfortable with their doctors and trust them more.
“I had fabulous doctors, I mean my, my oncologist… it didn’t hurt at all that he
was young and just absolutely good looking and … I don’t know, he was just so
kind, he would put his hand on my shoulder. You know, just… he would touch and
ask me questions that didn’t necessarily relate to the diagnosis, but I just really felt
like he cared about how this was all affecting me. He wanted to speak with my
husband. He insisted that, you know my husband be there for all of those initial
Doctors showed patients they cared for them talks about all of the options and so forth. He was so kind and so gentle, and I would
say that it’s absolutely essential that you find a doctor who you not only trust because
you know that he’s a good doctor, but somebody that you really want to go and talk
Section two
to, you know, that you feel good just being in his presence. And like I said I was
Caring behaviors exhibited by doctors/ really thrilled that he was young, I mean, he was younger than I was but, it was
health care professionals: (physical)
really stupid, but it kind of makes you feel like I’m not like old and ugly and
cancerous because, you know, he was being so nice to me.”
“My doctor would call me during the week after, the surgery or something and just
say, yeah, I’m just calling to see if you have any questions, how are things going
and… I’m like oh my gosh my doctor is calling me at 5:30 in the evening just to
see how I am!”
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Psychology
“I had a lot of psychological help from my doctor and my nurses, they were cheering
me on saying I was doing great and it was better for me to keep doing this than sit
home and worry, which I really agree, I’m glad that I kept playing and teaching.”
“Um… I didn’t feel like I was fighting for me life because I kept getting
encouragement from my doctor and from the nurses that my situation while it was
not good, it wasn’t horrible, I mean it could have been a whole lot worse. They
decided that with my history and with it being a HER2 positive tumor that they
Section two
needed to treat it aggressively to make sure it didn’t come back. That was actually
their focus the whole time, they kept telling me we’re making you this sick to make
Caring behaviors exhibited by doctors/ sure that it, you know to REDUCE the possibility of it coming back. So mostly I
health care professionals: (psychological) was just thinking I had to endure this so that maybe I wouldn’t have to do it again.”
“I thought I was going to die. I thought between the kidney disease and the cancer
and the chemo and all that stuff, yeah, I thought I wasn’t going to make it...but
that didn’t last very long. That was about 2 weeks and then I expressed that to my
doctor and I think what I said, “I felt like I had a loaded gun pointed at my head”
and he laughed and he said “Oh well, they’re waving it around, but they’re not
pointing it at you!” his humor helped me get past it.”
Be as honest as you can and listen to your patients and remember that they’re people
and it could be your daughter or your wife or your mother.”
Recommendations to doctors
Section two
Listen to patients and let them
guide you:
Section two
Answer questions:
“Listen and investigate. Don’t tell me… oh… yeah… well, we just… you know.
Listen, investigate, and don’t even necessarily sympathize, I don’t want that. Just
find out what the problem is. And if you don’t know then tell me that.”
“Well, yeah, even though they try to dress it up, it’s um…I don’t know, what I
would tell the medical profession…is basically let the patient guide your response,
rather than having a programmed or a canned response or treatment…you know
that you tell everybody.”
“Well that they are treating a human being and, you know, I think that it is kind
of symptomatic in the medical profession across the board not just with cancer
patients but I think but it should be particularly in terms of people who are seriously
ill and facing cancer that they are dealing with a person who has or who had up to
that point a full life and, um, that things that they enjoyed and, um, that what they
are going through is very scary and not to be, um, sarcastic or flip with their answers
that anything that the patient has to ask them is a worthwhile question no matter
how silly it sounds. To not be intimidated by questions and I went in, I did a lot of
reading on the internet and I put together all kinds of questions and some doctors
were okay with it and others weren’t. Um, but you know the fact is that my approach
was that knowledge is power and if you don’t take the time and ask the questions
and try to get answers that you understand, um, at least for me that I felt like that
I was just floundering that I that I needed that that to hold on to.”
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UST McNair Scholars Program Research Journal
“Yeah, I guess, maybe if they [doctors] can put in their mind, kind of move
musicians in the same category as athletes, and that you really have to think about
all the possible physical, I mean obviously they know the anatomy and what’s
connected to what and that obviously is going to affect your playing.”
Section two
Understand musicians:
Section three
Patient Resilience
Section three
Understand that the show must go on:
“I just feel like, um, the medical community needs to have a little more
understanding of what quality of life is for an individual person, not just the
treatment but the… or the fact that, okay, yeah! You’re going to live, but are you
going to live with the quality or with what you need to survive. Because living and
surviving and being successful are really different things to everybody. You know
what I mean. There are different qualities and different aspects that have to go into
all those things. You know. Yeah, you can live but if you’re not living the quality of
life or the success that you need for your life, then it seems a lot pointless.”
The following quotes below reflect what patients wanted doctors to
understand. The patients wanted to get back to their music as soon as
possible and wanted the doctors to understand and aid them in this.
“They told me after the biopsy, they said… no, you’re not going to want to go back
to work. Well, fortunately I had a winter break so that wasn’t a problem. But then
after the surgery, he said you’re not going to want to go back for a while. But I had
a winter break, so I had a week off. But then I was right back at school on Monday.
They couldn’t believe it. They’re like; you’ve got to be kidding. I said… No, I’ve
got to work. So I did.”
“I said well how long it is going to take to recover. She said most people lay up for
about a week. I said, no I can’t do that. So I had the surgery on Friday and I was
back at school on Monday. She couldn’t believe it. I was walking like bent over, but
I was determined that I had to be back. So I guess I’m crazy, but that was pretty
amazing.”
“I wish they had told me maybe a little bit more about how bad chemo could really
get. But they wouldn’t know that because everybody is different, some people breeze
through chemo and I was, I flunked everything about chemo. I was the worst chemo
patient ever.
Everything that could go wrong did. I wish they had prepared me for that a little
bit more.”
Section three
Patients would have like more
information
“After surgery nobody told me that you can’t lift you arm. I mean they sort of said
yea you might have a little stiffness, well hell I couldn’t put the dishes away, you
know. The bowls that went up on the high shelf, I couldn’t put them away. They
weren’t real big on telling me the treatment effects, they were just so focused on
getting rid of the breast.”
They would say here are some exercises, and here is a sling, goodbye, and see you
later. They were kind of not real, maybe that’s not their job. They weren’t real
specific on the fact that they were going to take lymph nodes out.
It seems like everybody is real focused on their job. The surgeon is a surgeon and
the radiologist is the radiologist. They can’t really do their job well if they don’t
talk to the next guy, because it is all connected. You need all of them as the team.
They often don’t seem to interact with each other. You just get sent to the next
person for the next thing that was already found and they ask you the same questions.
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Psychology
Section four
The quotes below reflects a collective voice of the participant in the study.
The women were experiencing difficulties such as neuropathy or chest pains
after they were supposed to be cured. The women wanted long term care
targeted at these issues which persist after treatments were over.
“I don’t find a lot of attention to long term care and how are you and not that I
think doctors have a lot of time to surround, mainly when I go to my oncologist
appointment, now which I will in April, a few key questions will be asked and they
will get my ****bones and see**** and they will check on the critical things and
do I have cancer. There are no signs that I have cancer. And sometimes my oncologist
does ask about my comfort level and I guess, I always kind of get the idea, you know,
they are busy dealing with people who are dying from cancer, they are not all that
concerned with how am I doing in the long term. And I have never said that I’m
doing poorly. I have continued to pursue this soreness and each time I go in I say
well, you know, can you, to begin with I wanted physical therapy and he was willing
to, you know, write a prescription for that and the massage is helping so he took my
massage person’s card, um, but I guess I would hope for a little bit more attention
to the long term effects.”
More attention to survivorship
Section four
Long term care options
“I wish they had said a little bit more about what to do instead of just giving me
this paper, here do these exercises maybe sort of.”
“I see them [doctors] every 6 months. I see my surgeon and my oncologist and my
radiation oncologist. And I have to tell you, I mean, I go on in my treatment there,
the visits get quicker and quicker but if I need to know stuff they are very good
about it.”
I would hope for a little bit more attention to the long term effects. I am in the …
medical system and they do have a newsletter that goes out to patients that have
had breast cancer. I have seen more awareness developing in that of sort of like long
term kind of thing, you know, exercise classes or what are the effects after you have
had cancer 10, 5-10 years later. I have seen a little bit more attention given to talking
about it but I haven’t heard a lot from my doctors.
5 years ago or so there was a point in which I was thinking, I should go back and
she the surgeon because, um, yes they took care of the mastectomy, they took care
of it and everything but I’m still having a lot of issues in that area and she should
know about it. I felt like, wow, here it is, 9 years out and this surgeon should know
what happened. You know, that I still have problems with these scar areas
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UST McNair Scholars Program Research Journal
Quasi-Statistics on mattering
More attention to life quality
18
ABSTRACT
Early childhood education is critical to support healthy child development, promote
educational equity, and prepare an educated, economically productive, and civically
engaged populace. The goal of this project is to explore possibilities for enhancing early
childhood education for low-income children by incorporating key principles and practices
of the Montessori education within Head Start programs. Head Start is the primary
source of early childhood education for low-income children. The Montessori method,
accepted worldwide as a premier approach to early childhood education, is rarely seen
within Head Start classrooms. Studies exploring the integration of these two approaches
to early childhood education are almost non-existent. This project summarizes Maria
Montessori’s theory of development, educational philosophy, and educational methods as
well as the history and common practices of the Head Start program. Research on the
effectiveness of each method is discussed. Recommendations are made for the incorporation
of Montessori practices within Head Start classrooms based on exploration of the two
approaches, as well as consultation with the director of a Montessori training center and
school and an educational coordinator of a Head Start program.
Nearly 42 percent of America’s children are low-income (National Center
for Child Poverty, 2010). It is absolutely crucial to provide quality early
childhood education to all children, but especially low-income children to
ensure they have the skills necessary to succeed. Quality education is necessary
to support each child in reaching his or her full potential. Children from lowincome backgrounds are often at a disadvantage in life, but quality early
childhood education can provide children the foundation they need to thrive.
The continual review of common approaches to early childhood education
provides opportunities to enhance it, thus enhancing the educational
opportunities available to America’s children.
Extensive research points to the necessity of quality early childhood
education for all children (Follari, 2007). Research suggests the importance of
early childhood education by confirming the key to learning lies in educating
children from a very early age (Shore, 2009). The brain develops faster between
conception and age five than any other point in a person’s lifetime, making it
the most important time to lay a strong educational foundation (Shore, 2009).
Ensuring a well educated and economically productive society hinges on
providing quality early childhood education for all children.
Clues for closing the gap in achievement among children of various
backgrounds also lie in the stages of brain development. Varying levels of
achievement, be it high school graduation rates, test scores, literacy rates or
any other measure of educational success exist among children of different races
and socioeconomic statuses. Birth through age five is a crucial time to begin
formal education due to the large amount of brain development taking place
during this period. Access to quality education is especially important for
children who are not exposed to a stimulating environment at home (Shore,
2009). In order for all children to achieve their potential, they must have access
to early childhood education that provides a strong cognitive foundation for
additional learning to be built upon.
ENHANCING EARLY
CHILDHOOD
EDUCATION FOR LOWINCOME CHILDREN:
EXPLORING
POSSIBILITIES FOR
INCORPORATING
MONTESSORI
METHODS WITHIN THE
HEAD START
PROGRAM
Kesha Berg ’13
University of St. Thomas
Mentor
Ruthanne Kurth-Schai, Ph.D.
Professor of Educational Studies
Macalester College
19
UST McNair Scholars Program Research Journal
Attention must be devoted to each child’s emotional,
physical, and social development in addition to concern for
his or her cognitive development. Educators must concern
themselves with the development of the whole child
beginning at the preschool level. Children who are raised
in poverty often have had less attention devoted to their
emotional, physical, and social development than those
from more affluent families (Follari, 2007). Adopting an
educational method that supports dimensions of development beyond cognitive growth is essential for healthy
children and a productive society.
In an effort to provide early childhood educational
opportunities for low-income children, the Head Start
program was enacted under President Lyndon Johnson’s
War on Poverty (Mills, 1998). Head Start, as described on
its website, is a “program that promotes school readiness
by enhancing the social and cognitive development of
children through the provision of educational, health,
nutritional, social, and other services to enrolled children
and families” (2011). The Head Start program provides
grants to local “agencies to provide comprehensive child
development service to economically disadvantaged
children” (Office of Head Start, 2011). Head Start grants
an opportunity for low-income children to begin building
an educational foundation during the most crucial years of
their lives for learning. Additionally, the program concerns
itself with children’s well-being outside their education,
providing services such as dental and eye examinations for
children who would otherwise go without (Mills, 1998).
The Head Start program has provided critical
educational and well-being opportunities for low-income
children since its enactment. However, every education
system requires continued revision to ensure it is providing
the best possible education for its students. Enhancing
Head Start could deepen support for low-income children
by expanding their access to the quality of education
necessary in providing a strong base on which to build
upon throughout their educational career.
While low-income children are predominantly educated
through Head Start, many other effective forms of
preschool education produce successful students. The
Montessori approach is acknowledged worldwide as a
leader in effective preschool education concerned with
educating the whole child. The method aims to “nurture
the child’s natural desire to learn and grow” (Montessori
20
Training Center of Minnesota [MTCM], 2011). Children
of Montessori schools learn to work independently to
develop both life skills and curriculum knowledge through
a prepared environment (MTCM, 2011).
This research explores possibilities for enhancing early
childhood education for low-income children by
incorporating key principles from the Montessori education
within Head Start. Maria Montessori’s theory of development, educational philosophy, and educational methods are
summarized, as well as the history and common practices
of the Head Start program. Research of the effectiveness of
each method is discussed. Recommendations are made for
the incorporation of Montessori principles within Head
Start classrooms based on careful review of the two
approaches, as well as consultation with the director of a
Montessori training center and school and an educational
coordinator of a Head Start program.
AN INNOVATION IN EDUCATION: THE MONTESSORI
METHOD
THE STORY OF AN EDUCATIONAL PIONEER: MARIA
MONTESSORI’S LIFE EXPERIENCES
Maria Montessori was born in Chiaravalle, Italy, in 1870
to a wealthy and educated family (Hainstock, 1997).
Academics were not Montessori’s strength as a child, but
her determination and sense of self allowed her to excel in
school (Hainstock, 1997). At age twelve, she enrolled in
an all-male technical school seeking to become an engineer
(Hainstock, 1997). At a time when women had limited
career options, Montessori was determined to study science,
typically a subject reserved for men (Hainstock, 1997).
Encouragement from her mother to break traditional
gender roles gave Montessori the support she needed to
pursue her interests despite her father’s resistance (Povell,
2007). After receiving a degree in natural sciences in 1892,
she enrolled at the medical school at the University of
Rome (Povell, 2007). Montessori graduated at the top of
her class, becoming the first Italian female medical doctor
(Hainstock, 1997). She gained recognition for
accomplishing this feat as a “champion of women’s rights”
and spent considerable time advocating equality (Follari,
Public Policy
2007; Povell, 2007). Montessori soon became known as a
leader in the European women’s movement (Gutek, 2011).
Following graduation, Montessori began working and
volunteering for the University of Rome’s psychiatric
clinic, where her job included “visiting insane asylums to
select patients for treatment at the clinic” (Hainstock,
1997, p. 11). Montessori’s interaction with children in this
setting sparked her interest in their development
(Hainstock, 1997). Physicians and psychologists JeanMarc-Gaspard Itard and Edouard Sequin quickly became
sources of study for Montessori, and would later have a
grand impact on the theories she developed (Hainstock,
1997). Itard and Sequin’s work included assessing the
development of children with learning disabilities
(Cossentino & Whitcomb, 2007). Montessori shared Itard
and Sequin’s belief that “mental deficiencies were more
problems of the way in which defective children were being
taught, and less a medical problem” (Follari, 2007, p. 221).
Theories of Rousseau, Pestalozzi, and Froebel also
influenced Montessori’s work (Follari, 2007).
When Montessori assumed the directorship of a school
established by the National League for Retarded Children
in 1900, she used Itard and Seguin’s theories and materials
as a guide (Hainstock, 1997). Montessori modified their
observational methods and incorporated her own ideas to
best educate her students after intense observation of their
needs in a specially prepared environment (Cossentino &
Whitcomb, 2007; Hainstock, 1997). Montessori gained
recognition as the developmentally delayed children in her
classroom began to function and achieve the same as
“normal” children (Nutbrown, 2006). At this time
Montessori was also operating a private medical practice
(Cossentino & Whitcomb, 2007). Interaction with children
in this setting, especially children labeled as learning
disabled, lead her to believe the children were actually
quite capable of high levels of achievement (Cossentino &
Whitcomb, 2007). After a two-year study of the children,
Montessori concluded they were simply “starved for
stimulation and were not biologically defective” (Follari,
2007, p. 221).
As Montessori continued to explore educational
philosophy and pedagogy, her interest in working with
“normal” children grew (Cossentino & Whitcomb, 2007;
Hainstock, 1997). In 1907, Montessori opened her first
school, Casa dei Bambini (Children’s Home), in Rome’s
Kesha Berg
Enhancing Early Childhood Education
poverty stricken San Lorenzo district (Gutek, 2011). The
practices that emerged from the first Casa dei Bambini
have become Montessori’s well-known educational method.
This marked the turning point in Montessori’s career; she
had left the field of medicine and would spend the rest of
her life developing her educational methods (Cossentino &
Whitcomb, 2007).
The Montessori method quickly became known
worldwide (Martin, 1996). Intrigued educators traveled to
Rome to witness her lectures and visit her classrooms
(Gutek, 2011). As Montessori’s method spread, gaining
both international praise and criticism, she became
concerned with the degree to which new programs
modeled her original Casa dei Bambini (Follari, 2007). She
preferred a very strict adherence to her method and
philosophical beliefs, controlling all aspects of material
production and teacher training (Follari, 2007; Gutek,
2011). In 1929 Montessori established the Association
Montessori Internationale (AMI) to oversee the sale of
materials, publication of her writings, and Montessori
teacher training (Gutek, 2011). Montessori traveled the
world beginning in 1909, including two trips to the
United States, to promote her educational philosophies by
delivering speeches (Cossentino & Whitcomb, 2007;
Gutek, 2011). Soon after, Montessori began documenting
her educational ideas and speeches in books (Gutek, 2011).
Cossentino and Whitcomb describe the spread of the
Montessori movement as “swift and international in scope”
(2007, p. 113). Mussolini promoted Montessori’s methods
throughout Italy after coming to power in 1922, despite
their philosophical differences (Gutek, 2011). After
Montessori turned down a position from Mussolini in
1934, he closed Montessori schools and banned her from
the country (Gutek, 2011). Montessori quickly established
residency in multiple other countries including India and
the Netherlands, confident her methods would gain broad
and lasting support elsewhere (Cossentino and Whitcomb,
2007; Gutek, 2011). As Montessori aged, she delegated
many tasks to her only son, Mario, who took full
responsibly after his mother’s death (Gutek, 2011).
However, Montessori continued writing, training teachers,
and attending conferences until her death in 1952 (Martin,
1996).
Following the initial recognition and fame of her ideas,
Montessori’s influence faded (Martin, 1996). Her methods
21
UST McNair Scholars Program Research Journal
did not gain prominence again until the 1950s and 1960s
when a greater emphasis was placed on academically
focused early childhood education (Follari, 2007; Gutek,
2011). This growing popularity sparked the establishment
of the American Montessori Society in 1960, which
provides an Americanized version of some of Montessori’s
methods (Gutek, 2011). In America, a rise in interest
regarding Montessori’s work was seen again in the 1980s,
and curiosity is peaking today (Follari, 2007; Murray &
Peyton, 2008). The American Montessori Society reports
there are roughly 4000 Montessori schools currently in
America, though their adherence to Montessori’s original
methods vary (2011; Follari, 2007). Substantial portions
of these schools are private, allowing access to the
Montessori education for a limited group only (Gutek,
2011). However, a growing public interest has resulted in
a greater number of public Montessori schools in the recent
past (Gutek, 2011).
THE BLOSSOMING CHILD: MARIA MONTESSORI’S THEORY OF
DEVELOPMENT
The theories of development that form Maria
Montessori’s educational approach were built on close
observation of the developing child (Cossentino &
Whitcomb, 2007). Montessori’s developmental theory
gives validity to her emphasis of early childhood education
(Gutek, 2011).
Montessori’s theory consists of four different planes, or
stages, of development. The planes track growth from the
most basic reflexive motor skills through concrete and
abstract thinking (Cossentino & Whitcomb, 2007). Each
plane is accompanied by specific concepts of the child’s
development during the identified period and learning
which must take place during that time (Cossentino &
Whitcomb, 2007; Gutek, 2004). The planes run in 6 year
cycles beginning at birth: birth through age 6, age 6
through 12, age 12 through 18, and age 18 through 24,
each running smoothly into the next (Cossentino &
Whitcomb, 2007; Gutek, 2004). Additionally, some
planes are divided into two sub-planes to further specify
developmental progress and needs at the appropriate times
(Cossentino & Whitcomb, 2007).
Within each plane Montessori designated “sensitive
periods” (Gutek, 2011). A sensitive period is a stage at
which a child is ready to learn or master a certain skill or
22
concept that will prepare the child for further learning
(Follari, 2007; Gutek, 2004). During sensitive periods
children experience intellectual, social, and moral
awakenings, making sensitive periods especially important
during the first plane (Cossentino & Whitcomb, 2007).
The role of the adult is to provide the proper stimulation
needed during each sensitive period to produce optimal
awakening (Cossentino & Whitcomb, 2007). Montessori
emphasized the importance of the adult adjusting to the
child’s needs in order to maximize development and
learning (Follari, 2007).
Montessori dubbed the first stage, between birth and
age 6, as that of the “absorbent mind” (Gutek, 2011).
During this period, children absorb information from the
environment through their senses (Gutek, 2011). Children
absorb information and gain knowledge by exploring,
constructing concepts of reality, beginning to use language
and take on their culture (Cossentino & Whitcomb, 2007).
This time period is essential in developing their sensory
and motor skills (Cossentino & Whitcomb, 2007). The
latter three years of the first plane are critical in developing
cognitive skills and beginning the processes of socialization
and acculturation (Gutek, 2011). Montessori’s theory of
the absorbent mind is a foundational piece of her
educational theory; ages 3 through 6 are vital in creating a
strong foundation for further growth (Follari, 2007).
During the second plane, ages 6 through 12, children
expand upon the knowledge they gained during their first
six years (Cossentino & Whitcomb, 2007). The second
plane comes with a greater sense of understanding
relationships between a part and the whole (Cossentino and
Whitcomb, 2007). This period allows time for children to
reinforce and master the skills and concepts introduced and
absorbed during the first plane (Cossentino & Whitcomb,
2007). A greater emphasis is placed on organization of
tasks and deliberate work during the second plane of
development (Cossentino & Whitcomb, 2007). Plane three
involves reaching maturity (Cossentino & Whitcomb,
2007). During this plane, less sensory learning takes place,
as children in plane three develop a broader understanding
of social and economic roles and determine their place in
society (Cossentino & Whitcomb, 2007).
Kesha Berg
Enhancing Early Childhood Education
Public Policy
FOUNDATIONS OF THE APPROACH:
EDUCATIONAL PHILOSOPHY AND METHODS
MONTESSORI
“The Montessori Method is a comprehensive, highly
elaborated, and fully integrated system of intellectual,
social, and moral development” (Cossentino & Whitcomb,
2007, p. 111). Maria Montessori’s educational method is
known for its holistic approach, especially when applied to
early childhood education (Cossentino & Whitcomb,
2007). However, Montessori developed a philosophy of
education across all ages based on her scientific observation
of children and their development, research in
anthropology, psychology, and pedagogy, and spiritual
insights (Gutek, 2011). Montessori employed her medical
background to build a model for education from science
(Gutek, 2004). The scientific foundation of her methods
continues to validate them today (Follari, 2007). The
educational philosophy and methods developed by
Montessori are built on natural human tendencies she
became familiar with during close clinical observation of
her students (Gutek, 2004; Nutbrown, 2006). She believed
education is a careful combination of the child’s natural
development within nature (Gutek, 2004). The broader
educational philosophy Montessori developed is aimed at
“remaking the world,” which she saw as the work of
humanity (Gutek, 2011). Montessori advocated peace;
peace became a central premise for Montessori education,
as both a goal and context for it (Cossentino & Whitcomb,
2007).
Montessori described her broad educational theory as a
cosmic education, meaning her educational theory has a
focus of bringing together universals and particulars, both
in the structure of its curriculum and the environment
where learning takes place (Cossentino & Whitcomb,
2007). The cosmological education emphasizes the
connectedness of all things, linking cognitive, moral, and
social development (Cossentino & Whitcomb, 2007). At
the heart of the cosmic education is a child’s discovery of
his or her cosmic task (Cossentino & Whitcomb, 2007). In
other words, the aim of education as Montessori saw it was
to help each child discover his or her role in greater society.
Montessori referred to each child in search of his or her task
as a “cosmic being” (Cossentino & Whitcomb, 2007).
Finding each child’s place in society is linked directly with
his or her development, giving explanation to the heavy
focus on children’s development in Montessori’s
educational philosophy and methods (Cossentino &
Whitcomb, 2007). Montessori’s cosmic education is
comprised of three key components and attention to four
skill sets.
Fundamental concepts.
The key to proper development, Montessori believed,
revolves around preparing a particular environment for a
child’s needs during each plane (Cossentino & Whitcomb,
2007). Montessori based her theories on the idea that
infants are born into a world they find chaotic, of which
they naturally try to make sense (Follari, 2007). The
environment surrounding a child is crucial for this reason
(Gutek, 2011). Montessori asserted children are able to
make order of the chaos of the world because of a natural
sense of spirituality, inquisitiveness, capability, purpose,
creative energy, and compassion with which all humans are
born (Cossentino & Whitcomb, 2007; Follari, 2007).
Montessori named this impulse to create order and peace
the “spiritual embryo” (Cossentino & Whitcomb, 2007).
Proper development fulfills a person’s innate capacities if
the spiritual embryo is nurtured correctly within the
proper environment (Cossentino & Whitcomb, 2007;
Gutek, 2011). The spiritual embryo is replaced in later
planes by moral and abstract thinking (Cossentino &
Whitcomb, 2007). While most adults believe children to
be rowdy, Montessori observed otherwise. Montessori noted
the “secret of childhood” as children’s natural desire to
become orderly and productive and engage in activities to
further these goals (Follari, 2007). Montessori saw children
as eager to become more independent, naturally motivating
themselves to explore and develop on their own (Gutek,
2011). This concept composes one of the fundamental
principles of her philosophy (Gutek, 2004). Montessori
went so far as to identify adults as generally
misinterpreting children’s needs and hindering their
development (Follari, 2007). She believed each child’s
development to be self-regulated (Follari, 2007). Proper
development is achieved through what Montessori termed
“freedom within limits” (Cossentino & Whitcomb, 2007).
Successful development requires children to be free to
explore what they please within an environment prepared
specifically for them (Cossentino & Whitcomb, 2007).
Montessori cited the structured environment as something
that enhances children’s freedom (Gutek, 2004). This
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UST McNair Scholars Program Research Journal
means that children also must be free from dependence on
adults (Gutek, 2011). Interacting with an environment
brings about full development as a human being, including
moral growth, greater willpower, self-discipline, and selfesteem (Gutek, 2011).
Based on her theory of development, Montessori
believed a specially prepared environment must be in place
for children to flourish at each stage of their development
(Gutek, 2011). Montessori’s emphasis on children’s
independence influenced her theories of the prepared
environment (Cossentino & Whitcomb, 2007). A primary
objective of the prepared environment was to ensure that
children were free from dependence on adults (Cossentino
& Whitcomb, 2007). Montessori outlined strict guidelines
for the preparation of the environment in which children
would live because of the intimate connection she felt it
had with their development. Different planes of
development require different needs, thus different
environments must be prepared for different planes
(Cossentino & Whitcomb, 2007). It is the task of the
teacher, or guide, to prepare the environment according to
the children’s needs and Montessori’s guidelines (Follari,
2007). Environments are prepared to accommodate groups
of children of various ages, typically in three year cycles
(Cossentino and Whitcomb, 2007). Thus, a primary
Montessori classroom serves children ages 3 through 6
(Cossentino and Whitcomb, 2007). The environment
surrounding a child determines the possibilities for that
child; therefore, it is important the environment presents
the maximum number of opportunities for learning
(Gutek, 2011). The preparation of a Montessori classroom
must be oriented around the children’s needs so they have
freedom to pursue questions and construct understandings
(Cossentino and Whitcomb, 2007). Montessori also
believed the physical environment dictated the energy of
the space, providing another reason for the environment to
be crafted with care (Follari, 2007). Cossentino and
Whitcomb outline six features of the Montessori prepared
environment: order, aesthetic beauty, broad access to
materials, permeable boundaries, community responsibility, and flexible movement (2007). The prepared
environment, as Montessori referred to it, must be orderly
(Cossentino & Whitcomb, 2007). It must have clean, white
spaces with an appropriate amount of artwork so the
environment is not over stimulating or distracting for
24
children (Follari, 2007). Emphasis is placed on the
aesthetic beauty of the environment because Montessori
affirmed that a pleasing environment would instill respect
(Cossentino & Whitcomb, 2007). Now commonplace, the
child-sized furniture and materials that Montessori used
were innovative at her time (Gutek, 2011). Materials are
to be neatly arranged by discipline on child-sized shelves
for easy access by all children (Cossentino & Whitcomb,
2007). Montessori’s emphasis of child-empowered learning
means the environment has few textbooks and a wealth of
hands-on materials instead (Cossentino & Whitcomb,
2007). The child needs to have freedom to move about the
classroom and access different materials at different times
(Cossentino & Whitcomb, 2007). For this reason, the
Montessori classroom does not have rows of desks facing
forward, but rather tables and chairs with unassigned
seating so children can move about and work where they
need to (Cossentino & Whitcomb, 2007). Montessori
aimed to organize the classroom in a way that caused
purposeful movement for work (Cossentino & Whitcomb,
2007).
The idea of “work” is another staple of the Montessori
education. Montessori referred to a student’s learning and
exploration as his or her “work” (Gutek, 2011). Unlike
most early childhood education programs, the Montessori
education does not include time for free play (Follari,
2007). Montessori believed play interrupts the child’s
desire to be productive (Follari, 2007). However, some
outdoor time is generally allotted around midday,
providing an outlet for play (Cossentino, 2006). Indoors,
however, children guide their own work. Montessori
dubbed this concept the “auto education,” again
emphasizing the child’s desire and ability to be
independent (Follari, 2007). Montessori identified the
“divine urge” to be the force propelling children into selfactivity (Gutek, 2004). Montessori believed children are
excited about learning new skills and becoming
independent (Gutek, 2011). According to Montessori, the
self-directed education naturally maximizes development
(Follari, 2007). In a traditional Montessori classroom,
students begin their days with three hours of
uninterrupted, self-directed work time (Cossentino &
Whitcomb, 2007). The multi-age groups of the children
in each environment allows for children to work at various
levels and help each other (Rambusch McCormick, 2010).
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Enhancing Early Childhood Education
Public Policy
During work time, children are free to use any of the
materials they have been shown how to use. Often times,
children work on small mats, a staple of the Montessori
classroom (Cossentino, 2006). The rectangular cotton rugs
or mats provide a space for children to set out their
materials (Cossentino, 2006). The children are taught at
an early age how to roll, unroll, and carry a mat properly,
as it is a symbol of work in the Montessori environment
(Cossentino, 2006).
During this period of work the teacher, referred to by
Montessori as a directress or guide, invites children for
lessons (Cossentino & Whitcomb, 2007). The guide
generally engages with children individually or in small
groups to direct them in the use of a new material or lesson
(L. Drevlow, personal communication, July 6, 2011). This
allows for personalized attention for each child’s
developmental needs and interests by the guide so each
child can explore his or her interests when appropriate
(Cossentino and Whitcomb, 2007). The job of the guide
is to be familiar with each student’s level of development
and to present lessons accordingly (Follari, 2007). The
guide assists the child in directing his or her own work and
education without interrupting the child’s own discovery
(Follari, 2007; Nutbrown, 2006).
Montessori created a specific set of materials to be used
within the environment (Gutek, 2011). Her background
in science is seen in the precision of each material and
demonstration of its use (L. Drevlow, personal
communication, July 6, 2011). Montessori’s advocacy of a
strict adherence to her method is seen in the details for
presenting a lesson (L. Drevlow, personal communication,
July 6, 2011). In a conversation, Lisa Drevlow, of the
Montessori Training Center of Minnesota, explained the
process of presenting a lesson to a child. The guide has
step-by-step instructions he or she must follow in
presenting a lesson to a child. A lesson includes
demonstrating how to use a new material and observation
of the child mimicking the guide’s work. Lessons are aimed
at a simple objective, such as folding a napkin. In the lesson
of folding a napkin, the guide would invite the student to
engage in the lesson and demonstrate how to fold in a very
specific manner. Next, the student would be encouraged
to repeat the action. The student would then practice
folding until the skill was mastered without the aid of the
guide (L. Drevlow, personal communication, July 6, 2011).
If need be, the guide can present the material a second
time, but it is the job of the guide to know when a student
will be ready for each material (Gutek, 2011). The central
role of the guide is to observe the children and document
their development, noting when each child is ready for
different materials (Follari, 2007). Although most learning
takes place through student exploration, the guide does
prompt learning through guidance within the environment
and other specific means. The guide is responsible for
presenting material to students, which the students then
further investigate independently (Cossentino &
Whitcomb, 2007).
Montessori believed children need to see a whole before
being able to thoroughly understand each of its parts
(Cossentino & Whitcomb, 2007). Information is presented
on a large scale first for this reason (Cossentino &
Whitcomb, 2007). For example, Montessori crafted five
stories entitled “The Great Lessons” for guides to relay to
their students (Cossentino & Whitcomb, 2007). The
lessons, which provide a substantial portion of the
curriculum, convey the story of the universe including the
creation of the earth, beginning of life and humans, and
the development of society through language, numbers,
and so forth (Cossentino & Whitcomb, 2007). The Great
Lessons do not include much detail, as to keep children
curious (Murray, 2011). Montessori believed the stories
would intrigue the children, causing them to desire more
knowledge and understanding (Murray, 2011). The entire
history of the universe is presented to children to prompt
discovery of individual portions of it. Similarly, an entire
animal is presented before its parts are examined and the
whole structure of the English language is presented at an
early age (Cossentino & Whitcomb, 2007). This tactic sets
Montessori’s philosophy apart from others, which generally
present pieces of the whole first (Cossentino & Whitcomb,
2007).
Critical skill sets.
Montessori’s central focus on development produced
emphasis on four skill sets in her educational method:
practical life, sensory education, language and
mathematics, and physical, social, and cultural
development (Gutek, 2011). Practical skills are still
emphasized to give children a greater sense of
independence and self-confidence (Gutek, 2011). Teaching
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UST McNair Scholars Program Research Journal
a child how to do things such as dress him- or herself, wash,
brush teeth, prepare food, set the table, and so on allows
the child to be free of dependence on an adult (Gutek,
2011). This skill set and independence is emphasized
heavily in Montessori’s methods because of her belief that
children learn successfully only when their motivation is
intrinsic; children need to have the ability to pursue their
environment (Follari, 2007). A fundamental principle of
Montessori’s method is the need for children to have
freedom to bring about their own growth and development
(Gutek, 2011). Montessori emphasized practical skills in
promoting physical, social, and cultural growth (Gutek,
2011). Practical skills also aid in development of muscular
coordination (Gutek, 2004). Montessori classrooms are
home to plants and pets, which require care (Gutek, 2011).
Responsibilities to take care of this aspect of the
environment promote the acquisition of additional
practical skills (Gutek, 2011). Montessori created frames
for lacing, tying, buttoning, and snapping to provide
children additional practice of these skills (Gutek, 2004).
Practical skills are ordinary in a Montessori classroom
because of the nature of the environment Montessori
sought to create. Montessori’s first school opened in Rome
to both educate and watch over children whose parents
worked during the day (Cossentino & Whitcomb, 2007).
This situation encouraged Montessori to develop the
classroom as a sort of “school-home” for her students
(Cossentino & Whitcomb, 2007). Therefore, practical skills
such as sweeping and cleaning have a natural place within
the setting. The school-home environment is central to
Montessori’s education philosophy. The context in which
Montessori’s first Casa dei Bambini was created explains in
part why Montessori emphasized the classroom as a second
home (Martin, 1996). In fact, Montessori criticized the
common translation of Casa dei Bambini to “Children’s
House,” preferring “Children’s Home” (Marin, 1996).
Montessori intended her environment to be a home for
children, a place for them to develop cognitively, socially,
and morally while feeling safe, secure, and loved (Martin,
1996).
Montessori emphasized the importance of the ability of
children to understand the world through their senses.
Developing sensorial skills impacts children’s awareness of
dimension, texture, shape, color, pitch, volume, and so on,
thus developing their awareness of natural beauty
26
surrounding them (M. O’Shaughnessy, personal
communication, July 21, 2011). Additionally, sensorial
development prepares children for future math and
language learning (M. O’Shaughnessy, personal
communication, July 21, 2011). Montessori crafted specific
materials to aid children in developing each skill set. For
example, children use materials that develop
understanding of size and dimension by stacking specially
designed blocks or cylinders (Follari, 2007). All of the
materials are self-correcting to assist the child in mastering
his or her work (Gutek, 2011). For instance, the pink block
tower will topple over if not stacked properly and a glass
bowl will break if not shown proper care (Rambusch
McCormick, 2010). These materials guide children by
their senses, teaching them to use things properly
(Rambusch McCormick, 2010). Montessori observed that
during their first plane of development, children desire to
manipulate things to learn from their surroundings
(Gutek, 2004). This provides both cognitive development
as well as practice of motor skills (Gutek, 2004).
The third skill set focuses on language and mathematics
(Gutek, 2011). By age 6, Montessori children have the
ability to understand letters and their sounds, write words,
sentences, and stories, read fluently, and communicate with
clarity (M. O’Shaughnessy, personal communication, July
21, 2011). Montessori created three-dimensional materials
to assist children in development of language abilities (M.
O’Shaughnessy, personal communication, July 21, 2011).
Vocabulary is developed by learning names and categories
of different items (Gutek, 2011). This aspect of learning
can be tailored to the interests of the child. If a child is
interested in animals, cards of different animals and their
appropriate categories can be used to develop vocabulary
and practice categorization. Development of vocabulary is
closely related to learning the alphabet and letter sounds,
and the vocabulary cards are used again for this purpose
(Gutek, 2011). Montessori believed children learn
language in three steps: first through syllables, then whole
words, and finally syntax and grammar (Gutek, 2004). Her
guidelines for children’s exploration of words are outlined
similarly. Eventually, children trace sandpaper letters to
familiarize themselves with each letter, its shape, and its
sound (Gutek, 2011). The movable alphabet is used when
children begin creating words from the sounds they have
Public Policy
learned (Follari, 2007). This eventually gives way to
writing (Gutek, 2004).
Another aspect of the third skill set is mathematics
(Gutek, 2011). The primary Montessori education aims to
instill sufficiency in ability to understand meanings of
quantities, concepts of even and odd numbers, categories
of unit, tens, hundreds, thousands, addition, subtraction,
multiplication, division, and memorization of basic math
facts (M. O’Shaughnessy, personal communication, July 21,
2011). Math is learned through the use of geometric
objects, counting rods, golden beads, and sandpaper
numbers (L. Drevlow, personal communication, July 6,
2011). Each material prepares students for the next and
builds on previously acquired knowledge and skills (Gutek,
2011). Sandpaper numbers are traced to learn numbers in
learning mathematics (Gutek, 2011). These cards are used
in conjunction with various counting rods, beads, bean
counting, memory games, and fraction exercises to help
children take their first steps in mathematics before
elementary school (Follari, 2007; Gutek, 2011). These
processes give way to more completed functions such as
subtraction, multiplication, and division (Follari, 2007).
Eventually, children expand on basic operations to more
advanced mathematics (Follari, 2007). Examples of other
didactic materials include solid cylindrical insets, red rods
of various lengths, geometric solids, cards with geometric
shapes, and musical tone bells (Gutek, 2011).
The fourth skill set is focused on children’s physical,
social, and cultural development (Gutek, 2011). In
addition to creating materials for cognitive learning,
Montessori developed materials for social and cultural
development. The Montessori curriculum is formatted
around what Montessori called the “cultural subjects,”
which include history, geography, geometry, arts, and the
sciences (Cossentino & Whitcomb, 2007). Study of the
subjects takes place via three questions: (1) What am I? (2)
Where do I come from? (3) What is my role in the
universe? (Cossentino & Whitcomb, 2007). Montessori felt
it important for children to learn through cultural
exploration and relationships between individuals and the
larger society (Follari, 2007).
Unlike many traditional classrooms today, Montessori
encouraged an affectionate relationship between the guide
and students, as well as among the students (Gutek, 2004).
The environment was intended to be a community of
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Enhancing Early Childhood Education
members who cared for each other (Cossentino &
Whitcomb, 2007). Montessori envisioned members of the
Casa dei Bambini to be a family, each member operating
independently while still contributing to the larger group
(Gutek, 2004). Children’s assistance among each other is a
crucial component of the Montessori environment
(Nutbrown, 2006). As a proponent of equality among the
sexes, Montessori expected equality within the classroom
as well (Follari, 2007). Some criticized the intimacy within
the classroom for mixing too closely the separate worlds of
home and school, private and public (Gutek, 2004). Social
skills are learned through absorbing the culture (Gutek,
2004). To further children’s social skills, the guide offers
lessons in grace and courtesy to teach children proper social
etiquette (L. Drevlow, personal communication, July 6,
2011). One such lesson focuses on requesting attention
without interrupting (L. Drevlow, personal communication, July 6, 2011). Children are taught to demonstrate
to their teacher their need for attention without speaking
(Cossentino, 2006). Often, children request their guide’s
assistance by gently placing their hand on their guide’s
shoulder (Cossentino, 2006). Others look their guides in
the eye (L. Drevlow, personal communication, July 6,
2011). The properly prepared environment with the correct
social balance provides room for children to develop moral
character (Gutek, 2004). Montessori believed in a set of
universal principles that children developed awareness of
through interaction with their environment (Gutek, 2004).
Keeping peace as a central theme to her methods,
Montessori created the Peace Rose Ceremony to help
children develop socially (Cossentino & Whitcomb, 2007).
Cossentino and Whitcomb describe the Peace Rose
Ceremony as a means to settle disputes among children. A
space is designated within each prepared environment for
peace and this ceremony, which often consists of a table
with a vase and single peace rose and other calming objects,
such as beads and prints. Children take turns holding the
rose while discussing the issue at hand until peace is
declared. The guide often aids this process until children
are old enough to conduct the ceremony on their own.
Children are able to visit the calm area to regroup whenever
necessary (Cossentino and Whitcomb, 2007).
Montessori’s belief that learning needs to take place by
exploring beyond the prepared environment constitutes a
critical part of her philosophy of the cosmic education
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(Cossentino & Whitcomb, 2007). Montessori recognized
exploration of greater society as critical because it allows a
child to discover his or her place in it (Cossentino &
Whitcomb, 2007). Cossentino and Whitcomb describe
what Montessori referred to as “going out” as investigating
outside of the classroom. When a student’s inquiry cannot
be answered within the classroom, he or she is encouraged
to go out. Going out can range from collecting items in
the schoolyard to becoming more involved within the
community. As is the norm within the prepared environment, work outside the classroom is student directed.
Children go out both individually and in small groups.
Older students coordinate community visits on their own
(Cossentino & Whitcomb, 2007).
Theory in practice: A day in a Children’s House.
To supplement my review of the Montessori method, I
conducted two consulting visits to the Montessori Training
Center of Minnesota (MTCM). My first visit included a
conversation with Lisa Drevlow, the primary course
assistant, discussing further explanation of Montessori
materials and methods, a presentation of various
Montessori materials, and a look at Montessori teacher
training materials. My second visit to the MTCM consisted
of observation of a primary classroom for three hours. My
conversation with Lisa Drevlow and my classroom
observation reinforced my understanding of the Montessori
methods and materials as seen in practice.
Upon entering the Children’s House, the careful
preparation of the environment was evident. Walls of the
room displayed a modest amount of artwork on neutraltone walls. A door opened to the patio to provide natural
light and the opportunity for children to work inside or
outside depending on their preferences and materials. All
of the child-sized shelves were lined with trays containing
materials necessary for different work. Tables and chairs
proved lightweight as children moved them around the
room as they pleased. All materials were accessible by
children so they could successfully work independently of
anyone else, including the guide.
The effectiveness of the prepared environment in
facilitating the auto-education was reinforced when the
children entered the classroom and began working on their
own. One child walked around the classroom to survey the
materials she could work with before selecting a tray from
28
a shelf and carefully carrying it to a table. Once there,
another child assisted her in putting on her apron. Soon
she was scrubbing her shoes with soap and water. Before
moving on to another piece of work, the child cleaned up
her workstation and replaced the tray with the materials
on the shelf.
Evidence of the importance of independence in
children’s development was also provided through the
snack area. A table with two chairs provided a place for two
children to eat snack at a time, whenever they felt hungry.
Some students enjoyed one or two snacks, while others
focused on their work without a snack. Children who
desired a snack filled a bowl with apples, sat down, and ate
while conversing with the other child at the snack table.
When finished, the children dipped their bowl in a soapy
bucket and then rinsed it clean before leaving it in a rack
to dry and returned to their work.
Throughout the three-hour work period, the guide never
interrupted a working child. Instead, she aided children
when they requested her attention. Older students
approached her for math problems to solve with various
materials and others asked the guide to write sentences for
them to read. When a child was having trouble finding
work to select, the guide would pull him or her onto her
lap for a hug while speaking to the child about what he or
she might like to work with. Montessori’s idea of a family
within the Children’s House was reinforced.
The central role of peace was also seen within the
classroom. The environment itself was very peaceful. The
children were reminded of peace as a goal. When two
children made gun shapes with their hands the guide made
very clear that any type of violence or reference to violence
was absolutely not tolerated.
Respect for children was also present within the
environment. Children were expected to help prepare the
room for lunch. Some children moved tables and chairs
together to form longer tables. Other children placed
plates, silverware, and cups in line with each chair. The
capabilities of children were also respected during a
meeting before lunch. Children engaged in an open
discussion with their guide in which they were free to
present thoughts and questions respectfully.
Public Policy
REVIEW OF RESEARCH: EFFECTIVENESS OF THE MONTESSORI
EDUCATION
Research concerning the Montessori education dates
back over a century covering diverse topics (Dohrmann et
al., 2007). Two leading contemporary studies regarding the
Montessori education provide evidence it has positive longterm effects on students and their achievement (Dohrmann
et al., 2007). Various studies have also shown Montessori
students perform at or above national standards and
averages (Lillard & Else-Quest, 2006). I examined two
major studies that reported on the effectiveness of
Montessori methods in public schools. Lillard and ElseQuest examined the social and cognitive abilities of
Montessori students in comparison to those of nonMontessori students in a study assessing students at ages
five and twelve (2006). The study was carried out within
an Association Montessori Internationale accredited school,
meaning it strictly adheres to Montessori’s methods, which
served urban minority students. The school accepts
students via a random lottery system, which was used by
Lillard and Else-Quest to create the control and
experimental groups. Children who sought enrollment and
were accepted to the school made up the experimental
group, while those who were not enrolled became the
control group. This negated criticism that parents who
enroll their children in Montessori programs are different
from those who do not; therefore, Montessori students
cannot be compared with students who did not seek
Montessori education. A total of 59 Montessori students
who had attended a Montessori school for at least three
years were compared with 53 students who attended public
inner city, suburban public, and private, voucher or charter
schools. Students from the control group had similar
parental income levels as those in the experimental group
(Lillard & Else-Quest, 2006).
The outcome of Lillard and Else-Quest’s study
illustrated the abilities of Montessori students to be
superior to those of their non-Montessori counterparts
(2006). At age five, Montessori students performed better
on letter and word identification, decoding speech sounds,
and applied math. They also outperformed non-Montessori
students in a test of executive function. Additionally,
Montessori students used higher-level reasoning, including
references to justice and fairness, when presented with a
story involving a social problem. This finding was
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reinforced by the conclusion that Montessori children
engaged in more positive peer interaction and less rough
play than other children. However, Lillard and Else-Quest
reported no difference was seen between Montessori and
non-Montessori students in vocabulary, spatial reasoning,
or concept formation. In general, by the end of
kindergarten, Montessori students performed better on
standardized tests of reading and math and had higher
levels of social cognition and executive control. The twelveyear-old Montessori students outperformed their nonMontessori counterparts in creative writing and sentence
structure. A greater amount of positive peer interaction was
seen among this group as well (Lillard & Else-Quest,
2006).
The long-term effects of the Montessori education
showed similar outcomes (Dohrmann et al., 2007). In a
study comparing public high school students from
Montessori and non-Montessori backgrounds, Dohrmann
et al. found children who attended Montessori elementary
programs to be performing as well as or better than nonMontessori students (2007). One hundred and forty-four
students who attended Montessori schools from preschool
through fifth grade were compared with a demographically
identical group of students who graduated from the same
high school as the Montessori students. Particular
differences were seen in the higher scores of Montessori
students in math and science. Furthermore, students with
a Montessori background had higher GPAs (Dohrmann et
al., 2007).
Further evidence the Montessori education is effective is
found in school districts around the country. Demand for
the Montessori education has caused huge waiting lists in
a high performing district of 32,000 students speaking 80
languages and dialects in Indiana (Robinson, 2006). In
response, the culturally and racially diverse district has
converted more of their traditional classrooms to
Montessori-based environments (Robinson, 2006).
Research in various other areas confirms the effectiveness
of practices derived by Montessori. Montessori’s emphasis
on self-motivation is backed by current research, which
supports that autonomy is key to fostering intrinsic
motivation (Murray, 2011). Murray reports self-directed
learning to increase intrinsic motivation (2011). These
findings help explain why Montessori students transition
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UST McNair Scholars Program Research Journal
from Montessori to non-Montessori classrooms successfully
(Dohrmann et al., 2007).
Although existing research provides helpful insights
about the Montessori education, limitations do exist. Often
methodological limitations, such as small sample sizes and
lack of random assignment, impact the data (Dohrmann et
al., 2007). The Montessori name is not trademarked;
therefore, various degrees of adherence to Montessori’s
method are seen throughout the world. Accounting for this
variation must also be taken into consideration when
evaluating Montessori schools. The Montessori method
requires children to be part of the environment for three
years. Variations in the amount of time children have been
educated in a Montessori setting also influence research
(Dohrmann et al., 2007).
HELP FOR AMERICA’S LOW-INCOME CHILDREN:
PROJECT HEAD START
LEGACY OF THE WAR ON POVERTY: THE CREATION OF HEAD
START
The Head Start program provides services to prepare
children for kindergarten and “to improve the conditions
necessary for their success in later school and life” (Butler,
Gish, & Shaul, 2004, p. 2). Head Start is a product of
President Lyndon Johnson’s War on Poverty (Follari,
2007). President Johnson’s federally funded efforts to
employ poor adults through the War on Poverty did not
receive thorough support (Abdill, 2009). Sargent Shriver,
an appointee of Johnson and influential player in the War
on Poverty, suggested a program to support poor children,
rather than their parents, because it would be more widely
accepted (Abdill, 2009). In the 1960s children accounted
for half of America’s impoverished (Zigler, Gordic, &
Styfco, 2007). Thus, policy makers designed Head Start to
specifically address communities of disadvantaged children
despite the implementation of other early intervention
preschool programs at this time (Follari, 2007).
Project Head Start continues to be the “nation’s leading
investment in early childhood care and education”
(National Head Start Association [NHSA], 2011) and is
“recognized as one of the most successful and lasting
antipoverty programs in the United States” (Abdill, 2009).
30
Head Start serves a diverse population of over 900,000
children, more than 65 percent of whom are minorities
(Abill, 2009; Haskins & Barnett, 2010). The U.S.
Department of Health and Human Services oversees the
Office of Head Start under a $7.2 billion budget (Haskins
& Barnett, 2010; Office of Head Start, 2011). Head Start
is structured in a way to give most control to local
organizations, as they better assess how each Head Start
can be most effective in their area (NHSA, 2011). Federal
funding for Head Start is awarded to local grantees, which
organize local Head Start programs (NHSA, 2011). The
federal government provides up to 80% of yearly costs for
each program while the remaining 20% must be collected
through contributions or donations (NHSA, 2011).
Children must meet the federal requirements and any local
criteria to be eligible to enroll (Love, Banks Tarullo, Raikes,
& Chazan-Cohen, 2005). The federal government requires
at least ninety percent of the population of each Head Start
be at or below the federal poverty line (Love et al., 2005).
However, Head Start is not an entitlement for
impoverished families, as many more are eligible than are
enrolled (Love et al., 2005).
SUPPORT FOR EARLY CHILDHOOD EDUCATION: THE
EMERGENCE OF DEVELOPMENTAL RESEARCH
A new awareness of the importance of a “strong start
early in life” among policy makers, civil rights activists,
psychologists, and sociologists in the early 1960s also
sparked interest in expanding early childhood education as
a means of eradicating other social problems (Follari, 2007,
p. 131). Fostering a strong early start in life was especially
important within low-income and high-poverty
communities because of the developmental delay children
in those communities often face (Follari, 2007). In 1964,
Benjamin Bloom cited critical periods when the child
develops most early in life (Zigler, Gordic, & Styfco, 2007).
In the 1950s, new evidence in brain development research
began to expose the connection between development and
environmental stimuli (Follari, 2007). In 1961, Joseph
McVickor Hunt declared the environment of great
importance in a growing child’s cognitive development
(Zigler, Gordic, & Styfco, 2007). Adequate stimuli are
required for appropriate and healthy development (Follari,
2007). Situations of poverty often leave children without
environments for healthy development, which creates a
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difference between low-income children and their
classmates from more affluent backgrounds (Follari, 2007).
Project Head Start was created with the intent of
addressing the gap between children’s levels of
achievement (Follari, 2007).
A HOLISTIC FOCUS: HEAD START’S COMPREHENSIVE
APPROACH
Head Start was created to address more than children’s
academic success. Project Head Start “provides
comprehensive early childhood development, educational,
health, nutritional, social, and other services” for enrolled
children and their families (Butler et al., 2004, p. 2). Many
programs today provide medical care, dental care, and
mental health services to the families they serve (Abdill,
2009). In 1965, the first pilot Head Start program opened
to alleviate risks of living in poverty for both enrolled
children and their families (Follari, 2007). Zigler, Gordic,
and Styfco discuss how the focus of Head Start has shifted
over time (2007). Head Start emphasized the importance
of raising IQ scores after its inception. However, raising IQ
scores had not been an intended goal of the creators. The
deviance from original goals became a problem, as focus on
IQ disregarded many of the other intentions of Head Start.
The focus of Head Start turned to children’s social
competence, which proved difficult to evaluate. By the
early 1990s, the program had switched focus again, this
time defining its goal as school readiness. Focus on
preparation for further schooling provided goals closer to
those the program was intended to address. These goals
included more specific guidelines, including improvements
in children’s physical well-being and motor development,
social and emotional development, language development,
and cognitive and general knowledge. Despite these
guidelines, school readiness has been complicated to assess,
as measurement is difficult. However, this emphasis has
proven a turning point toward focus on preparation for
standardized testing (Zigler, Gordic, & Styfco, 2007).
COMMON PRACTICES OF HEAD START PROGRAMS
The way in which Head Start is organized allows for
variation in practices between each Head Start classroom.
However, the federal government does outline some
general goals and specific procedures for local programs
(Office of Head Start, 2011). The aim of the Head Start
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educational approach is holistic, as is the intent of the
whole program (Follari, 2007). Physical and mental
examinations are provided regularly (Follari, 2007). An
emphasis on the strength of the educational aspect of the
Head Start program is a goal maintained across the nation
(Follari, 2007). The performance standards of the program
offer suggestions for a successful practice including
providing a variety of materials, offering challenging
individual and group activities, concentration on building
relationships, and engaging in active learning experiences
(Follari, 2007). Recently, the program has seen a greater
emphasis placed on development of language arts skills and
less focus dedicated to social development, as had been seen
in the past (Follari, 2007). Prominence is also placed on
numerical skills in preparation for standardized testing
(Follari, 2007).
Parent involvement is critical to the Head Start program
(PICA, 2011). One aim of Head Start is to establish a
system in which parents are encouraged to participate
(Follari, 2007). In addition to helping in the classroom,
parents serve as a governing board, making decisions for
local programs (Follari, 2007). Head Start programs are
generally located within communities with low
socioeconomic statuses (Follari, 2007). To improve quality
of life, Head Start programs often give preference to parents
of enrollees when paid jobs become available within the
program (Follari, 2007).
A majority of Head Start classrooms operate using either
the High/Scope curriculum or The Creative Curriculum
for Preschool (Bierman et al., 2008). Both methods are
based on child centered learning with support from the
teacher (Bierman et al., 2008).
The High/Scope Curriculum.
The High/Scope method was developed in the 1960s
and is aimed at educating low-income children based on
the developmental research of Jean Piaget (Follari, 2007).
High/Scope utilizes both small and large group activities
to build social and group problem solving skills while still
focusing on each child’s individual learning and
development through individualized planning (Bierman et
al., 2008). Follari explains that ten critical learning areas
are outlined through 58 key experiences, or learning goals
(2007). Specific skills are associated with each key
experience within each of the learning areas. Teachers guide
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their student’s progress through the planning element of
the plan-do-review routine. Planning allows the child to
select his or her activity while thinking through the actions
he or she will take with the help of the teacher. After
planning, children are given nearly two hours to carry out
their activities individually, with small groups, and
sometimes with the teacher. A group dialogue between the
children and their teacher following work time provides
space to reflect and review the previous two hours of
activity. Children also reflect through other means such as
drawing or writing. Throughout this process, the teacher
interacts in a way that causes children to engage deeper
within their learning. This interaction allows the teacher
time to observe each student and encourage the child based
on the teacher’s assessment of the child’s development. The
High/Scope method emphasizes the individual through
providing attention to each child’s level of development,
culture, and so on. The method focuses on allowing the
child to take an active role in his or her education by
pursuing his or her interests (Follari, 2007). Research has
proven the High/Scope model effective in long-term
scenarios such as increasing graduation rates, influencing
lower crime rates, and contributing to better employment
outcomes (Bierman et al., 2008).
The Creative Curriculum for Preschool.
The Creative Curriculum for Preschool takes a holistic
approach to working with the preschool age child with an
educational focus on literacy, math, science, social studies,
the arts, and technology (US Department of Education,
2009). Teaching Strategies, Inc., the founding organization
of the Creative Curriculum, emphasizes the role of research
in creating the curriculum (Teaching Strategies, Inc.,
2011). The child may explore any of the eleven areas of
interest within the classroom: blocks, dramatic play, toys
and games, art, library, discovery, sand and water, music
and movement, cooking, computers, and the outdoors
(U.S. Department of Education, 2009). Each area of
interest is associated with specific outcomes of learning and
corresponding interactions between the teacher and child
(U.S. Department of Education, 2009). “Studies” supplement exploration of the areas of interest (U.S. Department
of Education, 2009). A study refers to a project that
examines an aspect of science or social studies, providing
an outlet for children to practice math, literacy, and other
32
skills (U.S. Department of Education, 2009). The teacher
observes children to guide their play and development,
though emphasis is given to child assessment (U.S.
Department of Education, 2009). The Creative Curriculum
provides a method from which teachers can expand upon
and modify to their classroom needs (Teaching Strategies,
Inc., 2011). A 2009 report by the What Works
Clearinghouse found that the Creative Curriculum had no
discernable effects on oral language, print knowledge,
phonological reasoning, or math skills, although Teaching
Strategies, Inc. cites improved classroom quality and
stronger academic and social-emotional skills when The
Creative Curriculum is used (U.S. Department of
Education, 2009).
REVIEW OF RESEARCH: EFFECTIVENESS OF HEAD START
Head Start requires frequent evaluation due to its status
as a federal aid program (Follari, 2007). From its inception,
Head Start has claimed commitment to research and
evaluation, though the Head Start program was not
thoroughly evaluated until 1998 when assessment was
mandated for reauthorization (Love et al., 2005). Research
prior to the 1998 study proved flawed and inconsistent
(Love et al., 2005). The Nixon administration even
considered phasing out the Head Start program after
various studies illustrated Head Start was having a small
effect (Zigler, Gordic, & Styfco, 2007). Still today, each
reauthorization revives discussion around whether or not
Head Start is meeting its intended goals and is effective in
providing successful early childhood education and services
to bridge the gap between children of various backgrounds
(Follari, 2007). However, the lack of clearly defined goals
by which Head Start operates has made assessment difficult
(Zigler, Gordic, & Styfco, 2007). Assessing whether or not
Head Start is successful in its vague goals has caused debate
and confusion throughout its history (Zigler, Gordic, &
Styfco, 2007). Little research was available to guide Head
Start’s creators in formatting goals for educating lowincome children (Zigler, Gordic, & Styfco, 2007). This lack
of solid foundation causes variability and inconsistency of
quality in Head Start programs today (Zigler, Gordic, &
Styfco, 2007).
In the early 1990s, the Administration for Children and
Families (ACF), which oversees Head Start, increased the
emphasis placed on research within Head Start’s program
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planning (Love et al., 2005). Action by the ACF to expand
research coincided with mandates made by Congress to
carry out several studies regarding Head Start children’s
performance and progress during and after enrollment
(Love et al., 2005). The Family and Child Experiences
Survey (FACES) study began in 1997 and will continue
through 2013 to better determine Head Start’s strengths
and effectiveness, as well as areas where the program is
unsuccessful or lacking (Follari, 2007). The study follows
a representative group of children and their families
through Head Start and beyond (Love et al., 2005). The
completed study will consist of five cohorts of Head Start
enrollees from all fifty states and the District of Colombia
(Office of Head Start, 2011). Each child is assessed three
to four times one-on-one for language, literacy, and math
skills to determine his or her school readiness (Office of
Head Start, 2011). FACES has already revealed Head Start
does narrow the gap between Head Start preschoolers and
preschoolers who attended an alternative early childhood
education program both academically and socially (Follari,
2007). Particularly, students whose development was
significantly behind norms when they entered preschool
saw the greatest improvements (Love et al., 2005). Head
Start children made the most significant gains in cognitive
development in the areas of vocabulary and early writing
(Follari, 2007). However, Head Start students, on average,
still remain below the national averages for abilities at their
age, scoring lower on standardized tests (Follari, 2007).
Additionally, the FACES study has shown the
improvements made during a child’s Head Start years often
fade after two years (Follari, 2007). This finding illustrates
Head Start’s inability to produce sustained benefits, an area
of great importance (Follari, 2007). Head Start is offered
in both full-day and half-day settings across the country
(Love et al., 2005). This is cited as one reason why lasting
effects are not seen; three to four hours of classroom time
per day does not allow much time to correct the child’s
development and make gains (Zigler, Gordic, & Styfco,
2007). However, the National Head Start Association
claims Head Start is actually providing long-term benefits
such as decreases in the amount of grade repetition, special
education placements, and dropouts (NHSA, 2011).
Similar findings have been reported from the Head Start
Impact Study (HSIS). HSIS was carried out by an
independent research panel and aimed at assessing the
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impact of Head Start on participants and identifying the
source of the impacts (Love et al., 2005). The study was
begun in 2002 to answer two questions: (1) What
differences does Head Start make to the key outcomes of
development and learning of the nation’s low-income
children? and (2) Under what circumstances does Head
Start work best and for which children (Love et al., 2005,
p. 7)? The HSIS compared 3 and 4 year old Head Start
children with 3 and 4 year old Head Start eligible children
who were enrolled in an alternative program or were cared
for by their parents through the spring of their first grade
year (Love et al., 2005). With data collection running from
2002 to 2006, the HSIS involved roughly 5000 3 and 4
year olds from 84 Head Start programs across the nation
(Office of Head Start, 2011). Head Start programs were
used in areas where Head State applicants outnumbered
enrollees (Office of Head Start, 2011). Child assessments,
interviews, parent and teacher ratings, and observations of
Head Start and alternative settings were used to assess the
impact of Head Start (Love et al., 2005). Of the 4 year olds
assessed, Head Start preschoolers outperformed non-Head
Start preschoolers in multiple areas of development (Love
et al., 2005). In 2005, results illustrated that cognitively
the Head Start preschoolers were better able to identify
words, name letters, and spell (Love et al., 2005). The Head
Start three year olds assessed showed even greater results
than their non-Head Start counterparts (Love et al., 2005).
They, too, were better able to identify words and letters,
draw a design, use varied vocabularies, name colors, and
respond to oral communication (Love et al., 2005; Puma
et al., 2010). The Head Start 3 year olds also showed
reductions in behavior problems and hyperactivity (Love
et al., 2005). Overall, the Head Start children showed signs
of better health and parent relationships (Love et al., 2005;
Puma et al., 2010). Black students and students with
special needs were identified as making the most
substantial gains (Puma et al., 2010). Deviance from the
success seen in HSIS came primarily from non-English
speaking homes, families with young mothers, and
mothers with high levels of depression symptoms (Love et
al., 2005; Puma et al., 2010). However, when data from
the HSIS was produced again in 2010, there were no
impacts found on children’s cognitive, social, or emotional
development (Haskins & Barnett, 2010). Researchers
concluded, based on Head Start’s poor effectiveness, reform
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was needed after the 2010 evaluation (Haskins & Barnett,
2010). Thus, a need for strengthening the educational
aspects has been identified to ensure all Head Start
graduates are well prepared for future schooling (Bierman
et al., 2008).
In an assessment of school readiness, Bierman et al.
found Head Start graduates to be adequately prepared in
areas of oral comprehension skills and speech sounds
(2008). Additionally, findings indicated high levels of
aggressive behavior and lacking social skills among Head
Start graduates (Bierman et al., 2008). The Civil Rights
Education Fund described Head Start’s impact as modest,
due in part to the small amount of statistical difference in
both cognitive and social skills between Head Start and
non-Head Start students (Besharov, 2005). Other programs
continue to outperform Head Start due to its lack of
organizational support and lack of properly trained
educators (Bierman et al., 2008; Haskins & Barnett, 2010).
However, the National Head Start Association reports the
Head Start graduates are achieving national norms in early
reading and writing and are close to national norms in early
math and vocabulary by the spring of their kindergarten
year (NHSA, 2011).
While Head Start has been recognized for providing a
well-working system for reaching low-income children,
there is a need to reach a broader community (Love et al.,
2005). Currently, debate revolves around whether or not
Head Start provides equal access to non-English speaking
families and various cultures within the classroom
(Jacobson, 2007; Love et al., 2005). Additionally, findings
on achievement have differed among various races within
the program (Love et al., 2005). Head Start is working to
address how to expand positive results to all children by
determining what works well for different groups (Love et
al., 2005).
TWO COMPLIMENTARY APPROACHES: THE
MONTESSORI EDUCATION AND HEAD START
AREAS OF COMPATIBILITY
Although Head Start and Montessori approaches to early
childhood education have independent backgrounds, their
goals are similar and their methods are compatible (Hixon,
34
2002). Both programs were created in response to the need
to enhance educational opportunities for low-income
students. Both embrace a holistic approach to child
development. These similarities are reflected in
philosophical and pedagogical compatibilities. Similarity
also arises from each method’s dependence on research.
Maria Montessori developed her method based on scientific
observations of child development. Since the creation of
Montessori’s methods, additional research has supported
Montessori’s developmental theory. Similarly, research
provided a basis for creating Head Start and it continues
to play an instrumental role within the program.
Head Start is structured to allow different programs to
adopt various methods. Some Head Start classrooms fully
incorporate Montessori methods. Most, however, use either
the High/Scope or Creative Curriculum for Preschool.
While both approaches recognize some key Montessori
principles—for example child-centered learning and
leaning through doing—expanding emphasis on
Montessori methods and materials could be beneficial.
EVIDENCE OF SUCCESS
The rise of Montessori methods within the United States
during the time in which Head Start was established
resulted in some early Head Start programs employing the
Montessori method (Gutek, 2011). However, there is
extremely limited literature regarding the use of the
Montessori method within Head Start programs. An article
from Montessori Life conveys that a Head Start classroom in
Ignacio, Colorado, that began using the Montessori method
saw success (Hixon, 2002). In fact, the director stated, “We
found that the two philosophies were not only compatible,
but very complimentary” (Hixon, 2002, p. 38). The
director elaborated on the success of the program saying,
“Parents are reporting children who are more self confident,
more respectful, and better prepared academically” (Hixon,
2002, p. 38). Positive results were also reported from a
Nokomis, Florida Head Start program that began using
Montessori methods (Allen-Jones, 2006). The program
emerged from collaboration between Children First, a local
non-profit, Sarasota County’s Head Start, and the Island
Village Montessori Early Childhood Program (Allen-Jones,
2006). Parents of enrolled students, as well as school
officials, attested to the success of the collaboration (AllenJones, 2006). The program’s children surpass the national
Public Policy
standards and mandates (Allen-Jones, 2006). Further
evidence for the achievement of the collaboration came
with the National Head Start Association’s recognition of
the program as a “program of excellence” (Allen-Jones,
2006).
The limited available documentation of Montessori
methods within Head Start signals the room for growth
and development in the field. The brief amount of
literature available does confirm the success of adherence
to Montessori methods within Head Start in the past.
INSIGHT FROM EXPERTS
I conducted two interviews to further develop my
understanding of the guiding philosophies, theories, and
practices of the Montessori education and Head Start
program. Information gathered during each of these
interviews has provided guidance in developing a sense of
the main opportunities for improving early childhood
education. Furthermore, this information has served as a
guide in making practice recommendations for the
incorporation of Montessori principles within Head Start
classrooms. My first interview was with Molly
O’Shaughnessy, the director of the Montessori Training
Center of Minnesota. My second interview was with Jeanne
Dickhausen, the education coordinator of the Community
Action Partnership of Ramsey and Washington Counties,
the St. Paul grantee for Head Start.
Question 1: What is the overall philosophy, principles, and
child development theory that guides the Montessori/Head Start
education?
Molly O’Shaughnessy identified freedom for the child
as one of the guiding principles of the Montessori
education. Allowing the child to be actively involved in
his or her own learning and to have responsibility is critical
for the child’s growth. Additionally, it helps foster
independence. O’Shaughnessy discussed the ability to be
functionally independent as a primary objective of the
Montessori education. Developing this independence
requires purposeful activity within the classroom,
concentrating on the repetition of skills until they are
mastered. Children’s independence is achieved through the
prepared environment. Another guiding philosophy of the
Montessori education cited by O’Shaughnessy is the
inclusion of multiple ages within one classroom. This
allows older students to reinforce skills and knowledge by
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helping younger children learn. Montessori stressed giving
the best of culture to her students and providing them with
the nicest, real materials with which to work. Peace is
emphasized within the Montessori classroom, as
Montessori saw it as a goal of humanity. O’Shaughnessy
also discussed Montessori’s identification of “normalization” as the most important outcome of her work,
meaning a successful education will lead all children to be
contributing members of society.
Jeanne Dickhausen referenced the mission and
philosophy of the Community Action Head Start program
as guiding statements. The mission states, “Head
Start/Early Head Start’s mission is to help children and
parents achieve their full potential through high-quality
child development and family support services
(Community Action Head Start Family Handbook/
Calendar, 2010). Elements of the guiding philosophy,
which was developed by the Community Action
Partnership staff, Head Start parents, and community
members, emphasize the importance of individualized
attention to children’s interest, learning through
engagement in various activities and play, and the
importance of respect for healthy families and their
cultures. Dickhausen discussed the high worth of parent
involvement within the Community Action Head Start
program. Head Start teachers must get to know each family
and child individually to best help the child learn.
Dickhausen emphasized the importance of addressing each
child’s developmental needs and interests in ensuring he
or she is really learning. Additionally, Dickhausen
emphasized the importance of the use of research-based
approaches within the Community Action Head Start
program. Assessment of children’s development is also
crucial. The Community Action Partnership uses an
ongoing assessment system to track each child’s
development and progress. Parents and Head Start teachers
set goals for each child, and assessment provides a way to
determine progress.
Question 2: What are the key early childhood education
practices used by the Montessori/Head Start program?
Molly O’Shaughnessy identified the Montessori
education’s focus on the observation of children. Guides
observe the children at work, interrupting them only when
a child’s behavior is destructive. A Montessori classroom
consists of one guide, an assistant, and thirty children of
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mixed ages. Including various ages in one classroom
provides the opportunity for children to grow socially and
reinforce their learning through helping other students.
The guiding principles of Head Start classroom vary
because not all classrooms use the same approach. Jeanne
Dickhausen explained the Community Action Head Start
classroom utilizes the Creative Curriculum. A focus of the
Creative Curriculum classroom is placed on a welcoming
and inviting environment. Eleven areas of interest are
provided for students to explore and engage with.
Relationship building is emphasized both between student
and teacher and among the students. The teacher must
ensure children develop a broad range of skills, even if the
children’s interests seem to be narrow.
Question 3: What are some recent trends in early childhood
education?
Molly O’Shaughnessy identified the increasing number
of early childhood education providers that have begun
offering full-day programs to accommodate working
parents. Also, a rise in bilingual children has increased the
necessity for more than one language to be spoken within
the classroom and in interactions with parents.
O’Shaughnessy also discussed that policy reform has gained
strength within recent years, including objectives such as
diversifying the teaching pool and providing broader access
to quality early childhood education.
Jeanne Dickhausen noted the increase in research-based
curriculum and assessment that is now being used in early
childhood education. Another recent focus in early
childhood education referenced by Dickhausen was the
growing role of teacher education. A greater focus has been
placed on the education for early childhood teachers as well
as their professional development. The Community Action
Head Start program requires their teachers and staff to be
members of a professional registry. Also, the higher
education provided for early childhood education teachers
has recently increased continuity among programs. The
importance of each early childhood education teacher
learning and teaching the same material across the country
is growing.
Question 4: What are some problems with early childhood
education today?
The excessive use of technology by young children was
identified as a problem for education today. Family
influences are also having an impact on early childhood
36
education. Various and extreme parenting styles present
problems within the classroom. In a Montessori setting,
children are encouraged to become independent, but with
“helicopter parenting,” independence is often stifled at
home. External family factors such as poverty also affect
learning in the classroom. With high poverty rates today,
stress and violence at home translates into problems within
the classroom. Increased immigration and the introduction
of new cultures add more challenges to early childhood
education. With children moving in and out of classrooms
often, it is difficult to ensure quality education.
Accommodating multiple cultures within a classroom
provides another challenge.
Jeanne Dickhausen identified regulated expectations and
assessments required of children at an earlier age as a
problem within early childhood education. She explained
that what used to be expected of a first grade child is now
expected of a preschool child. The effects of this added
expectation and assessment can be developmentally
unhealthy for young children. As a federal grantee, Head
Start programs are continually worried about their financial
stability, which provides an ongoing problem. Due to the
continuing concern of funding, Dickhausen said
Community Action Head Start is continually looking for
ways to demonstrate the effectiveness of its program on
children’s education and development. Part of ensuring
effectiveness includes involving parents. Dickhausen cited
the continued struggle to keep parents highly involved
with their children’s lives, educations, and the Head Start
program. Specifically, Dickhausen explained the difficulty
of engaging parents from low-income areas that are often
spending a lot of time working.
Question 5: What are the most important steps that could be
taken to improve early childhood education for low-income
children?
Molly O’Shaughnessy discussed the importance of
focusing on developing the child’s independence through
practical life activities in enhancing early education. She
cited any activity that aided in developing the child’s
independence as important to incorporate in an early
childhood education program.
Jeanne Dickhausen identified broader access as a crucial
component of enhancing educational opportunities for lowincome children. She also mentioned the importance of
well trained and prepared teachers in ensuring quality
Public Policy
education. To improve this aspect, Dickhausen encourages
the higher education community to continue to collaborate
so various programs are on the same page. Another way to
improve education for low-income students discussed by
Dickhausen involved providing the best opportunities for
children to learn based on their life experiences and
situations. Dickhausen identified the ability of staff to
provide research-sound support for their students while
maintaining personal relationships to be crucial.
A reflection on the interviews.
Throughout the interviews, common themes between
the two approaches emerged which provided guidance in
creating recommendations. First, both O’Shaughnessy and
Dickhausen addressed elements of the guiding principles
of their respective approaches that overlapped. Both
approaches are aimed at addressing the needs of children
individually. The establishment of the Montessori
environment as a place to foster independence and promote
freedom of the child gives attention to each child as an
individual, just as the Community Action Head Start
program emphasizes attention to each child’s interests and
development. The Head Start program also prides itself on
getting to know children and families individually. Both
O’Shaughnessy and Dickhausen discussed how their
approaches are concerned with child development beyond
education. Both methods are aimed at aiding the child in
all aspects of his or her life, Montessori’s through providing
practical life skills and fostering independence and Head
Start’s through providing additional services. Both
O’Shaughnessy and Dickhausen identified devoting
attention to children’s individual needs as a means of
improving early childhood education. O’Shaughnessy
discussed allowing children to have freedom to choose their
work based on their own interests. Similarly, Dickhausen
emphasized the importance of engaging each child in his
or her learning through relating learning to his or her life
experience and interests.
In discussing recent struggles within the field of early
childhood education, both O’Shaughnessy and Dickhausen
mentioned the increase in effects seen due to growing levels
of poverty. The high levels of stress put on children living
in poverty often present themselves through behavior
problems. Additionally, poverty affects children’s leaning
in other ways. For example, learning is impacted when
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nutritional needs are not being met. Providing resources
for children and addressing problems that arise from
situations of poverty is something that requires attention
in all classrooms.
RECOMMENDATIONS FOR THE INCORPORATION
MONTESSORI PRINCIPLES WITHIN HEAD START
OF
While access to quality early childhood education is
important for all children, it is absolutely critical for
children from low-income backgrounds. Early childhood
education provides opportunities for every child’s growth
into a successful member of society. Access to quality,
holistic early childhood education is necessary to prepare
all children for life as a self-fulfilled, educated,
economically productive, and civically engaged adult.
Integrating Montessori methods within Head Start
provides a philosophically consistent, pedagogically sound,
and financially feasible approach to enhancing educational
opportunities and experiences for low-income children.
The following four recommendations are directed
toward enhancing the quality of early childhood education
for low-income children. All recommendations are aimed
at assisting children from low-income families to develop
self-reliance, self-confidence, personal responsibility, and
the ability to care for others.
Recommendation 1: Self-directed work.
Allowing children to make choices about what they
would like to do is critical in fostering intrinsic motivation
and independence. I recommend Head Start programs
incorporate the concept of self-directed work within their
curriculum. Providing children with choices about which
activities or materials they engage with allows them to
pursue their own interests. A child learns best when
exploring his or her interests. Montessori stressed the
importance of allowing children to work independently for
three hours each day. At least a portion of each school day
should be devoted to uninterrupted, self-directed work.
This provides time for children to fully engage in and
complete each activity they begin.
Recommendation 2: The prepared environment.
The environment of a classroom has a significant impact
on the possibilities for learning. For that reason, devoting
specific attention to the careful preparation of each learning
37
UST McNair Scholars Program Research Journal
environment is key. I recommend Head Start programs
devote attention to preparing each learning environment
in a way that provides accessible materials for children and
allows space for children’s movement and work. Maria
Montessori outlined several factors that would enhance any
environment for learning. In addition to the environment
being welcoming to children, it should be orderly.
Materials within the classroom should be easily accessible
by children, so they are able to retrieve any materials they
may need for their work. An orderly environment helps to
facilitate material accessibility. If the environment is
orderly, children know where things can be found and
should be returned to for future use. This also promotes
respect for the environment and materials. Another critical
aspect of the prepared environment includes space for
children to work and move throughout the room. Using
various materials may require more space, and it is
important for children to have space to work as needed.
Recommendations 3: Incorporation of materials.
The Montessori education emphasizes the use of handson materials and the use of physical objects to promote
learning. I recommend Head Start programs utilize some
of the Montessori materials within the classroom, especially
in the areas of language, mathematics, and practice life
skills. The use of hands-on objects can be applied to all
subject areas to help children learn. For example, the
moveable alphabet is used to help children formulate
reading and writing skills. Various three-dimensional
objects can also be used in learning mathematics, such as
sandpaper numbers and different counting devises. In
addition, utilizing hands-on materials for the acquisition
of practical life skills is useful in developing independence.
Providing materials for children to build practical skills
such as buttoning, tying, pouring, washing, and so on can
be achieved through the incorporation of additional
Montessori materials within the classroom.
Recommendation 4: The teacher as a guide.
Incorporating self-directed work and Montessori
materials within a traditional classroom will, in most cases,
require the teacher to take on a slightly different role. Head
Start classrooms that incorporate self-directed work must
also incorporate the concept of the teacher as a guide to
children’s independent exploration and learning. In
38
allowing children to work independently, it is important
that the teacher allows the student to choose his or her task,
rather than assigning a task for all children to complete.
Once children have engaged with their work, the teacher
should not unnecessarily interrupt the child’s work. The
child may request the help of the teacher or work in
collaboration with other students within the classroom.
Throughout the self-directed work period, the teacher
should offer guidance in helping individual children
discover what the child would like to work with and
demonstrate how to successfully complete each activity.
Overcoming barriers to implementation.
Three primary barriers exist in integrating methods of
the Montessori education within the Head Start program.
To address these barriers, I suggest the following:
First, Montessori methods must be implemented in a
manner responsive to the needs of each unique Head Start
setting. Implementing the above recommendations will be
different within each different classroom community. For
this reason, the recommendations are defined broadly, so
they can be adapted to work within various educational
approaches and environments. Flexibility is key to ensuring
successful integration of methods.
Second, successful incorporation of Montessori methods
requires advanced teacher education. Teachers must be
carefully prepared to take on the role of a guide to facilitate
self-directed work, prepare the environment, and properly
use Montessori materials. Training needs could be
addressed by engaging Head Start and Montessori
educators in developing cost and time efficient in-service
opportunities for participating Head Start teachers.
Third, incorporating Montessori methods within Head
Start will require funding. This could be addressed by
redirecting existing funds within the Head Start budget to
support recommended changes. For example, funding for
currently used materials may be redirected for Montessori
materials. Additionally, funding could be sought for pilot
programs through grant writing. Successful pilot programs
could then be used to advocate for further funding.
Although more research is required, overall, my project
suggests efforts to incorporate key elements of the
Montessori education within Head Start programs would
enhance early childhood education for low-income
children.
Public Policy
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doi:10.1080/15240750701491233
ABSTRACT
Human immunodeficiency virus, HIV, is the causative agent of AIDS, a pandemic
affecting over 30 million people worldwide. Understanding how drug resistance develops
in HIV is essential for improving antiretroviral therapy and is an important research
area in the fight against HIV/AIDS. While much is known about HIV-1, the virus
that accounts for majority of global infections and the mutations it acquires during drug
resistance, information on HIV-2’s drug resistance is limited to a handful of studies.
HIV-2 is prevalent in West Africa and the limited spread of the infection contributes to
the lack of available research on this virus type. The present study will investigate HIV2 drug resistance to nucleoside reverse transcriptase inhibitors, a drug class that inhibits
activity of the reverse transcriptase enzyme, a major generator of mutations in HIV. We
will create HIV-2 mutants containing HIV-1 resistant conferring mutations and observe
how the mutants influence drug susceptibility and mutation frequency, two factors that
stimulate drug resistance. NRTI-resistant reverse transcriptase increases mutation
frequency in HIV-1, which results in a higher selection for drug resistant mutations
and further diminishes NRTI potency. Because HIV-1 and HIV-2 have similar reverse
transcriptase enzymes, we hypothesized that HIV-2 resistant RT would also increase
mutation frequency and HIV-1 mutations will confer resistance in HIV-2. Current
results from two, single round replication assays and flow cytometry show that HIV-2
has an average mutant frequency of 0.239 ± 0.041 (first replicate) and 0.273 ±
0.033 (second replicate). HIV-2 mutants will be generated by site-directed mutagenesis,
and we can observe how these mutations influence mutant frequency and drug
susceptibility. The ultimate goal is to develop a better understanding of HIV-2 drug
resistance that could be used to create potential treatment options for the HIV-2 infection.
EXPLORING THE
INFLUENCE OF HIV-1
RESISTANT
CONFERRING
MUTATIONS ON
ANTIRETROVIRAL
DRUG RESISTANCE IN
HIV-2
INTRODUCTION
A retrovirus is a RNA virus that encodes for the reverse transcriptase (RT)
enzyme; RT converts viral RNA into DNA that can be integrated in a host
cell’s nucleus. HIV is a retrovirus that attacks and replicates inside of T cells,
a group of white blood cells that play a role in immune defense. The HIV life
cycle begins when a virus particle binds and fuses into the host cell and releases
its genetic material as RNA. The reverse transcriptase enzyme converts viral
RNA into DNA, which is then transported into the host’s nucleus and spliced
into human genetic material by the integrase enzyme. Proviral DNA is
transcribed, using human enzymes, into mRNA and complete copies of HIV
genetic material. The mRNA is used as a blueprint to create long chains of
HIV protein. Protease cuts these chains into individual proteins, which join
with HIV genetic copies to form a new virus particle. As the newly assembled
virus particle is released from the host cell, it takes part of the cell’s membrane
containing proteins necessary to bind to and infect new cells (Tavassoli, 2011).
HIV is the causative agent of acquired immunodeficiency syndrome, AIDS,
a pandemic affecting over 30 million people worldwide. There are two types
of HIV; HIV-1 is the common virus accounting for the majority of infections
globally, and HIV-2 is centralized to West Africa. HIV-1 and HIV-2 are
genetically similar; their virion (virus particle) structures are alike and they
Mondraya Howard ’13
University of St. Thomas
Mentor
Louis Mansky, Ph.D.
Professor of Microbiology and
Diagnostic and Biological
Sciences
University of Minnesota
41
UST McNair Scholars Program Research Journal
share a 60% homology in the amino acid sequence of
reverse transcriptase. However, HIV-2 has a lower
transmissibility than HIV-1, which explains the low
prevalence of HIV-2 infections outside of West Africa
(Schim van der Loeff and Aaby, 1999). Since the discovery
of AZT as an antiretroviral drug against HIV-1, several
drugs have been developed for use in HIV-1 treatment
(Menendez-Arias, 2002). No treatment has been developed
for HIV-2; management of HIV-2 is based on HIV-1
treatment guidelines. Both virus types develop resistance
to drug therapies, but available data on HIV-2 drug
resistance is lacking. The present research project will
study factors that influence HIV-1 drug resistance and
investigate if these factors present the same influence in
HIV-2. Research on HIV-2 drug resistance is essential to
the development of potential treatment options for the
HIV-2 infection.
Drugs currently used to treat HIV inhibit the activity
of enzymes that are essential to viral replication.
Monotherapy with antiretroviral drugs has given way to
combination therapy because acquisition of resistance
occurs in HIV (Menendez-Arias, 2002). Highly active
antiretroviral therapy, HAART, combines three or more
drug classes, usually two reverse transcriptase inhibitors
and a protease inhibitor, to suppress viral replication. The
accumulation of mutations that lead to drug resistance
exacerbates antiretroviral therapy. HIV has a high mutation
rate, 3 x 10-5 mutations/base pair/cycle for HIV-1, which
introduces one mutation every three genomes produced
(Mansky, 1996; Mansky, 2002). The reverse transcriptase
enzyme is a major generator of mutations because it has no
proofreading ability. In normal DNA synthesis, DNA
polymerase proofreads and removes incorrect base pairs or
nucleosides from the growing DNA strand. RT synthesizes
DNA from viral RNA and its polymerase activity is largely
error prone (Goff, 1990). This research investigates
mutations that lead to resistance to nucleoside reverse
transcriptase inhibitors (NRTIs), a drug class that inhibits
RT activity. NRTIs are nucleoside analogs; they are similar
to normal nucleosides and can be incorporated into
growing DNA. However, they act as DNA chain
terminators and inhibit the attachment of additional
nucleosides because they lack a 3’OH group in the ribose
ring (Isel, Ehresmann, Walter, Ehresmann & Marquet,
2001; Menendez, 2002). Resistance to NRTIs occurs when
42
RT selects for mutations that prevent the incorporation of
nucleoside analogs. Antiretroviral drugs can stimulate drug
resistance in HIV. Studies show that antiretroviral drugs
influence the mutation frequency of HIV-1 (mutation
frequency is correlated to mutation rate and they are often
used interchangeably). Mansky and Bernard (2002)
investigated the influence of the antiretroviral drugs AZT
and 3TC and AZT- or 3TC-resistant RT on the rate of
HIV-1 mutation. Results from this study found replication
in the presence of either AZT or 3TC increased the HIV-1
mutation rate. AZT resistant variants also increased the
mutation rate. The selection of mutations that confer
resistance increases in the presence of antiretroviral drugs,
which allows resistance to occur at a rapid rate.
HIV-1 develops drug resistance through two mechanism
pathways. In the first pathway, mutations that inhibit RT
from incorporating nucleoside analogs arise. A study by
Sarafianos, Das, Hughes and Arnold (2004) identified
residues, such as K65 and Q151 that play a role in
positioning the incoming nucleoside; mutations at these
residues lead to resistance to NRTIs. In the second
pathway, mutations occur that promote adenosine
triphosphate, ATP, to remove nucleoside analogs from the
blocked DNA (Menendez, 2008). Previous studies have
found that resistance by ATP excision is common in
antiretroviral therapies that include thymidine analog
NRTIs. A study conducted by Isel, Ehresmann, Walter,
Ehresmann and Marquet (2001) found resistance to the
drug zidovudine (AZT), associated with mutations such as
M41L, D67N, K70R, T215F/Y and K219E/Q, is caused
by selective excision of the drug. In another study, Lin et
al. (1994) found the same set of mutations in viral isolates
from patients under stavudine (d4T) therapy. AZT and d4T
are both thymidine analogs, justifying their acquired
mutations as thymidine analog mutations (TAMs). HIV-1
uses one pathway more frequently than the other in the
presence of certain NRTIs (Boyer et al., 2006)
HIV-2 appears to acquire resistance by the first pathway
only. Previous studies identified genetic changes
responsible for HIV-2 drug resistance. These studies, which
sequenced isolates from HIV-2 infected patients under
NRTI therapy, found patients acquired HIV-1 resistance
conferring mutations that correspond to the first resistance
pathway. One trend found observed such studies were the
frequent emergence of the K65R and Q151M mutations
Mondraya Howard
HIV-1 Resistant Conferring Mutations
Pharmacy
in HIV-2. A study by Boyer, Sarafianos, Clark, Arnold and
Hughes (2006) found the Q151M to be the primary
mutation associated with AZT therapy. The Q151M
mutation has also been shown to induce resistance to
almost all NRTIs in HIV-1(Rhodes et al., 2000; van der
Ende et al., 2000). Another study conducted by Descamps
et al. (2004) found frequent emergence of the K65R
mutation in patients under 3TC therapy. In their study,
Smith et al. (2009) determined that the K65R and Q151M
mutations, together, promote class wide NRTI resistance.
The residues that these mutations take place play a role in
positioning the incoming nucleoside during DNA
synthesis. Resistance with these mutations follows the first
mechanism pathway of HIV-1. There was a low prevalence
of TAMs in HIV-2 resistance indicating that HIV-2 does
not employ the excision pathway to confer drug resistance
(Smith et al., 2009; Boyer et al., 2006).
The primary goal of this project is to create HIV-2
resistant RT by incorporating HIV-1 resistance conferring
mutations into HIV-2 RT. Drug susceptibility decreases
and mutation frequency increases in the presence of HIV1 resistant RT. Since HIV-1 and HIV-2 have genetically
and structurally similar RT, I hypothesize that HIV-2
resistant RT will confer resistance to NRTIs and increase
the mutation frequency of HIV-2. Mutation frequency of
HIV-2 was determined by producing the virus in a HIV2env- vector containing two marker genes, HSA and GFP,
and using flow cytometer to calculate the percentage of
cells expressing the marker genes (mutant frequency).
Using site-directed mutagenesis, the Q151M and K65R
mutations will be introduced into HIV-2 RT. Mutant HIV2 can be produced and replicated the HIV-2env- vector and
flow cytometry will examine the mutation frequency. Drug
susceptibility will be observed by replicating HIV-2
resistant RT in presence of NRTIs. Research on the HIV2 infection is limited to a handful of studies because of the
restricted spread of the virus. This research provides a
better understanding of HIV-2 drug resistance and can
contribute to development of potential treatment options
for HIV-2.
MATERIALS AND METHODS
CELL LINES AND PLASMIDS.
HIV-2ROD viral DNA was obtained from the Mansky
Lab, Institute of Molecular Virology (University of
Minnesota). The 293T cell line was obtained from the
American Type Culture Collection. Antibody to mouse
heat-stable antigen protein (HSA) was purchased from BD
Pharmingen (San Diego, CA). The Purelink Quick Plasmid
miniprep kit was obtained from Invitrogen (Grand Island,
NY). HIV-2env- vector was obtained from Hu Wei-Shau.
pIRES2-EGFP was obtained from Clontech (Mountain
View, CA). Restriction enzymes were purchased from New
England Biolabs (Ipswich, MA). The pCR-18S plasmid
was a gift from Mauro Magnani (Universita’ Degli Studi
Di Urbino).
CONSTRUCTION
DETECTION.
OF THE
HIV-2
VECTOR FOR MUTATION
HIV-2 vector (obtained from Wei Shau) was modified
by restoring the gfp and HIV-2 vpr genes via site-directed
mutagenesis. The vector contains the gene for HSA as well
as a frame-shift mutation at the 5’end of env, which limits
the virus to one round of replication. The internal ribosome
entry site (IRES)-green fluorescent protein (GFP) fragment
was PCR amplified from pIRES2-EGFP and subcloned
into pCR2.1. This plasmid, as well as HIV-2env- was
restriction digested with XhoI. Following purification,
HIV-2env- and the IRES-enhanced GFP (EGFP) fragments
were ligated and then transformed using DH5α cells.
Restriction digestion and DNA sequencing analysis was
used to verify the clones.
TRANSFECTION OF 293T CELLS
293T cells were maintained in Dulbecco’s modified
Eagle’s medium (DMEM) containing 10% fetal clone 3
(FC3) serum (HyClone, Logan, UT) and penicillin/
streptomycin at 37°C in 5% CO2. 293T cells were plated
on poly-L-lysine- coated 10-cm culture dishes 24 h before
transfection. The cells were then transfected by calcium
phosphate coprecipitation with 10m g of the HIV-2 vector
(HIG) and 1m g of a plasmid encoding the HIV envelope,
VSVG. The medium was replaced with 6 ml of DMEM
containing 10% FC3 serum and penicillin/streptomycin
43
UST McNair Scholars Program Research Journal
24 h after transfection. Virus was harvested 24 h later by
filtration of the cell supernatant through a 0.2-mm filter.
INFECTION OF TARGET CELLS AND FLOW CYTOMETRY
U373-MAGI-CXCR4C E M cells, maintained at 37°C
in 5% CO2 in selection medium composed of DMEM with
10% FC3 serum, 1 mg/ml puromycin, 0.1 mg/ml
hygromycin, and 0.2 mg/ml neomycin, were plated in a
12-well culture dish 24 h prior to infection. After
pretreatment, the viral stock (500 ml) was added to each
well. Cells were harvested for analysis 48 h after infection.
Cells were then analyzed for fluorescence at 488 nm and
568 nm. Quadrants were drawn using non-infected cells
to determine background levels of fluorescence. Cells
expressing both HSA and GFP were used to determine the
percentage of infected cells.
Replication assay protocol was adapted from Mansky,
Pearl and Gajary (2006).
FIG. 1 (Adapted from Clouser, Patterson and Mansky, 2010)
Single round replication assay use to assess mutation frequency.
HIV-2 virus is produce in 293T cells by transfection of two
plasmid constructs: the HIV-2 envelope-deficient vector contains
two marker genes that are used to measure mutation frequency.
The second plasmid encodes for HIV envelope. After
transfection, the supernatant containing virus is collected and
added to target cells. Cells are harvested after infection and flow
cytometry is used to examine expression of marker genes.
frequency, we used an assay that detects HIV-infection
through the expression of two marker genes, HAS and
GFP. The assay, Fig 1, uses a HIV-2 vector construct with
a mutated Env gene, which limits the virus on replication
cycle. 93T cells are used to produce the virus, which is used
to infect target cells, U373-MAGI-CXCR4C E M cells.
The expression of target genes is assessed by flow cytometry
to determine mutation frequency.
The two target genes, HSA and GFP, were used to
simultaneously detect HIV infectivity and mutation
frequency. To determine mutation frequency, the flow data
were divided into four quadrants based on the expression
of GFP and/or HAS (Fig 2). Cells infected with the wildtype HIV-2 construct were expected to express both GFP
and HSA, whereas cells infected with a mutant HIV-2
construct express either one or no marker gene. Cells that
express only one marker gene have been infected with
mutant HIV-2 that inhibits the expression of the other
marker gene. Therefore, cells infected with mutant HIV
were detected as cells expressing either HSA or GFP, but
not both. The relative mutation frequency was then
calculated as a fraction by dividing the percentage of cells
infected with mutant virus by the total percentage of cells
infected. Results shown in Table 1 demonstrate that HIV2 had an average mutant frequency of 0.239 ± 0.041 in
the first replication assay. Table 2 shows that HIV-2
produced an average mutant frequency of 0.273 ± 0.033
in a second replication assay. Once HIV-2Q151M mutants
are generated, we can produce a HIV-2 resistant virus and
repeat replication assay protocol to observe if resistanceconferring mutations influence HIV-2 mutation frequency.
RESULTS
a)
Resistance conferring mutations have been shown to
increase mutation rate of HIV-1. Since HIV-1 and HIV-2
have similar reverse transcriptase, we asked if HIV-2
resistant RT would influence the mutation rate of HIV-2.
Mutation rate determines how many mutations are
occurring per replication cycle and contributes to the
emergence of drug resistance in HIV. To examine mutation
44
Mondraya Howard
HIV-1 Resistant Conferring Mutations
Pharmacy
b)
FIG. 2. Flow data of single round replication assay use to assess
the mutation frequency. (a) Flow data from 1st replicate. (b) Flow
data from 2nd replicate Flow data were divided into 4 quadrants
based on expression of HSA and GFP genes. Mutation frequency
was calculated by dividing the number of cells infected with
mutant virus (Q4) by the total number of infected cells (Q1Q13). Values from this calculation expressed the mutation
frequency in each replicate (Table 1, 2).
2
HIVAverage %
2Replicate infection
(n=3) ± sd
Average mutant χ (df = 1) p-value
frequency
(n=3)± sd
1st
replicate
19.6 ±4.1
0.239 ±0.041
12.52
0.0004
2nd
replicate
12.0 ± 2.9
0.273 ±0.033
65.02
<0.0001
Table 1. Summary of infection percentage and mutant frequency
from flow cytometry data
DISCUSSION
HIV has a high mutation rate that introduces mutations
into the viral genome each replication cycle. The reverse
transcriptase enzyme is a major generator of mutations and
is a targeted enzyme in antiretroviral therapy. Antiretroviral therapy is frustrated when the virus develops
resistance to drugs. Resistance occurs from the accumulation of resistance conferring mutations. HIV-1 resistance
conferring mutations have been identified, but less is
known of HIV-2 mutations because of the limited spread
of the HIV-2. Clinical studies of HIV-2 infected patients
under NRTI treatment; found that HIV-1 resistance
conferring mutations also conferred resistance in HIV-2
(Boyer et al., 2006).
HIV-1 mutation rate increases in the presence of
antiretroviral drugs and antiretroviral resistant RT, because
the virus rapidly selects for resistant mutations (Mansky
and Bernard, 2002). Here, how NRTI-resistant RT
influence the mutation rate of HIV-2. Current results have
determined the average mutant frequency of HIV-2 to
0.239 ± 0.041 in the first replicate and 0.273 ± 0.033 in
the second replicate (Table 1, Table 2). Our next steps
include using site-directed mutagenesis to incorporate
HIV-1 resistance conferring mutations into HIV-2. We
will investigate how HIV-2 mutants influence factors that
contribute to the virus’ drug resistance such as drug
susceptibility to NRTIs and mutation frequency.
There is limited data on HIV-2 drug resistance and this
research project can provide a better understanding of HIV2 drug resistance. HIV-2 research is essential to the
development of potential treatment options for the HIV-2
infection. The current project also offers comparison of
genetic differences between HIV-1 and HIV-2, which is
important in understanding how and why the two virus
types are prevalent in different regions and exhibit different
infection rates.
REFERENCES
Boyer, P., Sarafianos, S., Clark, P., Arnold, E., and Hughes, S.
(2006). Why do HIV-1 and HIV-2 use different pathways to
develop AZT resistance? PLoS Pathogens. 2 (2), 101-111.
Clavel, F., Hance, A. (2004). HIV Drug Resistance. The New
England Journal of Medicine, 350: 1023-35.
Clouser, C., Patterson, S., and Mansky, L., (2010). Exploiting
Drug Reposition for Discovery of a Novel HIV Combination
Therapy. Journal of Virology, 84 (18), 9301-9309.
Descamps, D., Damond, F., Matheron, S., Collin, G., Campa, P.,
Delarue, S., Pueyo, S… Vezinet, F. (2004). High Frequency
of Selection of K65R and Q151M Mutations in HIV-2
Infected Patients Receiving Nucleoside Reverse Transcriptase
Inhibitors Containing Regimen. Journal of Medical Virology.
74, 197-201.
Hizi, A., Tal, R., Shaharabany, M., and Loya, S. (1991). Catalytic
Properties of Reverse Transcriptase of Human Immunodeficiency Viruses Type 1 and Type 2. The Journal of Biological
Chemistry. 266 (10), 6230-6239.
Isel, C., Ehresmann, C., Walter, P., Ehresmann, B., and Marquet,
R. (2001). The Emergence of Different Resistance
Mechanisms toward Nucleoside Inhibitors is explained by
the Properties of the Wild Type HIV-1 Reverse Transcriptase.
The Journal of Biological Chemistry. 276 (52), 48725-48732
Mansky, L., and Bernard, L. (2000). 3-Azido-3’ -Deoxythymidine
(AZT) and AZT-Resistant Reverse Transcriptase Can Increase
the In Vivo Mutation Rate of Human Immunodeficiency
Virus Type 1. Journal of Virology, 74 (20), 9532-39.
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Mansky, L., Pearl, D., and Gajary, L., (2002). Combination of
Drugs and Drug-Resistant Reverse Transcriptase Results in
a Multiplicative Increase of Human Immunodeficiency Virus
Type 1 Mutant Frequency. The Journal of Virology, 76(18),
9253-59.
Menendez-Arias, L. (2002). Targeting HIV: antiretroviral
therapy and development of drug resistance. TRENDS in
Pharmacological Sciences. 23 (8), 381-387.
Menendez- Arias, L. (2008). Mechanisms of resistance to
nucleoside analogue inhibitors of HIV-1 reverse transcriptase.
Virus Research, 134, 124-146.
Rhodes, B., Holguin, A., Soriano, V., Dourana, M., Mansinho,
K., Antunes, F., and Gonazalez, J. (2000). Emergence of
Drug Resistance Mutations in Human Immunodeficiency
Virus Type 2- Infected Subjects Undergoing Antiretroviral
Therapy. Journal of Clinical Microbiology, 38: 1370-74.
Sarafianos, S., Das, K., Hughes, S., and Arnold, E. (2004).
Taking Aim at a Moving Target: Designing Drugs to Inhibit
Drug- Resistant HIV-1 Reverse Transcriptases. Current
Opinion in Structural Biology, 14: 716-30.
Smith, R., Gottlieb, G., Anderson, D., Pyrak, C., and Preston,
B. (2008). Human Immunodeficiency Virus Types 1 and 2
Comparable Sensitivities to Zidovudine and Other
Nucleoside Analog Inhibitors In Vitro. Antimicrobial
Agents and Chemotherapy, 52: 329-32
Smith, R., Anderson, D., Pyrak, C., Preston, B., and Gottlieb,
G. (2009). Antiretroviral Drug Resistance in HIV-2: Three
Amino Acid Changes Are Sufficient for Classwide Nucleoside
Analogue Resistance. The Journal of Infectious Diseases. 199,
1323-1326.
Tavassoli, A. (2011). Targeting the protein- protein interactions
of the HIV Lifecycle. Chemical Society Reviews, 40, 1337-1346
Van der Ende, M., Guillon, C., Boers, P., Ly, T., Gruters, R.,
Osterhaus, A., and Schutten, M. (2000). Antiviral Resistance
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of Acquired Immune Deficiency Syndromes (JAIDS). 25. 11-18.
46
ABSTRACT
Food waste in the United States is contributing to serious environmental, economic, and
social distress. Individual consumers have the potential to combat food waste through a
variety of simple mitigation practices. An important unanswered question is what would
motivate Americans to waste less food. The current research adapted methods used by
Nolan et al. to explore stated motivations for conserving energy. As in the Nolan et al.
study, we presented 239 participants with either an information-only message or one of
four messages describing a reason to reduce food waste: environmental, financial self
interest, social responsibility, and descriptive social norm. In addition, we tested whether
the addition of a striking image of food waste made the message more motivating.
Different from the case of energy conservation, our participants reported that the financial
self-interest message was most motivating. However, the result of this study demonstrated
that participants expressed similar motivations to reduce food waste as they did to conserve
energy. Future research will examine whether a further pattern found in energy
conservation also holds true for reducing food waste: that though people do not express
explicit motivation from a social norm message, it has the highest influence on actual
behavior.
WASTE(LESS): A
PSYCHOLOGICAL
APPROACH TOWARD
REDUCING FOOD
WASTE
America is a nation that throws away almost half of its food (Stuart, 2009).
This enormous amount of food waste endangers the environment, the economy,
and society. One of the most severe environmental problems with food waste
is the fact that food waste in landfills is one of the leading sources of methane,
a harmful greenhouse gas contributing to global warming. From an economic
standpoint, many Americans cannot financially afford to waste money during
a recession, yet spend money on food that ultimately gets thrown into the
garbage. Finally, food waste is a social problem: How is it that in a country
concerned with nationwide obesity, millions go without being able to eat each
day? The United States’ food waste habits are contradictory to its goals of
protecting the environment, gaining financial stability, and being a responsible
society.
BLOOM’S THREE: WHY FOOD WASTE MATTERS
Food waste is pervasive in America, and occurs at all stages of American
food production and consumption. In his book American Wasteland, Jonathan
Bloom (2010) explains how food is wasted throughout the agricultural process,
beginning at the farm and ending with consumers. First, harvesters must pick
through their crops and select only the best produce to sell to markets. The
remaining crops are often hauled off to landfills where the potentially edible
food is dumped and left to rot. The long travel period of most produce leads
to more food waste. By the time the produce reaches the market, grocers must
perform another pick through and discard produce that does not meet their
premium standards. Finally, consumers purchase fruits and vegetables, use a
portion of what is purchased, and throw away what goes bad, what is not
wanted, or both. Considering only what is thrown away at home, an average
American wastes an annual total of 197 pounds of food, about the weight of
Bridgette Kelly ’12
University of St. Thomas
Mentor
Christie Manning, Ph.D.
Visiting Assistant Professor of
Environmental Psychology
Macalester College
47
UST McNair Scholars Program Research Journal
an average American man (Center for Disease Control and
Prevention, as cited in Bloom).
Bloom highlights three compelling reasons why
Americans should care about food waste:
Environmental Impact The majority of food being thrown
away is not recycled or recovered, meaning the majority of
food waste ends up in landfills (Environmental Protection
Agency [EPA], 2011). When food decomposes in landfills
it creates methane, a harmful greenhouse gas. Methane
traps heat more effectively than carbon dioxide, meaning
methane emissions may contribute to global warming even
decades from now (Bloom, 2010). Multiple EPA reports
detail alarming facts about the consequences related to
these landfills. In 2007, the EPA reported food scraps to
account for 19 percent of the waste Americans dumped
into landfills, making it the second most disposed item in
landfills behind paper waste (as cited by Bloom). The most
current information identifies landfills as a leading source
of human related methane emissions in the United States
(EPA, 2011). There are also concerns regarding the
potential for landfill toxins to leach into surrounding
bodies of water, which would pollute the drinking supply
of nearby inhabitants (Bloom). Reducing food wasted in
America is one way to combat global warming and
environmental degradation.
Economic Significance Wasting food translates to wasting
money. With a family of four discarding an estimated 1525 percent of the food purchased each year, financial losses
are estimated to be between $1,350 and $2,200 (Bloom,
2010). American consumers are also paying an increased
price for food wasted throughout the food chain, as it is
built into the price of our groceries. Farmers produce the
amount of crops necessary to supply the amount of food
demanded by consumers. The more food wasted by
consumers, the higher the demand for more food to be
supplied. Our current agricultural system is mostly
dependent upon expensive technology, such as pesticides,
which is predicted to drive up the price of all produce
(USDA, 2010). Cutting down on the amount of food our
country grows each year would lead to reducing the
amount of money needed to produce it. One calculation
estimated a rough total annual cost in the United States to
be $160 billion in squandered food costs (Bloom, 2010).
This cost for Americans should encourage waste avoidance.
The amount of money being lost due to squandered food
48
is shocking, but it is also preventable if consumers change
their wasteful habits.
Societal Dilemma In a country where virtually half of the
food being produced is wasted, there are still 35 million
Americans living in households without sufficient food
access (Stuart, 2009). In 2008, 15 percent of Americans
did not have enough to eat at some point in the year and
22 percent of children in America lived in homes lacking
food security (Bloom, 2010). Both food waste and food
insecurity exist within the United States, one of the
wealthiest countries in the world. Part of the problem is
the unequal distribution of resources. Recovering a portion
of the food wasted in this country could potentially feed
millions of Americans (EPA, 2011).
These three reasons alone should provide strong
motivation for Americans to change their food wasting
ways. Strong efforts to mitigate food waste in the United
States must occur now. Consumers have the ability to
reduce food wasted in their households even though food
wasted during agricultural production, transport, and
processing is outside of their control. Currently, though
most American households throw away a substantial
amount of food that could have been eaten, most do not
recognize it as a major problem or feel the need to address
it. How can the issue of food waste be brought to American
households’ attention and create a national effort toward
reducing food waste? How can the problem be
communicated in a way that will provoke Americans to
take action?
Successful efforts to reduce food waste have been made
in other countries. For example, the Japanese government
passed the Food Waste Recycling Law in 2001 which
demanded food businesses to recycle 48 percent of their
food waste by 2006, which resulted in 59 percent
commercial and industrial food waste recycling (Stuart,
2009). This law has since been revised with a goal for
businesses to reach a recycling rate of 66 percent by 2012
(Stuart). Japan provides an example of how the government
is able to take an effective role in reducing national food
waste.
The UK has become another example of a country
dedicated to reducing its national food waste. Campaigns
such as Love Food, Hate Waste (LFHW) have
demonstrated success in aiding individuals to reduce their
food waste (www.lovefoodhatewaste.com/). The LFHW
Environmental Sciences
campaign was created to raise awareness about the issue of
food waste and reduce the amount of household food waste.
The Charter Institute of Waste Management (CIWM)
reported the two year LFHW campaign resulted in a
significant increase in the number of Manchester residents
taking action to reduce their food waste by 48.5 percent as
well as a 509 percent increase in traffic to the LFHW
website (CIWM, 2011). The website contains helpful
information regarding how to store food so it lasts longer,
ways to creatively use last night’s leftovers, and tips for
saving money on food bills. The amount of food wasted in
America would decrease if more of its citizens adopted
these simple behaviors. What would motivate Americans
to take this sort of action?
MOTIVATION
Almost every model for green behavior, those which
benefit the environment, includes an element of
motivation. Stern (2000) developed the Value-Belief-Norm
theory of environmentalism (VBN) in order to explain how
one’s motivations affect environmentally significant
behaviors. Environmentally significant behaviors can be
defined as actions with the intention of benefitting the
environment. VBN suggests that values and beliefs are
important in determining behavior. For example, if a
person values the environment, and believes food waste
harms the environment, then the individual will be more
motivated to change his behavior around food waste.
Furthermore, VBN suggests one’s personal and social
norms have a significant effect on motivation. Similarly,
the theory of planned behavior identifies intention as the
central element used to predict behavior (Azjen, 1985).
Motivational factors drive intention and determine the
extent to which someone is willing to act. Clayton and
Brook (2005) have proposed a model for conservation
psychology that suggests personal motives are an important
element in addressing environmental problems. Since
personal motives are one of the drivers of behavior,
environmental issues are framed to reflect relevance to an
individual’s personal motives in hopes of increasing proenvironmental behaviors. Understanding which
motivations are the most influential on behaviors allows
policy makers, government organizations, and individuals
Bridgette Kelly
Reducing food waste
to promote pro-environmental information to the public
in a way that will elicit increased compliance.
What would motivate the American public to reduce
food waste? According to Bloom (2010), there are three
important reasons why food waste should be decreased:
environment, economy, and social justice. However, do
these reasons motivate people to reduce the amount of food
they waste? Past research examining motivation to conserve
energy confirms people do consider these three reasons
(environment, economy, and social justice) to be
motivating. Nolan, Schultz, Cialdini, Goldstein, and
Griskevicius (2008) asked participants to rate how
important it was that using less energy protected the
environment, saved money, benefited society, and mirrored
many other people trying to conserve on a scale from 1 (not
at all important) to 4 (extremely important). Participants
rated environmental protection highest among the four
reasons to conserve energy followed by benefitting society
and saving money. Interestingly these highest three rated
reasons for energy conservation align with the reasons for
why people should care about food waste. The findings
from this study demonstrate an experimental framework
that can be used to address the issue of food waste.
While the environment, finances, and social
responsibility may be motivating for some, research in
social psychology has identified a more powerful motivator
for green behaviors: the social norm. Social norms are the
stated or implied rules society has for acceptable behaviors
(Aronson, Wilson, Akert, 2010). If green behaviors are seen
as acceptable or encouraged by society, then people are
more likely to perform the behavior.
Assessing one’s own behaviors based on the behaviors of
others is a form of social proofing. The Principle of Social
Proof states people look at what others around them believe
and do in order to decide what they should believe or do
and has been noted as a main factor for influencing
behaviors among individuals (Cialdini, 2009).
In fact, in the Nolan et al. study (2008), while
participants rated “a lot of other people conserving” (p.915)
as the least influential motive out of the four, a follow-up
analysis determined individuals’ conservation behaviors
showed the strongest correlation with their beliefs
regarding their neighbors’ conservation efforts. These
findings suggest that beliefs about the standards performed
49
UST McNair Scholars Program Research Journal
and held by others, social norms, are especially motivating
to our own behaviors.
People are more likely to engage in a behavior if they
perceive many others in the same situation behave a certain
way (Cialdini, 2009). In a second study conducted by
Nolan and colleagues (2008), an experimental design was
used to determine which forms of motivational messages
were most effective to actually reducing participants’ home
energy use. The households received either a self-serving
(financial), environmental, social responsibility (ethical),
information only (control), or descriptive normative
message. The descriptive normative messages informed
households that the majority of neighborhood residents
were making an effort to conserve energy in some way.
Meter readings were used to measure the energy used by
the households. Over the next month, the households that
received the descriptive norm messages used less energy
than all of the households in other conditions combined.
These findings provide strong evidence for the effectiveness
of normative messages on changing people’s behaviors.
Other research has also found social norms and
normative pressure to be effective in promoting proenvironmental behavior change. Griskevicius, Tybur, &
Van (2010) found consumers purchased “green” products
more often when in public than when in private,
suggesting that for many people green consumption is
done more for public acceptance than as an altruistic act
on the behalf of the environment. In another study,
conducted by Schultz (1999), descriptive normative
information, how we believe most people behave in a
situation, was the most powerful influence on people’s
behavior. The study found that when information was
given to households regarding the amount recycled by a
neighborhood family, the amount and frequency of
curbside recycling behaviors of other neighbors increased.
Finally, a study by Goldstein, Cialdini, and Griskevicius
(2008) found that hotel guests reused their towels 23
percent more when normative messages were displayed in
the bathroom promoting towel reuse compared to when no
message was present. These results demonstrate that people
are motivated to change their behaviors when they are
influenced by normative information.
It appears that social norms and normative messages can
influence a range of “green” behaviors, however, no study
to date has addressed whether normative information
50
might motivate people to reduce their food waste. There
are strong social, environmental, and economic reasons why
people should be motivated to waste less food. Are these
reasons strong enough? In the Nolan et al. study (2008),
the social, environmental, and economic reasons for
conserving energy were often cited, but in fact a normative
message about energy conservation was the most influential
when it came to actual behavior. Is it possible that the same
is true for the issue of food waste? The current study is a
partial replication of the second Nolan et al. study to
examine motivations for reducing food waste. We
hypothesized, following Nolan et al.’s results, normative
messages regarding food waste would be rated as the least
motivational and the environmental and social
responsibility messages would be rated as the most
motivational.
PSYCHOLOGICAL DISTANCE
The current study is based on prior research by Nolan
and colleagues’ (2008) investigation into motivations to
conserve energy. Nolan et al. used a single item dependent
variable asking people how motivated they were by the
particular energy conservation message they had received.
The current study includes this item but also includes two
additional measures: salience and abstraction.
A 19-item scale that assesses personal engagement/salience regarding food waste and institutional
affiliation was included in the survey. Food waste is an issue
that may not seem relevant to the American public. Food
waste does not present a direct threat like war, weather, or
a faltering economy. Thus, it is not an issue people think
much about. By measuring personal salience, we can see
whether messages about food waste make the issue more
relevant and psychologically present.
People do not see polluting landfills, starving people,
or wasted money as a result when they throw away food.
Thus, the idea of wasted food being a problem remains
abstract. An abstract problem is not as emotionally
engaging and is less likely to result in action (Marx, Weber,
Orlove, Leiserowitz, Krantz, Roncoli & Phillips, 2007) A
scene becomes less abstract when individuals are presented
with a visual representation of the scene (Henderson,
2005). Therefore, a second variable tested in this study was
Bridgette Kelly
Reducing food waste
Environmental Sciences
the effect of an image of food waste. We hypothesized
presenting participants with a picture of wasted food would
make the issue less abstract, more concrete, and more
personally engaging and salient than if they did not have
a visual representation of food waste. Thus, participants
presented with a message including a scene of food waste
should report being more motivated to reduce their food
waste than those presented with messages not including
the picture.
MITIGATING COLLEGE CAMPUS FOOD WASTE
Relatively little research has been done on food waste in
the U.S., but the issue is gaining the attention of certain
thoughtful, young activists throughout the nation. The
current study was conducted on a college campus. Though
food waste is not an issue that has gained much attention
in households in the U.S., there has been a growing
movement to reduce food waste on college campuses (G.J.,
2005; Hattam, 2007; Sullivan, 2010). Efforts include
promotional campaigns geared at reducing food waste,
removing trays in the cafeterias to lessen the amount of
food taken by students, and displaying a day’s worth of
cafeteria food waste to show students how much they are
wasting.
College is a time in life when young adults have new
experiences in ambiguous situations. People most often
look at others around them when deciding how to behave
in ambiguous situations, especially when they feel those
people share similarities with them (Cialdini, 2007). The
college atmosphere fosters both of these elements, thus
looking to others to provide information on how to
properly behave will often be employed during college.
Students form lifestyle habits that will predict their future
behaviors (Neal, Wood, & Quinn, 2006), making it
important to mitigate their food waste habits as early as
possible. Furthermore, younger generations have been
reported to be less involved in pro-environmental behaviors
(i.e. energy conservation) than older generations (Nolan,
Schultz, Cialdini, Goldstein, and Griskevicius; 2008),
making it even more important to investigate college
students’ motivations to reduce food waste.
The proactive role taken by college students about the
issue of food waste suggests there is already an infra-
structure in place. This provides an opportunity to increase
involvement in reducing food waste through understanding attitudes, current behaviors, and motivations to
reduce food waste stated by students. These young adults
may eventually become the leaders, decision makers, and
work force in the U.S. Knowing how to captivate this
audience to reduce the amount of food they waste would
be a pivotal step toward a waste(less) society in the future.
This project endeavored to find effective ways of
communicating the food waste issue to the public. This
project sought to do three things: 1) Identify which
messages college students rate as the most motivating to
reduce their food waste, 2) Determine whether a picture of
food waste affects reported motivations to reduce food
waste, and 3) Determine whether personal relevance of a
message is correlated with participants’ rated motivation.
METHOD
INFORMAL STUDENT POLL
The researcher first conducted an informal poll of 20
undergraduate students from the University of St. Thomas
and Macalester College. The participants were contacted
via a facebook message. The message informed students
that participation in the poll was voluntary, answers would
remain anonymous, and the purpose of the poll was to
provide the researcher with information regarding
students’ current efforts to reduce food waste. Participants
were then directed to a Qualtrics survey link that asked
“Do you try not to leave uneaten food on your tray when
you bring it to the dish room in order to reduce the amount
of food you waste?” The participants answered either “yes”
or “no.” The percentage of students that answered “yes”
served as a statistic utilized in the descriptive norm
intervention during the study.
INTERVENTION AND PSYCHOLOGICAL DISTANCE SURVEY
Participants Undergraduate students at the University of
St. Thomas, Minnesota volunteered to participate in this
study. No particular age, gender, or ethnicity was targeted
for this study. Students were recruited through a variety of
methods. A posting in the campus’s daily online bulletin
advertised the study, listed the researcher’s contact
51
UST McNair Scholars Program Research Journal
information, and provided a link to the online survey.
Posting the study in the daily online bulletin allowed the
researcher to contact students not on campus during the
summer session. Paper posters were placed near campus
dining halls, student centers, and residence halls. Finally,
the researcher created a facebook invitation to recruit
volunteers for the anonymous online survey. Each of the
recruitment methods informed students of a drawing for
two $25 gift cards to the campus bookstore upon
completion of the survey.
MATERIALS AND PROCEDURE
The study methods were adapted from procedures used
by Nolan and colleagues (2008) in their experiment (Study
2) examining California residents’ motivations to conserve
energy. Qualtrics Survey Software hosted the online survey.
Participants logged on and were presented with a consent
form that included the purpose of the study, contact
information of the researcher, and the option to withdraw
from the study at any point. After indicating their consent
to participate, students were randomly assigned to an
experimental condition in which they were presented with
a scenario and then asked to answer a set of questions. The
study used a 2x5 factorial design. The first independent
variable, with two levels, was the presence or absence of an
image accompanying the text scenario. The second
independent variable was the type of message. There were
five message conditions, each presenting a different reason
for reducing wasted food: descriptive norm, self interest
(economic), environment, social responsibility, or
informational control. All message conditions except the
information only conditions contained motivational
information as to why the student should reduce the
amount of food they waste. In addition to varying the
message, half of the participants were shown a picture of
food waste in a cafeteria setting, while the other half
received no picture along with the message (see Figure 1).
Each participant was then asked “How much did the
information provided motivate you to reduce the amount
of food you waste?” They then responded to a series of
statements to assess their perceived psychological distance
to the issue of food waste. The set of 19 statements
described their personal reactions to the idea of food wasted
on campus and students indicated their level of agreement
with each one. As part of the personal reactions measure,
52
participants then were asked to write-in three words that
came to mind when they thought of food waste. Finally,
the survey concluded with a demographic section to give a
general picture of who took the survey. When participants
reached the end of the survey, they read a message thanking
them for their participation and were shown a debriefing
page.
RESULTS
These preliminary results are based on 239 responses.
Participants were asked “How much did the information
in this message motivate you to reduce food waste on
campus?” with responses ranging from 1 (not at all) to 4
(extremely). Participants rated the environmental message
(M = 2.35, SD = .80) as the most motivational for
conditions with no picture present, followed by the
financial self interest message (M = 2.29, SD = .64) and
the social responsibility message (M = 2.25, SD = .55).
The descriptive social norm message (M = 2.05, SD = .80),
and the informational control message (M = 1.95, SD =
.70) were rated as the least motivational by participants for
conditions with no picture present.
Participants rated the financial message (M = 2.62, SD
= .88) as the most motivational for conditions with a
picture present, followed by the social responsibility
message (M = 2.56, SD = .77) and the environmental
message (M = 2.25, SD = .99). Once again, the descriptive
social norm message (M = 2.16, SD = .69) and the
informational control message (M = 1.96, SD = .82) were
rated as the least motivational by participants for
conditions with a picture present.
Overall, participants rated the financial messages (M =
2.47, SD = .79) as being the most motivational, followed
by the social responsibility messages (M = 2.42, SD = .69)
and the environmental messages (M = 2.31, SD = .88).
Participants rated the descriptive social norm messages (M
= 2.12, SD = .73) and the informational only messages (M
= 1.95, SD = .76) as being the least motivational overall
(refer to Table 1).
Pairwise comparisons showed that the scores for the
information control conditions were significantly lower
than those in the financial self interest conditions (t = .503, p = .003), the environmental conditions (t = -.350,
Environmental Sciences
p = .030), and the social responsibility conditions (t = .453, p = .007) but not significantly different from the
descriptive social norm conditions. These comparisons also
showed that the scores for the descriptive social norm
conditions were significantly lower than those in the
financial self interest conditions (t = -.351, p = .029) but
not significantly different from the environmental
conditions, the social responsibility conditions, and the
informational control conditions (see Table 2).
An ANOVA showed that, overall, the presence of a
picture of food waste did not have significant effect on
rated motivations (F (1, 229) = 1.72, p = .19), as there was
not a significant difference between picture present
conditions (M = 2.31, SE =.07) and no picture present
conditions (M = 2.18, SE = .08) (refer to Table 3).
However, the ANOVA did show that message type had a
significant effect on motivation ratings (F (4,161) = 2.81
= p < .05) (refer to Table 4).
These results did not address the set of 19 statements
describing participants’ personal reactions to the idea of
food wasted on campus, nor did they address the three
words participants wrote in as ones that came to mind
when they thought of food waste.
DISCUSSION
The results show that message type has a significant
affect on participants’ rated motivation to reduce food
waste on campus. These results cannot confirm that the
presence of an image displaying food waste has a significant
affect on participants’ rated motivations to reduce food
waste on campus. With a larger number of participants the
influence of image on motivation may have become clearer.
While no definitive statements can be made regarding the
image presence conditions, there are speculations as to
which messages may be most affected by presenting a
picture of food waste.
The financial self-interest and social responsibility
messages demonstrated the greatest differences between
the no picture present and picture present conditions (see
Figure 2). One explanation for this may be that participants
found the financial and social responsibility messages with
a picture to have provided them with the most experiential
learning (Marx et al, 2007). As a result of the experiential
Bridgette Kelly
Reducing food waste
learning, participants may be able to conceptualize
financial loss and nationwide hunger easier than they could
conceptualize environmental degradation, social
comparison, and straightforward information. Further
exploration is necessary to affirm any of these assumptions.
Collapsing the data across variables to focus on the
significant variable, message type, shows that the financial
self interest, social responsibility, and environmental
messages were rated as the most motivational by
participants, and the descriptive social norm and the
informational only messages were rated as being the least
motivational (see Figure 3). These findings partially
supported my first hypothesis that the social responsibility
message would be rated as one of the most motivating
messages. However, the environmental message was rated
as the third most motivating message and the financial selfinterest message reported higher motivational ratings
among participants than the social responsibility message.
This may be because college students are slightly more
concerned with financial hardship than hunger in America
at this point in their lives. These students may also not be
as familiar with hunger in America as they are with
financial stresses.
The results did not support my hypothesis that the
descriptive social norm message would be rated as the least
motivational. This may be due to the fact that wasting food
is not a topic which is discussed as frequently as energy
conservation. Energy conservation has become a behavior
which is considered to be positive due to the popularization
of “going green” campaigns. However, food waste has not
been as heavily focused upon in these conservation efforts;
therefore, participants may not have automatically
considered the action itself to be motivating. Though, it
is noteworthy that these messages were still rated as being
less motivating than the environmental, financial, and
social responsibility messages, following a similar pattern
to the results of the Nolan et al. (2008) study.
Limitations included a lack of participants due to the
time constraints. The researcher would have liked to collect
300 participant responses total to conduct a final analysis
of the data. Also, students may not wish to take the time
for the survey. The researcher also found difficulty in
recruiting St. Thomas students during the summer months
since not as many students were on campus.
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UST McNair Scholars Program Research Journal
A next step to this research will be to implement the
motivational messages at dining locations and determine
which of the messages will actually elicit the most
reduction in food wasted by students. A further interest is
whether the stated motivations will be the same as the
actual behaviors demonstrated in the dining halls.
Future analysis will also focus on the psychological
distance questions proposed during the study. The
researcher is interested to see whether rated personal
relevance to a message increased the rated motivation of
the message. Food waste is psychologically distant.
According to Construal Level Theory (CLT; Trope,
Liberman, & Wakslak, 2007) things that we do experience
as not personally relevant and not happening in the here
and now are subjectively felt as “distant.” Psychologically
distant events or issues are represented in the brain
differently than events or issues subjectively perceived as
near (psychologically near). Psychologically near events or
issues are represented in concrete, sensory detailed features
called low-level construals, whereas psychologically distant
events or issues are represented in abstract features called
high-level construals (Trope, Liberman & Wakslak). An
exploratory hypothesis is the more psychologically near the
issue of food waste feels to people, the more likely they will
be motivated to reduce their food waste.
CONCLUSION
The amount of food wasted in the United States has
reached an excessive volume. Combating this issue will
benefit our environment, the economy, and society. Thus
far, the United States has not demonstrated practices which
would nationally reduce food waste. Food waste mitigation
policies must be implemented in order to gain success in
this consumer battle. Becoming a waste(less) society will
take the efforts of the people purchasing and consuming
products.
This research is a first step toward providing a
framework for addressing the national food waste issue.
The stated motivations to reduce food waste demonstrate
similar patterns as stated motivations to conserve energy.
Thus, the method used to determine how to elicit energy
conservation behavior (Nolan et al., 2008) can be used to
further explore how to reduce food waste.
54
In conclusion, it is necessary to continue explicit research
which addresses the issue of food waste in order to provide
more accurate results and propose which steps to take in
the future. Implementing these motivational messages in
a real world context is a direction which will assist in
deepening the body of knowledge surrounding food waste
mitigation.
REFERENCES
Ajzen, I. (1985). From intentions to actions: A theory of planned
behavior. In J. Kuhi & J. Beckmann (Eds.), Action.control:
From cognition to behavior (pp. 11.39). Heidelberg: Springer.
Aronson, E, Wilson, T. D., Akert, R. M. (2010). Social Psychology.
Upper Saddle River, NJ: Prentice Hall.
Bloom, J. (2010). American wasteland. Cambridge, MA: Da
Capo Press.
Charter Institute of Waste Management. (2011, June 6). Love
Food Hate Waste Campaign Success. Retrieved from
http://www.ciwm.co.uk/CIWM/Publications/LatestNews/Lo
veFoodHateWasteCampaignSuccess.aspx
Cialdini, R. B. (2007). Influence: The psychology of persuasion. New
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Clayton, S., & Brook, A. (2005). Can psychology help save the
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Issues and Public Policy (ASAP), 5(1), 87-102. doi:10.1111/
j.1530-2415.2005.00057.x
Environmental Protection Agency. (2011, July 26). Food Waste.
Retrieved from www.epa.gov/wastes/conserve/materials/
organics/food/
G., J. (2005). Making the right connections to food loss Retrieved
from ezproxy.stthomas.edu/login?url=http://search.ebscohost
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=ehost-live
Goldstein, N. J., Cialdini, R. B., & Griskevicius, V. (2008). A
room with a viewpoint: Using social norms to motivate
environmental conservation in hotels. Journal of Consumer
Research, 35(3), 472-482. doi:10.1086/586910
Griskevicius, V., Tybur, J. M., & Van, d. B. (2010). Going green
to be seen: Status, reputation, and conspicuous conservation.
Journal of Personality and Social Psychology, 98(3), 392-404.
doi:10.1037/a0017346
Hattam, J. (2007). Go big green. Sierra, 92(6), 32-33. Retrieved
from http://ezproxy.stthomas.edu/login?url=http://search.
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4301&site=ehost-live
Henderson, J. M. (2005). Introduction to real-world scene
perception. Visual Cognition, 12(6), 849-851. doi:10.1080/
13506280444000544
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Hodges, B. (2009). Ecological pragmatics: Values, dialogical
arrays, complexity, and caring. Pragmatics & Cognition, 17(3),
628-652
Marx, S., Weber, E., Orlove, B., Leiserowitz, A., Krantz, D.,
Roncoli, C., & Phillips, J. (2007). Communication and
mental processes: Experiential and analytic processing of
uncertain climate information. Global Environmental Change,
17(1), 47-58.
Neal, D. T., Wood, W., & Quinn, J. M. (2006). Habits—A
repeat performance. Current Directions in Psychological Science,
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Nolan, J. M., Schultz, P. W., Cialdini, R. B., Goldstein, N. J., &
Griskevicius, V. (2008). Normative social influence is
underdetected. Personality and Social Psychology Bulletin, 34(7),
913-923. doi:10.1177/0146167208316691
Schultz, P. W. (1999). Changing behavior with normative
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Stern, P. C. (2000). Toward a coherent theory of environmentally
significant behavior. Journal of Social Issues, 56(3), 407-424.
doi:10.1111/0022-4537.00175
Stuart, T. (2009). Waste: uncovering the global food scandal.
New York, NY: W. W. Norton & Company, Inc.
Sullivan, D. (2010). College students initiate food waste
diversion. BioCycle, 51(9), Retrieved from www.jgpress.com/
archives/_free/002159.html
Trope, Y., Liberman, N., & Wakslak, C. (2007). Construal levels
and psychological distance: Effects on representation,
prediction, evaluation, and behavior. Journal of Consumer
Psychology (Lawrence Erlbaum Associates), 17(2), 83-95.
doi:10.1080/10577400701242227
United States Department of Agriculture. (2010, March 18).
Agricultural Research and Productivity: Background.
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background.htm
Waste Resources and Action Programme (2011, June) Love Food
Hate Waste. Retrieved from www.lovefoodhatewaste.com/
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UST McNair Scholars Program Research Journal
Table 1. Mean Ratings (1-4) for Image Presence and Message Types: How much did the information in this message motivate you to
reduce food waste on campus?
Image present or not
present
Message Type
Std.
Deviation
Mean
N
No picture present
Social norm message
Financial message
Environmental message
Social responsibility
Information only message
Total
2.07
2.33
2.38
2.27
1.89
2.23
.884
.686
.824
.594
.782
.763
15
18
24
15
9
81
Picture present
Social norm message
Financial message
Environmental message
Social responsibility
Information only message
Total
2.08
2.73
2.38
2.61
2.00
2.36
.717
.884
.973
.778
.739
.852
24
15
21
18
12
90
Total
Social norm message
Financial message
Environmental message
Social responsibility
Information only message
Total
2.08
2.52
2.38
2.45
1.95
2.30
.774
.795
.886
.711
.740
.811
39
33
45
33
21
171
56
Bridgette Kelly
Reducing food waste
Environmental Sciences
Table 2. Pairwise Comparisons of Means between Message Types
(I) Message Type
(J) Message Type
Mean
Difference
(I-J)
Std. Error
Sig. a
Social norm message
Financial message
Environmental message
Social responsibility
Information only message
-.458
-.303
-.364
.131
.191
.177
.191
.219
.018
.089
.059
.553
Financial message
Social norm message
Environmental message
Social responsibility
Information only message
.458*
.155
.094
.589*
.191
.183
.197
.224
.018
.398
.633
.010
Environmental message
Social norm message
Financial message
Social responsibility
Information only message
.303
-.155
-.061
.434*
.177
.183
.183
.212
.089
.398
.740
.043
Social responsibility
Social norm message
Financial message
Environmental message
Information only message
.364
-.094
.061
.494*
.191
.197
.183
.224
.059
.633
.740
.029
Information only message
Social norm message
Financial message
Environmental message
Social responsibility
-.131
-.589*
-.434*
-.494*
.219
.224
.212
.224
.553
.010
.043
.029
* indicates significance at p < .05
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UST McNair Scholars Program Research Journal
Table 3. Effectiveness of Message Type on Motivation Ratings
Sum of
squares
Contrast
Error
+
Mean
Square
df
7.155
4
1.789
102.377
161
.636
F
2.813
Sig.
Partial Eta
Squared
.027+
.065
Noncent.
Parameter
11.253
Observed
Power a
.759
indicates significance at p <.05
Table 4. Effectiveness of Image Presence on Motivation Ratings
Sum of
squares
Contrast
Error
Mean
Square
df
1.212
1
1.212
102.377
161
.636
F
1.905
Sig.
Partial Eta
Squared
.169
.012
Noncent.
Parameter
1.905
Note: effectiveness of image presence is approaching significance at p=.169
Figure 1. Image of Food Waste for Picture Present Conditions
www.cbc.ca/news/canada/prince-edward-island/story/2010/12/16/pei-upei-trayless-cafeteria-584.html
58
Observed
Power a
.279
Bridgette Kelly
Reducing food waste
Environmental Sciences
Figure 2. Estimated Marginal Means of “How much did this information motivate you to reduce food waste on campus?” for message
type and image status
Figure 3. Estimated Marginal Means of “How much did this information motivate you to reduce food waste on campus?” for only
message type.
Descriptive social norm
message
Financial self interest
message
Environmental message
Social responsibility
Message
Information control
message
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UST McNair Scholars Program Research Journal
APPENDIX
INTERVENTION MESSAGES
Descriptive Social Norm: Join other St. Thomas students
in reducing food waste on campus. A new school year will
begin soon and college students all over the U.S. are
making an effort to reduce their food waste. How are
students reducing their food waste? By not leaving uneaten
food on their trays when they bring them to the dish room.
Why? According to a recent poll, 8 out of 10 of students
reported that they try not to leave uneaten food on their
trays in order to reduce the amount of food they waste.
Taking only what will be eaten-the popular student choice.
Financial Self-Interest: Save money by reducing food waste
on campus. A new school year will begin soon and the time
is right for saving money on your student bill. How can
you save money? By not leaving uneaten food on your tray
when you bring it to the dish room. Why? According to
recent research, universities have saved up to $100,000 for
the school year by reducing costs relating to food waste.
Savings like this can prevent your meal costs from
increasing each school year, giving you extra cash to keep
in your pocket.
Environmental: Protect the environment by reducing food
waste on campus. A new school year will begin soon and
the time is right for reducing greenhouse gases. How can
you protect the environment this school year? By not
leaving uneaten food on your tray when you bring it to the
dish room. Why? According to recent research, food waste
had the highest rate of methane yield in landfills, which
accounted for 23% of all methane emissions. Taking only
what will be eaten-the environmental choice.
Social Responsibility: Do your part to reduce food waste
for those suffering from hunger in our country. A new
school year will begin soon and we need to work together
to reduce food waste on campus. How can you reduce food
waste on campus and aid those suffering from hunger? By
not leaving uneaten food on your tray when you bring it
to the dish room. Why? According to recent research, if a
quarter of the food currently wasted was redistributed, it
could provide three meals per day for 43 million
Americans. Taking only what will be eaten-the socially
responsible choice.
60
Informational Control: Food waste reduction on campus.
A new school year will begin soon and the time is right to
reduce food waste on campus. How can you reduce food
waste on campus this school year? By not leaving uneaten
food on your tray when you bring it to the dish room.
ABSTRACT
This research discusses healthcare accessibility issues among the Hmong ethnic group in
the Twin Cities metropolitan area located in Minnesota. Research was based on the
geographical access to healthcare in the Hmong community. Through the Geographical
Information System (GIS), I predict that the Twin Cities’ Hmong community lacks
access to healthcare. The Hmong community, when mapped, was concentrated in two
particular locations in Minneapolis and Saint Paul. The use of GIS helped to project
statistical analysis of different aspects concerning healthcare such as healthcare facilities,
healthy and affordable food, and public transportation. These were analyzed by mapping
their distances from the Hmong community. Statistical analysis was examined by scatter
plots where the correlation between the Hmong community and where healthcare, food
sources, and public transportation was located were weak. Statistical analysis showed
that the Hmong community of the Twin Cities metropolitan area is centrally located.
Given the study area at the scaled researched (1km), the Hmong were not especially
isolated from healthcare, food, and public transportation. This showed that this
community is isolated but isolation is not a major factor shaping healthcare outcomes.
Other factors may contribute to the limitations in this community, such as cultural and
language barriers and health literacy.
HEALTHCARE
ACCESSIBILITY IN
THE TWIN CITIES
METROPOLITAN AREA
HMONG COMMUNITY
INTRODUCTION
The Hmong, an ethnic group from Asia, sought refuge in many nations,
including the United States of America, beginning in the late 1970s. Although
their origin is debatable because of their nomadic culture, history of wars,
persecution, and acculturation, they are thought to come from China. From
China, the Hmong settled in Southeast Asian counties such as Laos, Thailand,
Vietnam, and Burma. The U.S. arrived in Laos to defend the Laotian people
from Vietnamese Communists, and the U.S. Central Intelligence Agency
recruited the Hmong in Laos to fight alongside them. This was known as the
Secret War of Laos. The U.S. fled Asia in 1975 resulting in Hmong persecution
by the Laotian government. Many Hmong fled to Thailand by crossing the
Mekong River, settling among many refugee camps. From these refugee camps,
the Hmong people moved to many parts of the world, including the United
States. Today, the largest population of the Hmong outside of Asia is in
California, Wisconsin, and Minnesota.
The Hmong people are a unique community due to their different culture,
religion, and healthcare practices. One ongoing challenge of the Hmong
community is providing culturally acceptable healthcare while trying to reach
the goal of respecting the Hmong culture and also providing quality
healthcare.1 Many Hmong in America still resort to herbal medicine and
religious healing (shamanism), especially the elderly. Other Hmong individuals
are still uncertain of Western health practices and the effects of living and
eating Western food. In addition to healthcare concerns, the aspect of food in
Hmong culture is very different. A study done by Franzen and Smith in
Minnesota showed that Hmong individuals who are American-born and/or
were raised in the U.S. have higher dietary acculturation than those born in
Chia Lee ’13
University of St. Thomas
Mentor
Paul Lorah, Ph.D.
Associate Professor of
Geography
University of St. Thomas
61
UST McNair Scholars Program Research Journal
Thailand or Laos. This study concluded that acculturation
of foods, store types, conveniences, and English fluency
were just some of the factors that contributed to the
surveyed Hmong individuals and their food access and
shopping behavior.2 Improvements in the Hmong
community with health and food are problems that need
to be tackled.
While the Hmong are still struggling to become
accustomed to Western medicine and food, the need for
healthy living is a concern for all. This is directly associated
with improving access to healthcare. According to the
American Public Health Association, “while the United
States spends more on health care than any other nation in
the world, it lags behind so many developed nations in
important health measures.”3 This particular statement
shows how health and wellness is such an important role
in our lives. Although money is spent for health purposes,
the health of the country is still poor. Healthy practices are
obtained with the availability of good, quality healthcare.
According to Lora Todovora, MPH, “people’s health is
closely related to access to health care.”4 As health and
wellness become a larger issue in today’s society, there is a
concern about equal access to quality health and promotion
to wellness.
In this particular study, the large Hmong community
in the Twin Cities metropolitan area of Minnesota was
studied to determine their access to opportunities of
healthy living. This access to health and wellness was
determined by locating and mapping four major aspects of
the promotion of health: healthcare facilities, food sources,
and public transportation. First, the Hmong community
was mapped to identify their location in relation to the
area. Access to healthcare was determined by locating and
mapping hospitals, clinics, dentists, and other healthcare
facilities in the Twin Cities. As being healthy includes
having the choice of nutritional, affordable, and quality
food, grocery stores were mapped. Public transportation,
such as buses, light rail, and bikeways were also mapped
to provide affordable transportation to healthcare facilities
and food sources. All these features provide an
understanding of whether the Hmong community is
geographically limited to healthcare access in the Twin
Cities.
This research is based on the geographical access of
healthcare in the community. Using the Geographical
62
Information System (GIS) in the University of St. Thomas
Geography Department, I propose that the Hmong
community in the Twin Cities metropolitan area lacks
geographical access to the promotion of a healthy lifestyle
due to the poor access of healthcare, food sources, and
public transportation.
LITERATURE REVIEW
In this section, I discuss the many different background
studies surrounding my research. Knowledge of who the
Hmong people are is significant, but there is also an
understanding of how complimentary geography and heath
are. This can be seen throughout various researches being
done on the Hmong community, the fields of geography
and public health, and the use of applications in GIS.
THE HMONG PEOPLE
The Hmong have traveled across the world as refugees
of war and oppression. The history of the Hmong people,
whether direct immigrants or descendents of immigrants,
is ingrained in their culture. Ancestry of the Hmong is
uncertain because of their oral and nomadic traditions.
From research, they are thought to come from China,
although those who have migrated to the United States
have come from Laos, Vietnam, and Thailand.5 Many
American people were (and still are) unaware of the Secret
War of Laos that occurred at the same time as the Vietnam
War in the mid-1900s. As American men were fighting
against the Vietnamese, Hmong men and boys were
recruited by the U.S. Central Intelligence Agency (CIA) in
the 1960s to battle the emergence of communism in Laos,
the Pathet Lao. The U.S. withdrew from Laos in 1975,
abandoning the Hmong as communism took power. This
created terror as “the Hmong became targets of retaliation
and persecution.”6 Re-education of the Hmong was ordered
by the Pathet Lao through camps, and the Laos raged
chemical warfare against the Hmong. Many Hmong fled
to Thailand by crossing the Mekong River into the safety
of refugee camps. Although out of the hands of the Pathet
Lao, many did not leave until years after entering the
refugee camps. Resettlement of the Hmong resulted in
many moving to different parts of the world, such as France
and the U.S., in the 1980s and years later. Many Hmong
Public Health
have returned to Laos due to the closure of refugee camps
in Thailand, resulting in torture and abuse.7 Today, large
concentrations of the Hmong population outside of Asia
reside in California, Wisconsin, and Minnesota.8
Upon their arrival in America, the Hmong had a
different culture, spoke a different language, and followed
a different religious belief resulting in a struggle of
acculturation. In the Hmong culture, the liver of a person
regulates emotion and is the center of human emotion
compared to the heart in Western beliefs. The liver plays
an important role in the health and mental well-being of a
person as well as their overall personality. The Hmong
culture is dependent on spiritualism and herbal healing. A
shaman is one who is able to travel between reality and the
spiritual world to communicate with spirits for health
purposes.9 Ua neeb khu is the ceremonial healing practice
used by shamans to treat health concerns involving
spirits.10 Along with shamans, herbalists are those who are
knowledgeable of herbal medicine and their use for health
conditions. As shamans and herbalists are important figures
in the Hmong community, so are clan leaders. The social
structure of the Hmong consists of a clan system (Xeem) of
originally 12 clans but now ranging from fifteen to twentyone.11 Clans are established through last names (paternal
ancestry) and clan members are considered family. Birth,
marriage, or adoption are the only ways of entering a clan.12
Clan leaders, usually the elderly men of a clan, are held in
high regard to leadership.13 In specific rituals, the head of
the clan is able to communicate with the deceased ancestors
of clan members.14 These clans are the different subgroups
of the Hmong community.
Rising numbers of health problems in the Hmong
community include cancer, diabetes, hypertension, gout,
and smoking today, which are only a few of Hmong health
problems.15 These various health concerns are due to the
acculturation of Hmong and American culture. Healthcare
is a concern to the Hmong community and health care
professionals. The lack of medical physiology and anatomy
terms in Hmong language has created a barrier between
translating medical terms and diagnosis. Different beliefs
between the Hmong and American culture also create
misunderstandings and unreliability between the two
sides.16 For quality care in the Hmong community, there
must be relationships built on trust and mutual respect of
both cultures along with cultural awareness.17 Sharon K.
Chia Lee
Health care Accessibility in Hmong Community
Johnson, Ph.D., suggests that negative health care
experiences have caused many Hmong to mistrust and fear
Western medical practice.18 A study done by Dr. Hee Yun
Lee and Suzanne Vang proposes that high mortality rate in
the Hmong community in Minnesota is due to high
prevalence of late stage cancer diagnosis. This study,
through extensive literature review, concluded late stage
diagnosis is because of barriers in the Hmong community.
These barriers include healthcare accessibility, culture, and
lack of cancer literacy.19
HEALTHCARE ACCESSIBILITY
Proper access to healthcare has become one of the biggest
current public health problems today.20 Health has become
a big issue in lives today resulting in the trends of dieting
and fitness, as well as eating disorders and obesity. There
is a growing concern for health care access as populations
continue to grow and health problems still exist.
Improvements in health have allowed healthcare to evolve,
but there is still a lack of healthcare access to one billion
people in the world.21 The life expectancy rates for
Americans are not the highest in the world and according
to Lawrence Jacobs of the University of Minnesota and
James Monrone of Brown University the partial answer to
longevity is unequal access to health care. Universal health
care, health insurance guaranteed to citizens from the
government, is present in many of the countries that have
surpassed the U.S.’s life expectancy. Citizens in those
countries are given access to vaccinations, annual checkups,
and a range of medical screenings, improving their nation’s
health and well-being.22
Health disparities have become a large concern and some
factors of this disparity could be linked to education,
household income, health insurance coverage, and cost
barriers. A study by the Centers for Disease Control helped
raise awareness of health disparities in racial and minority
populations in the United States. It suggests a need for
community-based policies, systems, and environmental
and individual-level changes while establishing prevention
strategies accustomed to different communities.23 This will
allow healthcare access to expand to different populations.
In Minnesota, some recent studies on healthcare access
have addressed racial disparities as well as socioeconomic
status. One particular study conducted in Hennepin
County, MN examined perceived discrimination and
63
UST McNair Scholars Program Research Journal
underutilization in association with perspective to
healthcare. The surveys conducted concluded an association
between perceived discrimination and underutilizing
medical care among Whites, U.S.-born Blacks, and
American Indians while there was an association of
perceived discrimination and underutilizing mental
healthcare among Whites, U.S.-born Blacks, Southeast
Asians, and American Indians.24 Another study was done
about homeless families in Minnesota and their lifestyle
choices due to shelter limitations and surrounding
community. The environments of homeless families in
shelters affected decisions such as food, work, and day care.
Modifications of communities giving shelter to homeless
families must involve access to affordable food, government
assistance programs, and the increase of access to affordable
day care.25 These are only two of the many researches done
in Minnesota showing disparities among health and wellbeing.
GEOGRAPHY
Geography is defined as ‘to write (graphien) the earth
(geo)’ and encompasses the fields of physical and human
geography. Human geography is broken down to humannature relations and society-space relations.26 Society-space
relations reflect social divisions.27 This is seen in
communities with housing values. Higher income
individuals are able to live and maintain a living in houses
of higher value and more pleasant environments while
lower income individuals are limited to lower valued
houses. These, then, become clustered, building a barrier
between high and low income. Time is also a very
important aspect with society-space relations. Socioeconomic systems impact humans as locations and travel
to such places are limited by time. This space-time path is
seen with human activity and their limitations such as
capability, coupling, and authority. Capability limitations
refer to physical or biological factors limiting movement
such as being in two places at one time. Interactions with
others and a certain time restraint is coupling limitation,
for example a family structure of work, school, and basic
needs of life. Authority is the limitations of locations
controlled by people or institutions such as government
areas and private places.28
64
HEALTH GEOGRAPHY
The advancement of technology has improved, but has
also held back lives today. A study done by Jane E. Brody
suggests cases of “outdoor deprivation disorder” are circling
the United States. Children are spending more time
indoors rather than with outdoor activities due to
electronic media. This lack of physical activity and
disconnectedness to nature is contributing to the growing
concern of obesity and obesity-related diseases in children
and adults. Many of the health concerns are named
“diseases of indoor living” by Dr. Daphne Miller, a
University of California, San Francisco affiliated family
physician. These health concerns include Type 2 diabetes,
high blood pressure, heart disease, asthma, nonalcoholic
fatty liver disease, vitamin D deficiency, osteoporosis,
stress, depression, attention deficit disorder, and myopia.
Engaging in green spaces and nature was seen to help
improve healthy living.29
According to a study done by Erin Largo-Wight, there
is a correlation between health and contact with nature.
Largo-Wight developed twelve suggestions for public
health: “(1) cultivate grounds for viewing, (2) maintain
healing gardens, (3) incorporate wooded parks and green
space in communities, (4) advocate for preservation of
pristine wilderness, (5) welcome animals indoors, (6)
provide a plethora of indoor potted plants within view, (7)
light rooms with bright natural light, (8) provide clear
view of nature outside, (9) allow outside air and sounds in,
(10) display nature photography and realistic nature art,
(11) watch nature on TV or videos, and (12) listen to
recorded sounds of nature.”30 There are also suggestions
that environmental sensory has a therapeutic impact on
health, mood, and safety.31
Another issue of concern is “food deserts.” These are
defined as low income neighborhoods lacking affordable
and healthy food.32 A typical food desert does not have a
supermarket within easy access limiting the access to
healthy, affordable food.33 This is significant because there
is a link between health disparities and health, particularity
due to food deserts. A study completed in New York City
researched low-income neighborhoods, predominantly
African-American/Black residents suffering from high rates
of obesity and diabetes. This study helped to give an
understanding of the direct correlation between the
environment and food. It had concluded that there is a
Chia Lee
Health care Accessibility in Hmong Community
Public Health
relationship between demographic features pertaining to
food deserts. An association between higher median
household income and being healthier was seen throughout
the neighborhoods studied.34
GEOGRAPHICAL INFORMATION SYSTEM
Geographical Information System, GIS, is a
technological advancement in the field of geography,
particularly cartography, the study of mapmaking. GIS can
be defined as a computer system which can store data,
make relations between data sets, provide statistical
analysis of data, data modeling, and display data as maps
along with spatial analysis.35 The main purpose of GIS is
mapmaking. This can be done by linking data sets to
project a map showing different relations. 36
The new evolving field of GIS in Public health has
brought breakthroughs into the health field. The use of
GIS will assist in the management and analysis of health
and health care data.37 A study done by Kerry Joyce shows
one perception of GIS use in public health, and the study
suggests that GIS is not a solution in public health. One
main concern was that GIS could be misused,
misinterpreted, and/or used wrongly.38 Although this may
be true, maps can help interpret data as a different
technique to examining data. One particular study done
by Jeanette Eckert and Sujata Shetty in Toledo, Ohio,
helped to examine quantitative and measureable food access
to help urban planners provide opportunities for healthy
food choices.39 GIS is also being used in other nations
where health care is a concern, such as Africa. In this
particular study, 23,000 homesteads were interviewed,
mapped, and given an estimated travel time to a clinic with
the consideration of public transportation and walking.
The median travel time was measured at 81 minutes to the
nearest clinic. There was also a decline of clinic visit
compared to the longer distance and travel time.40
Physical walking can be a barrier in one country while
in another promoted for physical well-being. A study was
done in Sweden to examine “neighborhood walkability and
walking for active transportation or leisure, and moderateto-vigorous physical activity” and their association with
demographic features such as age, gender, income, marital
status, and neighborhood-level socioeconomic status.
Neighborhood walkability and physical activity was seen
as a positive association in this Swedish study. Their
concerns were providing policies that promoted physical
activity with the collaborations of health professionals and
city planners.41 These studies show the useful applications
of GIS in public health concerns ranging from food access,
health care access, and physical activity in different
communities.
METHODS
To determine if there is a lack of geographical access to
health care in the Hmong community in the Twin Cities
metropolitan area, I first determined where this particular
population is located. Using the ArcGIS program in the
Geography lab located in JRC 426, I mapped where the
Hmong community is located relative to the Twin Cities.
In order to map certain projections, data must be obtained
from reliable resources such as Esri, ReferenceUSA, and
from the Geography department network. Data needed
included Census population, health care facilities, food
sources and public transportation. Health care facilities
comprised of hospitals, clinics and dentist offices. Grocery
stores reflected food sources while public transportation
consisted of bus stops, light rail stations, and bike paths.
Using the data that was found, GIS was utilized to make
maps and combine map layers for better understanding and
analysis of the study area and data. Statistical analysis was
also measured for significance. Tools from GIS helped to
store and organize data.
Mapping the Hmong community was a difficult task
where the U.S. Census did not have quality data of ethnic
groups, but rather races. In order to map where the Hmong
community was located, I used ReferenceUSA, a large
business database, with searches that contained key words
such as “Hmong” and prominent Hmong last names like
“Vang,” “Yang,” “Vue,” “Thao,” and “Xiong” seen in the
model in figure 1. Each of the other features looked at were
also mapped to consider where they were located in relation
to the Hmong community appearing in figures 2, 3, and
4. From these maps, 1km fishnets (squares) were projected
to obtain statistical data from each section. Scatter plots
were created along with the geographical weighted
regressions tool to statistically analyze the data obtained.
65
UST McNair Scholars Program Research Journal
Figure 1. Hmong Density = Hmong Community Model
Figure 2. Health Care Facilities Model
Figure 3. Food Sources Model
RESULTS
Geographical access to health care in the Hmong
community through the use of GIS was not seen as a
limitation to health care facilities, food sources, and public
transportation, rejecting my hypothesis. The Hmong
community of the Twin Cities metropolitan area of
Minnesota was seen as centrally located in Minneapolis and
St. Paul. Statistical analysis was also measured showing a
weak correlation between the Hmong community with
health care facilities, food sources, or public transportation
from the scatter plots. The scatter plots did show positive
correlation between health care facilities, food sources, and
public transportation, however, they were not correlated
with the Hmong community. The Twin Cities’ Hmong
community in this particular study area at the 1 km scale
by the use of the geographical weighted regression tool was
shown that they are not especially isolated from health care,
food, and public transportation. These results suggest that
factors other than geographical access may be contributing
to the lack of access to health care in the Twin Cities’
Hmong community.
Figure 5. Scatter plots of health care facilities, food sources,
transportation, and Hmong community.
Figure 4. Transportation Model
CONCLUSION
R
66
l
From my results, isolation was not a major factor in
shaping health care outcomes in the Hmong community.
It became questionable whether the limitations of health
care in the Hmong community are due to geographical
access or cultural barriers. The results of acculturation in
this community have shown a gap in those who has
Chia Lee
Health care Accessibility in Hmong Community
Public Health
blended into the American culture such as the younger
generation compared to those who are still holding on to
many Hmong beliefs, such as shamanism and herbal
healing in the older generation. This gap has created
barriers within the community to incorporate both Hmong
and American culture. Along with cultural barriers,
language and health literacy, according to this research’s
literature review, are other factors in the limitations of
health care. Some suggested recommendations would be to
battle two particular barriers: cultural and language.
Programs targeted towards the Hmong to learn proper
health practices such as regular check-ups and screenings
while still respecting their cultural beliefs would be
beneficial. Along with these programs, health care
providers in largely populated Hmong areas should be
provided with background on Hmong culture to better
adapt medical procedures for Hmong individuals. Quality
Hmong translators accessible in hospitals and clinics would
be beneficial in properly providing the information for
Hmong patients. To continue looking at health care
accessibility in the Hmong would be valuable with some
future research in this field.
APPENDIX
Map 1. Hmong Community Map
Map 2. Health Care Facilities Map
FUTURE RESEARCH
One particular research idea expanding from the idea of
the Hmong community and geographical access to health
care would be to restructure the research. A change in the
study area would remove rural areas and areas where the
Hmong community is not located such as only examining
Hennepin and Ramsey counties. Comparison of the
Hmong population would also be beneficial at studying
the community within itself, for instance, examining
economic status, gender, and age. This could result in
significance in the data and that the Hmong community’s
geographical access to health care is a Minneapolis-Saint
Paul area concern only. Some other future research ideas
would be to survey individuals in the community to
examine health disparities and barriers to accessibility as
well as incorporating health insurance coverage and other
factors contributing to health care access. Other
communities could also be researched to compare and
contrast with the Hmong community expanding the
awareness of health disparities.
Map 3. Health Care Facilities Distances
67
UST McNair Scholars Program Research Journal
Map 4. Food Sources Map
Map 7. Transportation Distances
Map 5. Food Sources Distances
Map 8. Hmong-owned Businesses
Map 6. Transportation Map
ENDNOTES
1
Torry Cobb, “Strategies for providing cultural competent
health care for Hmong Americans” [Abstract], Journal of Cultural
Diversity 17 no. 3 (2010): 79-83.
2
Lisa Franzen & Smith, Chery, “Food System access, shopping
behavior, and influences on purchasing groceries in adult Hmong
living in Minnesota” [Abstract], American Journal of Health
Promotion: AJHP 24 no. 6 (2010): 396-409.
3
American Public Health Association, “Healthiest Nation in
One Generation,” (2011).
4
Lora Todorova, “Limits and access to health care” [Abstract],
American Journal of Public Health 93 no. 11 (2003): 1794-1795.
5
Joanne P. Ikeda, Hmong American food practices, customs, and
holidays, American Diabetes Association, Inc, 1999: 1.
6
“Hmong History,” Hmong International Human Rights
Watch, 2007.
7
“History of the Hmong—A Timeline,” Lao Family
Community of Minnesota, Inc., 1997.
68
Chia Lee
Health care Accessibility in Hmong Community
Public Health
8
Ikeda, Hmong American food practices, customs, and holidays,
(1999) 1.
9
Ikeda, Hmong American food practices, customs, and holidays, 2.
10
Lisa L. Capps, “Ua neeb khu: a Hmong American Healing
Ceremony” [Abstract], Journal of Holistic Nursing” Official Journal
of the American Holistic Nurses’ Association 29 no. 2 (2011): 98106.
11
Dia Cha, Hmong American Concepts of Health, Healing, and
Conventional Medicine (New York: Taylor & Francis Books, Inc,
2003), 6.
12
“Hmong Families,” Lao Family Community of Minnesota, Inc.
(1997), http://www.laofamily.org/pdfs/Hmong_Families.pdf.
13
Ikeda, Hmong American food practices, customs, and holidays, 4.
14
“Hmong Families,” Lao Family Community of Minnesota, Inc.
(1997).
15
Ibid, 302; Ikeda, Hmong American food practices, customs, and
holidays; S. Wahedduddin et al., “Gout in the Hmong in the
United States” [Abstract], Journal of Clinical Rheumatology:
Practical Reports on Rheumatic & Musculoskeletal Diseases 16 no. 6
(2010): 262-266.
16
Sharon K. Johnson, “Hmong Health Beliefs and
Experiences in Western Health Care System” [Abstract], Journal
of Transcultural Nursing 13 no. 2 (2002): 126-132.
17
Torry G. Cobb, “Strategies for Providing Cultural
Competent Health Care for Hmong Americans” [Abstract],
Journal of Cultural Diversity 17 no. 3 (2010): 79-83.
18
Sharon K. Johnson, “Hmong Health Beliefs and
Experiences in Western Health Care System” [Abstract], Journal
of Transcultural Nursing 13 no. 2 (2002): 126-132.
19
Hee Yun Lee and Suzanne Vang, “Barriers to Cancer
Screening in Hmong Americans: The Influence of Health Care
Accessibility, Culture, and Cancer Literacy,” Journal of Community
Health 35 no. 3 (2010): 301-314.
20
Lora Todorova, “Limits and Access to Health Care,”
American Journal of Public Health 93 no. 11 (2033): 1794-1795.
21
Anup Shah, “Global Health Overview,” Global Issues,
(2010), Last Accessed 28 June 2011.
22
“U.S. Life Span Falls Behind,” Current Science 90 no. 11
(2005): 15.
23
Youlian Liao et al., “Surveillance of Health Status in
Minority Communities — Racial and Ethnic Approaches to
Community Health Across the U.S. (REACH U.S.) Risk Factor
Survey, United States, 2009,” Center for Disease Control, 2011.
24
Diana J. Burgess et al., “The Association between Perceived
Discrimination and Underutilization of Needed Medical and
Mental Health Care in a Multi-Ethnic Community Sample”
[Abstract], Journal of Community Care for the Poor and Underserved
19 no. 3 (2008): 894-911.
25
Rickelle Richards and Smith, Chery, “Shelter Environment
and Placement in Community Affects Lifestyle Factors among
Homeless Families in Minnesota” [Abstract], American Journal of
Health Promotion 21 no. 1 (2006): 36-44.
26
Philip Cloke, Crang, Philip, and Goodwin, Mark, ed.,
Introducing Human Geographies (New York: Arnold Publishers,
1999), x.
27
Susan J. Smith, “Chapter 2: Society—space,” Introducing
Human Geographies (New York: Arnold Publishers, 1999), 12.
28
John Corbett, “Tornsten Hägerstrand: Time Geography,”
Center for Spatially Integrated Social Sciences Classics, Accessed July
6, 2011, www.csiss.org/classics/ content/29
29
Jane E. Brody, “Head Out for a Daily Dose of Green Space,”
New York Times, November 29, 2010, p.7.
30
Erin Largo-Wight, “Cultivating Healthy Places and
Communities: Evidence-Based Nature Contact Recommendations” [Abstract], International Journal of Environmental Health
Research 21 no. 1 (2011): 41-61.
31
Todd Fergson, “Creating Healing Environments with
Evidence-Based Design” [Abstract], Occupational Health & Safety
79 no. 10 (2010): 14-16.
32
Cynthia Gordon et al., “Measuring Food Deserts in New
York City’s Low-Income Neighborhoods,” Health & Place 17 no.
2 (2011): 696-700.
33
R.E. Walker, Keane, C.R., and Burke, J.G., “Disparities
and Access to Healthy Food in the United States: A Review of
Food Deserts Literature” [Abstract], Health & Place 16 no. 5
(2010): 876-884.
34
Cynthia Gordon et al., “Measuring Food Deserts in New
York City’s Low-Income Neighborhoods,” Health & Place 17 no.
2 (2011): 696-700.
35
Alan L. Melnick, Introduction to Geographic Information Systems
in Public Health, (Gaithersburg: Aspen Publication, 2002), 9.
36
Ibid, 45.
37
L. Twigg, “Health based geographical information systems:
their potential examined in the light of existing data sources”
[Abstract], Social Science and Medicine 30 no. 1990 (1990): 143155.
38
Kerry Joyce, “’To me it’s just another tool to help
understand the evident’: Public health decision-makers’
perceptions of the value of geographical information systems
(GIS)” [Abstract], Health and Place 15 no. 3 (2009): 831-840.
39
Jeanette Eckert and Shetty, Sujata, “Food systems, planning
and quantifying access: Using GIS to plan for food retail”
[Abstract], Applied Geography 31 no. 4 (2011): 1216-1223.
40
Frank Tanser, Gijsbertsen, Brice, and Herbst, Kobus,
“Modeling and understanding primary health care accessibility
and utilization in rural South Africa: An exploration using a
geographical information system” [Abstract], Social Science and
Medicine 63 no. 3 (2006): 691-705.
41
Kristina Sundquist et al., “Neighborhood walkability,
physical activity, and walking behavior: The Swedish
Neighborhood and Physical Activity (SNAP) study,” Social Science
and Medicine 72 no. 8 (2011): 1266-1273.
69
UST McNair Scholars Program Research Journal
BIBLIOGRAPHY
American Public Health Association. “Healthiest Nation in One
Generation.” www.apha.org/advocacy/healthiestnation/ (Last
Accessed 27 June 2011).
Brody, Jane E. “Head Out for a Daily Dose of Green Space.” New
York Times, November 29, 2010, p.7.
Burgess, Diana J., Yingmei Ding, Margaret Hargreaves, Michelle
van Ryn, and Sean Phelan. “The Association between
Perceived Discrimination and Underutilization of Needed
Medical and Mental Health Care in a Multi-Ethnic
Community Sample” [Abstract]. Journal of Community Care
for the Poor and Underserved 19 no. 3 (2008): 894-911.
Capps, Lisa L. “Ua neeb khu: a Hmong American Healing
Ceremony” [Abstract]. Journal of Holistic Nursing” Official
Journal of the American Holistic Nurses’ Association 29 no. 2
(2011): 98-106.
Cha, Dia. Hmong American Concepts of Health, Healing, and
Conventional Medicine. New York: Taylor & Francis Books,
Inc, 2003.
Cloke, Philip, Philip Crang, and Mark Goodwin, ed. Introducing
Human Geographies. (New York: Arnold Publishers, 1999), x.
Cobb, Torry G. “Strategies for Providing Cultural Competent
Health Care for Hmong Americans” [Abstract]. Journal of
Cultural Diversity 17 no. 3 (2010): 79-83.
Corbett, John. “Tornsten Hägerstrand: Time Geography,” Center
for Spatially Integrated Social Sciences Classics. Accessed July 6,
2011, http://www.csiss.org/classics/content/29
Eckert, Jeanette and Sujata Shetty. “Food systems, planning and
quantifying access: Using GIS to plan for food retail”
[Abstract]. Applied Geography 31 no. 4 (2011): 1216-1223.
Fergson, Todd. “Creating Healing Environments with EvidenceBased Design” [Abstract]. Occupational Health & Safety 79 no.
10 (2010): 14-16.
Franzen, Lisa, and Chery Smith. “Food system access, shopping
behavior, and influences on purchasing groceries in adult
Hmong living in Minnesota” [Abstract]. American Journal of
Health Promotion: AJHP 24 no. 6 (2010): 396-409.
Gordon, Cynthia, Marnie Purciel-Hill, Nuripa R. Ghai, Leslie
Kaufman, Regina Graham, and Gretchen Van Wye,
“Measuring Food Deserts in New York City’s Low-Income
Neighborhoods.” Health & Place 17 no. 2 (2011): 696-700.
——. “History of the Hmong—A Timeline.” Lao Family
Community of Minnesota, Inc. www.laofamily.org/pdfs/
Hmong_History.pdf, 1997. (Last Accessed 27 June 2011).
——. “Hmong Families.” Lao Family Community of Minnesota,
Inc.
1997.
http://www.laofamily.org/pdfs/Hmong_Families.pdf
——. “Hmong History.” Hmong International Human Rights
Watch, 2007.
——. Hmong International Human Rights Watch. Hmong
History.
www.hmongihrw.org/index.php?option=com_
70
content&task=view&id=92&Itemid=32, 2007. (Last
Accessed 27 June 2011).
Ikeda, Joanne P. Hmong American food practices, customs, and
holidays. American Diabetes Association, Inc, 1999.
Johnson, Sharon K. “Hmong Health Beliefs and Experiences in
Western Health Care System” [Abstract]. Journal of
Transcultural Nursing 13 no. 2 (2002): 126-132.
Joyce, Kerry. “’To me it’s just another tool to help understand
the evident’: Public health decision-makers’ perceptions of
the value of geographical information systems (GIS)”
[Abstract]. Health and Place 15 no. 3 (2009): 831-840.
Largo-Wight, Erin. “Cultivating Healthy Places and
Communities: Evidence-Based Nature Contact Recommendations” [Abstract]. International Journal of Environmental
Health Research 21 no. 1 (2011): 41-61.
Lee, Hee Yun and Suzanne Vang. “Barriers to Cancer Screening
in Hmong Americans: The Influence of Health Care
Accessibility, Culture, and Cancer Literacy.” Journal of
Community Health 35 no. 3 (2010): 301-314.
Liao, Youlian, David Bang, Shannon Cosgrove, Rick
Dulin, Zachery Harris, Alexandria Stewart, April
Taylor, Shannon White, Graydon Yatabe, and Leandris
Liburd. “Surveillance of Health Status in Minority
Communities — Racial and Ethnic Approaches to
Community Health Across the U.S. (REACH U.S.) Risk
Factor Survey, United States, 2009.” Centers for Disease
Control, 2011.
Melnick, Alan L. Introduction to Geographic Information Systems in
Public Health. Gaithersburg: Aspen Publication, 2002.
Richards, Rickelle and Chery Smith. “Shelter Environment and
Placement in Community Affects Lifestyle Factors among
Homeless Families in Minnesota” [Abstract]. American
Journal of Health Promotion 21 no. 1 (2006): 36-44.
Shah, Anup. “Global Health Overview.” Global Issues, (2010) Last
Accessed 28 June 2011.
Smith, Susan J. “Chapter 2: Society—space.” Introducing Human
Geographies (New York: Arnold Publishers, 1999), 12.
Sundquist, Kristina, Ulf Ericksson, Naomi Kawakami, Lars
Skog, Henrik Ohlsson, and Daniel Arvidsson.
“Neighborhood walkability, physical activity, and walking
behavior: The Swedish Neighborhood and Physical Activity
(SNAP) study.” Social Science and Medicine 72 no. 8 (2011):
1266-1273.
Tanser, Frank, Brice Gijsbertsen, and Kobus Herbst. “Modeling
and understanding primary health care accessibility and
utilization in rural South Africa: An exploration using a
geographical information system” [Abstract]. Social Science
and Medicine 63 no. 3 (2006): 691-705.
Todorova, Lora. “Limits and Access to Health Care.” American
Journal of Public Health 93 no. 11 (2033): 1794-1795.
Twigg, L. “Health based geographical information systems: their
potential examined in the light of existing data sources”
Public Health
Chia Lee
Health care Accessibility in Hmong Community
[Abstract]. Social Science and Medicine 30 no. 1990 (1990):
143-155.
——. “U.S. Life Span Falls Behind.” Current Science 90 no. 11
(2005): 15.
Wahedduddin, S., J.A. Singh, K.A. Culhane-Pera, and E.
Gertner. “Gout in the Hmong in the United States”
[Abstract]. Journal of Clinical Rheumatology: Practical Reports
on Rheumatic & Musculoskeletal Diseases 16 no. 6 (2010): 262266.
Walker, R.E., C.R. Keane, and J.G. Burke. “Disparities and
Access to Healthy Food in the United States: A Review of
Food Deserts Literature” [Abstract]. Health & Place 16 no. 5
(2010): 876-884.
71
A QUALITATIVE
ANALYSIS OF
TEACHERS’
PERCEPTION
TOWARDS HMONG
AMERICAN
STUDENTS’
ACADEMIC
ACHIEVEMENT IN
MINNESOTA
Mai-Eng Lee ’12
University of St. Thomas
Mentor
Kendra Garrett, Ph.D.
Professor of Social Work
University of St. Thomas
72
ABSTRACT
Minnesota has a growing population of Hmong American students who are dropping
out of public high schools and graduating at lower rates than their counterparts at
significantly higher rates, especially in the Twin Cities area. Through qualitative
research, this study explores the perceptions of six teachers who have taught Hmong
students throughout their teaching career in regards to the necessary parental and
academic support that will empower Hmong students to excel in their academic success.
The results show Hmong students have literacy challenges with reading, writing, and
verbal communication in English. It is also evident from the current study Hmong
students are in need of a culturally sensitive school environment to help them identify
and learn about their own culture and language. In addition, Hmong students need a
supportive home environment that provides a quiet study space and some hands-on
learning activities to actively engage them in their learning. Moreover, regardless of the
lack of Hmong parents’ academic involvement within and intimidation by their
children’s school, they value education and want to understand the Western education
system to better provide a supportive home environment for their children. Therefore, it
is essential for teachers and other school professionals to collaborate and communicate
with Hmong parents in assisting Hmong students with the academic learning activities
to help them succeed in school. Further research is needed with Hmong parents and
students in order to understand how they perceive the Western education system.
The Hmong are an ethnic minority group of people. Though there are no
accurate records or evidence to prove where Hmong originated, scholars
suggested Hmong people came from the mountains of Southern China and
migrated over centuries to Vietnam, Thailand, Laos, and Burma. After the
Secret War of Laos in 1975, some of the Hmong people immigrated to the
United States. According to the U.S. Census 2000, Minneapolis and Saint Paul
are home to 97.3 percent of the Minnesota Hmong population at 44,205.
However, the American Community Survey (2007) estimated that the Hmong
American population in Minnesota is probably between 60,000 and 70,000
because Hmong have a young population and it is a fast growing community
(Lee & Pfeiffer, 2010).
Thirty-six years after Hmong arrived in the United States, education has
continuously been one of the most challenging issues facing Hmong American
children. Problems such as low educational attainment, high drop-out rates,
low test scores, and other education-related issues have preoccupied the Hmong
American community (Yang, 2003). According to Yang and Pfeiffer (2003),
Hmong refugees were pre-literate before they entered the United States in
1975. This was not unexpected because most of the Hmong of Laos did not
have their first village school until circa 1939, and only a few Hmong families
could afford to send their sons to school at that time (Yang & Pfeiffer, 2003).
This historical background and the cultural assimilation in America meant
Hmong had to start their educational development and new way of life at the
very base of society. After over thirty years in the United States, Hmong
Americans have observed successes, though they continue to face challenges
in academic achievement (Yang & Pfeiffer, 2003).
Social Work
Research on Hmong populations started emerging in
the late 1980’s. Many studies have been done on family
dynamics, cultural transitions related to student
achievement, and lifestyle challenges (Lor, 2008). From
these studies, Vang (2003) and Thao (2003) have found
students from culturally diverse backgrounds need a lot of
support from parents and teachers to perform better in
school. However, little research has been conducted
specifically on the types of collaboration and
communication parents, teachers, and other school
professionals need to engage in to assist Hmong children
to achieve their full academic potential. In order to do so,
this current study explores the perceptions of teachers in
regards to the necessary parental and academic support that
empowers Hmong students to excel in their academic
success. The study seeks to answer the following questions:
(1) What kind of school and home environment would be
supportive of Hmong students’ academic success? (2) What
kinds of communication and collaboration do parents,
teachers, and other school professionals need to engage in
to assist Hmong children to achieve their full academic
potential in school? (3) What type of school and home
activities are most useful in helping Hmong students
succeed in school? By looking at literature on acculturation
of Hmong American families, parent and teacher
communication, and home-school factors that help and
hinder Hmong children’s academic learning, it is hoped
that there can be a better understanding of the needed
parent and teacher collaboration to support students’
success.
A REVIEW OF THE LITERATURE
LIFE IN THE UNITED STATES
Studies have speculated that Hmong were unprepared
linguistically, culturally, educationally, and economically
to adapt to their new life in the United States (Yang &
Pfeiffer, 2003). Hmong parents struggled with assimilation
to Western culture while holding on to customs, spiritual
beliefs, values, and roles of the Hmong culture; whereas
children were placed in American schools where they
quickly learned English and adjusted to their new
surroundings (Thao, 2010). Suinn (2010) and McBrien
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Teachers’ Perception towards Hmong Students
(2005) have shown mixed findings on how acculturation,
the process of changing beliefs and behaviors as a result of
contact between cultures, impacts refugee students’ school
performance. According to Suinn, (2010) the process
linking acculturation and school work involves the attitude
of parents. Asian American children are performing better
academically than children of other ethnic groups because
their parents aspired for them to earn better grades and
progress toward higher education (Suinn, 2010). On the
contrary, researchers have found that acculturation can
contribute to anxiety among refugees in the way they cope
with and succeed in their new surroundings (McBrien,
2005). This means anxiety and economic struggles endured
by adults have direct influences on refugee children in
terms of emotional challenges and school performance.
McBrien (2005) also provides insights into the ways in
which educational success is essential for refugee children’s
acculturation. She found refugee students who can learn
the language of their new country and be accepted by their
teachers and peers are more likely to do better in school
(McBrien, 2005). These perspectives on acculturation will
be beneficial in addressing the very real factors that help
and hinder Hmong children to attain an education in the
United States.
WESTERN EDUCATIONAL SYSTEM
Today, refugee and immigrant students come to the
United States from every part of the world. According to
Vang (2005) language-minority students are one of the
fastest-growing segments of the total student population
in America. The Minnesota Minority Education
Partnership, Inc. (2009) found students in Minnesota
public schools speak 97 different languages, and the most
predominant primary home languages spoken by students
were Spanish (32,239 students), Hmong (22,665 students),
and Somali (9,583 students). Moreover, St. Paul Public
Schools are home to the largest Hmong student body in
the State of Minnesota, with approximately 10,590
students enrolled each year (Xiong, 2008).
According to gathered data by the Minnesota Minority
Education Partnership (2009), students of color and
American Indian students are dropping out of public high
schools and graduating at lower rates than their White
peers at significantly higher rates. The Minnesota
Department of Education shows students of color and
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UST McNair Scholars Program Research Journal
American Indian Students were 2 to 5 times as likely to
drop out of school as their White peers over the last five
years. The result also shows White students exceeding the
overall national average of graduation rates by nearly 6
points; in contrast, Minnesota students of color and
American Indian students average 10 to 17 points below
the national average for graduation rates (Minnesota
Minority Education Partnership, 2009).
This is further evidence of what previous studies have
stated about Asian American students fitting into the
model minority ideal. Too often, Asian-American students
have been stereotyped as the “model minority” in which
they performed academically better than other ethnic
groups (Lee, 1994; Um, 2000). This stereotype claims
Asian Americans are not educationally disadvantaged and
do not need any academic assistance (Ngo & Lee, 2007).
Hmong, as a refugee population, presents an important
view on the problems and challenges facing many groups
within this conception of Asian as the model minority
(Xiong, 2008). Hmong is one of the newest Southeast
Asian groups of people within this conception, considering
they have only been in the United States for approximately
thirty-six years. Therefore, it is imperative to understand
all Asians do not have similar values and cultural
background, nor do they share the same educational and
economic opportunity in the United States (HamiltonMerritt, 1993).
PARENTS’ AND TEACHERS’ COMMUNICATION
Historically, researchers have found that there has been
a lack of communication between school teachers and
South East Asian parents (Blakely, 1983). These parents
received notices of their children’s grades, opportunities for
students to join sports, and invitations to open houses, but
the majority were illiterate and did not understand these
school communications (Blakely, 1983). The study showed
how refugees in Cascade, Oregon exhibited similar
characteristics of other minorities immigrating to this
country. These refugees’ families were willing to start a new
life and saw formal education as a critical component to
surviving in the United States (Blakely, 1983).
Much research has been conducted on the importance of
teachers, parents, and other school professionals’ ways of
collaboration and communication to better assist Hmong
students in school. Thao (2003) found both parents and
74
teachers wanted a well-balanced relationship to better
engage their students at home and school. Parents and
teachers expressed how they want to be able to understand
one another and communicate about the academic needs of
Hmong students. Both Hmong parents and teachers want
to maintain trust, exchange resources, as well as share ideas
(Thao, 2003). Furthermore, Thao (2003) found that
providing a level of parent- teacher conferences would give
parents encouragement, role models, and technical tools to
support Hmong students both at school and home. The
study also suggested for parents, teachers, and administrators to get together to talk about their different
expectations, home and school, and talk about resources
that exist in the student’s home (Thao, 2003).
HOME AND SCHOOL FACTORS
Many studies have been done on the types of school and
home environments needed to better assist Hmong
students to achieve academic success. Thao (2003) found
the school environment needs to be a comfortable place and
not isolate the Hmong students and their culture. The
school environment must allow Hmong students to explore
the American culture without placing academic pressure
on the students (Thao, 2003). However, the home
environment must consist of loving and supportive parents
in order to motivate Hmong students to succeed in school.
Berger (1995) found students who come from different
cultures bring unique languages, ideas, feelings, strengths,
and weaknesses of their homes into their school life. It is
important that educators provide a supportive and nonthreatening environment to lesson academic anxiety for
Hmong students (Thao, 2003). Moreover, Thao (2003)
revealed in her study that teaching of the Hmong culture
and history within the school would be beneficial to
Hmong students so they can identify with their culture
and understand its values. Hmong children need to be in
classrooms where they have the opportunity to learn how
to balance cultural differences among their home, school,
and community (Shade et al., 1997). In addition, it is
important Hmong students have a study space along with
parents’ expectations in their home environment (Thao,
2003).
At present, Xiong (2008) found Hmong children are
growing up in economically and educationally disadvantaged families. Hmong students are among the poorest
Mai-Eng Lee
Teachers’ Perception towards Hmong Students
Social Work
citizens living in Minnesota and many of them are
concentrated in poor neighborhoods without adequate
resources to provide a strong education basis for these
young children (Xiong, 2008). The study identifies several
factors, most of which have to do with the low educational
histories and employment status that can be attributed to
the poverty of the Hmong population. As a consequence,
Hmong children grow up in low-income households, in
homes with lower market values and with parents and
adults who are either unemployed or in low-paying, lowskilled occupations (Xiong, 2008). Furthermore, the
linguistic isolation of Hmong parents may also explain
some of the reasons why Hmong children have lower test
scores in school. This study showed Hmong students
scored the lowest, followed by Hispanic and African
Immigrant students, after taking the Peabody Vocabulary
Test (Xiong, 2008). More specifically, 82 percent of the
Hmong students scored below the national average
compared to only 17 percent of Caucasian students (Xiong,
2008). This means Hmong families are still struggling
with language and poverty after more than thirty years of
living in the United States, and this has a direct affect on
their children.
SUMMARY OF LITERATURE REVIEW
It is evident that Hmong high school students are a
growing population in the State of Minnesota. Educators
must understand the history and culture of the people in
order to better understand the needs of Hmong students.
Acculturation also plays a role in how well Hmong
students can academically succeed in school. As a result of
these studies, it is critical that school professionals are
aware of students’ languages spoken at home and their
culture so they can begin to bridge this academic barrier
and better communicate with culturally diverse parents.
Many studies have found different factors that influenced
students to achieve academic success; however, these
studies did not provide in-depth perspectives about the
kinds of communication between parents and teachers and
the way these interactions have empowered Hmong
students to gain confidence in their academic skills, both
at home and school.
Therefore, it is crucial to explore parent and teacher
communication strategies in order to assist and empower
Hmong students to achieve their academic potential both
at home and school. The current study provides an indepth understanding of teachers’ perspectives about the
needed academic support to empower Hmong to excel in
school. This study seeks to answer these following
questions: (1) What kind of school and home environment
would support Hmong students to achieve academic
success? (2) What kinds of communications do parents,
teachers, and other school professionals need to engage in
to assist Hmong children to achieve their full academic
potential in school? (3) What type of school and home
activities are most useful in helping Hmong students
succeed in school?
METHODOLOGY
Through qualitative research, the primary researcher
looked in-depth at teachers’ perspectives of what activities,
school-home learning environment, and type of parentteacher communication is needed to help Hmong students
achieve academic success. According to Grinnell and Unrau
(2011), the qualitative research approach involves looking
at meaning, experience, emotions, richness, and depth to
better understand the interpretative perspective. This
research study was approved from the University of Saint
Thomas Institutional Review Board.
RECRUITMENT
The study focuses on teachers’ perspectives of Hmong
students’ academic achievements. The targeted population
was teachers who had experience educating Hmong
students throughout their teaching career in Minnesota.
These teachers were targeted with a snow ball sampling
approach (Grinnell & Unrau, 2011, p. 237), where the
primary researcher contacted teachers throughout the Twin
Cities area as potential participants and afterwards asked
them to identify teachers. The researcher followed-up with
the names provided and invited these individuals to
participate in the study. This target population has a
greater sense of understanding the language and cultural
barriers within the Hmong community. These teachers
engaged with the researcher to talk about Hmong students’
behavior and academic learning due to direct experience
with them in the classroom.
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Initial contact with potential participants was made
through the use of e-mail and telephone invitations (e-mail
and telephone recruitment letter can be found in Appendix
A). E-mail and telephone invitations were used as a simple
and quick way to invite potential participants to be a part
of the study. In order to provide compensation for the
participants in the study, they were given the opportunity
to enter a drawing for one of two $10 gift cards to a local
store.
PARTICIPANTS
Upon request for more information or acceptance of
participation, the researcher did a follow-up through
telephone or email to set up a time, date, and location to
conduct interviews, including a discussion of the minimal
risks of participating in the study. The teachers included
two females and four males. All six teachers have taught
ninth through twelfth grade students in local high schools
throughout the Twin Cities area. The female teachers
taught English and English Language Learning for
approximately five to six years. In contrast, the four male
teachers have taught between three to ten years in the areas
of math, social studies, and physical education. One of the
male teachers has been an advisor to their high school Asian
student organization for six years.
Each interview lasted for about 30-45 minutes
(interview questions can be found in Appendix B). All
interviews were audio recorded to ensure the clarity of all
words and thoughts of each participant for transcription
on a later date.
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FINDINGS AND DATA ANALYSIS
The primary researcher used content analysis as a way to
define and code the transcription. According to Grinnell
and Unrau (2011), content analysis is the recording of
frequency in which certain symbols or themes appear in a
communication. The researcher looked for recurrent
themes or units of analysis that were noticeable from the
individual interviews. Notable themes were the association
between teacher and parent collaboration, home and school
environment that may help or hinder learning, and
academic resources needed to help students succeed in
school. The results represented the perceptions, opinions,
and feelings of six teachers at local high schools throughout
the Twin Cities area.
To analyze the results, a recording sheet was developed
to tally the frequency of teachers’ comments from the
transcriptions. Table one shows six subcategories that arise
from the overall themes. The subcategories were 1) Literacy
Challenge, 2) Culturally Sensitive School Environment, 3)
Supportive Home Environment, 4) Parent’s Intimidation
Factors, 5) Academic Learning Activities, and 6) Gender.
The results are shown in the table below.
LITERACY CHALLENGES
Results from the six teachers were consistent in terms of
the literacy challenges experienced by Hmong students.
These teachers understood that Hmong students and their
parents have literacy challenges with reading, writing, and
verbal communication in English. All of them discussed
that acculturation to the Western education system may
Teachers
Literacy
Challenge
Concept Tally
Culturally
Sensitive School
Environment
Concept Tally
Supportive
Home
Environment
Concept Tally
Parents Intimidation Factors
Concept Tally
Academic
Learning
Activities
Concept Tally
Gender of
Teacher
Male Female
One
5
8
5
3
3
✓
Two
6
6
3
8
4
✓
Three
4
4
3
0
5
Four
5
9
4
4
4
✓
Five
7
5
5
3
5
✓
Six
4
6
3
1
3
✓
✓
Social Work
also have contributed to how well Hmong students are able
to perform on their tests and homework. All six teachers
suggested for Hmong students to improve on their
reading, writing, and verbal communication skills by
asking for more teacher assistance or seeking after-school
tutorial. The results illustrated that Hmong students need
more engaging learning activities to help them improve
on their reading, writing, and communication skills.
CULTURALLY SENSITIVE SCHOOL ENVIRONMENT
In order for Hmong students to excel academically, all
six teachers from the interviews suggested parent-teacher
communication was crucial. From the interactions between
teachers and Hmong parents, the majority of the parentteacher communications have been made through the use
of a Hmong interpreter, and the teachers agreed that a
translator was helpful. All teachers perceived a need for
improved staff representation among the Hmong
community along with expanding translation services
available for Hmong families. As seen in one of the
interviews, respondent six, a female teacher, mentions:
It is definitely effective to have someone, an adult that
is established in the Hmong community to work at
your school. I think the students see that as another
bridge or piece of communication that the family can
rely on. I just wish that we have better representations
of Hmong staff along with translators who are readily
available in our school. We never had a person here
specifically to do the translating for Hmong families,
but we did have a math teacher who is now retired
and you can always rely on him. Now it is a challenge
because if I need to get a document translated then it
might take longer than I anticipated so I have to plan
ahead.
Four teachers felt that the schools should provide a
Hmong language and cultural class geared toward Hmong
students. The course would be beneficial for Hmong
students and parents to maintain their culture and
language at school. Such a course would connect students
to their own culture and language within the school
community and this would allow educators to better
collaborate with Hmong parents. According to respondent
two, a male teacher:
Our school is very family-like. I think it works well
with the Hmong culture of having the support from
your family. We do have a Hmong language class. I
Mai-Eng Lee
Teachers’ Perception towards Hmong Students
think it’s nice for Hmong kids that struggled in
regular class because they often do well in the Hmong
class and it is good for them to have that success. The
class is also helpful for the growing number of kids
who do not speak Hmong or do not speak Hmong
well because they are getting disconnected from their
culture as time goes on. I think it’s definitely good to
have that component to help these students succeed.
SUPPORTIVE HOME ENVIRONMENT
The current study established an agreement among the
teachers about the need for an improved home environment
in the Hmong community. All six teachers mentioned the
lack of structure, a quiet space, and opportunities at home
to help Hmong students fully engage with their education.
The teachers seemed to understand that a lot of Hmong
parents are in a situation where they cannot provide their
children with adequate financial and academic support;
however, they urged parents to continue to motivate
students academically. Therefore, teachers have suggested
for Hmong parents to continue to interact with their
children either in their native language or simply check for
completion on students’ assignments. Teachers perceived
this as a useful way for Hmong parents to connect with
their students and assist them to seek additional academic
assistance if needed. As mentioned by respondent one, a
male teacher, stated:
The ideal best home environment is a place that provides
quiet time, structure, and a quiet space where these
students can do some work. I think having some resources
where they can go and ask for help would also be beneficial.
If the parents are really kind of out of touch with their
children’s learning or if this is the first child that is going
through it then I can see why this is really a difficult
situation. When there is no quiet space in doing their work
and no expectations on the part of the parents to get the
work done then this can become a struggle. In my class, I
see that it’s a challenge because some Hmong students tend
to do their homework in school and so if they don’t find
time to do it at home it’s not going to get done.
PARENTS’ INTIMIDATION FACTORS
Hmong parents may not necessarily understand the
Western academic system, but it is clear to the teachers
they understand the value of education. Four of the teachers
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stated they have had limited, but fairly positive, interaction
experiences with Hmong parents. This study found
Hmong parents are responsive to their students’ learning,
but only a few parents are active within the school. Four of
the teachers agreed Hmong parents have limited English
speaking skills and this may have contributed to how often
they volunteered at school events. The results do show
opinions on extreme levels where respondent two, highly
perceived Hmong parents as intimidated to enter the
school building due to language barriers and accessibility.
Respondent two said,
The most challenging thing working with Hmong
parents is getting any sort of communication with
them. We have mandatory calls with them all the
time. Even when we try calling home, so often their
phones are disconnected, their voicemail are full, they
will hang up when they see it’s our school that is
calling. It is a real challenge. We had in the past, do
home visits for all of our students. Even then, we have
parents who sit down and start to leave. I do not know
what it is, intimidation? There’s needed to be
something so parents are not intimidated of coming
into the building. It could be as simple as making the
front entrance more inviting and not having the metal
detector sitting right there or having so many locked
doors everywhere so they can at least come in and not
sit outside.
ACADEMIC LEARNING ACTIVITIES
Five teachers suggested Hmong students struggled to
learn English, but Hmong students are visual learners.
Hmong students need reading, writing, and hands-on
learning activities within their home and school
environment to help them succeed. Teachers suggested
Hmong students should have conversations with their
parents, have access to books at home, and go to the public
library. Hmong students may not have the opportunities
to go to camp and classes during the summer but having
additional resources could be helpful for Hmong students
to gain the academic and social skills they need in school.
Two teachers included in their comments that Hmong
students should interact more with students who are
different from them because it will help improve their
communication skills. The teachers also agreed Hmong
students are very open to learn about others’ cultures and
may not be comfortable at first, but other students enjoyed
78
interacting with them. In addition, teachers believe having
a mix of quiet times and interactive activities within the
classroom will allow Hmong students to fully engage in
their learning. As mentioned by respondent four, a male
teacher:
Many Hmong students are into the arts, such as,
singing, dancing, and poetry writing. I think
incorporating some things like that will definitely be
helpful to their learning. They are really hands on too
and like movement, and so any kind of hands-on
activity where they can get up and move around are
some of the things that we can definitely do to help
them achieve.
DISCUSSION
The findings from this current study correspond with
the results of previous studies that Hmong students need
additional support and academic resources within their
home and school environment in order to excel in school.
In Thao (2003), Hmong students were empowered when
their school valued their culture and utilized their parents
as resources. In this way, Hmong parents can collaborate
with school professionals to support their children’s
education and provide the necessary tools to guide the
students. It is also evident from Thao (2003) that the home
and school environment has a critical role in the academic
success of Hmong students. Hmong students should
receive relevant Hmong history and culture courses in the
school to help Hmong children identify with their culture
and understand its values (Thao, 2003). This perspective
was perceived to be imperative by four teachers in the
current study. Moreover, in correspondence to Xiong
(2008), Hmong children are growing up in disadvantaged
families, where Hmong parents lacked an educational
background, and as a result, may have hindered their
children from having a supportive home environment. This
finding was reinforced by the results of the current study
where five teachers felt Hmong parents are struggling with
language barrier and acculturation. These two factors were
perceived as the greatest hindrance to Hmong parents in
order for them to support their children academically.
Social Work
IMPLICATIONS FOR SCHOOL POLICY MAKERS
It has become evident that Minnesota has a growing
population of Hmong students in the Twin Cities area. The
essential implications for school policy makers that were
developed from the results are the following: 1) ensure
schools have formal translation services available for
teachers so they can better communicate effectively with
parents who do not speak English or have limited English
speaking skills, 2) provide additional funding to allow
Hmong students to have access to a Hmong language and
cultural classes, and 3) support school-based programs to
provide extra help for students who speak more than one
language. Moreover, there is a need for better
representations of Hmong staff because it allows Hmong
parents to feel less intimidated and instead more welcome
within the school building.
LIMITATIONS
Mai-Eng Lee
Teachers’ Perception towards Hmong Students
grammar activities. Hmong students are encouraged to
talk to other students and be in a mixed group of kids in
order to improve their communication skills.
Acculturation to the Western education system also may
have contributed to how well Hmong students are able to
perform in school. The results show Hmong students are
in need of a culturally sensitive school environment to help
them actively engage in their learning, where Hmong
students can learn about their own culture and language.
In addition, Hmong students need a supportive home
environment that provides a quiet study space and some
hands-on learning activities to enhance their academic
learning abilities. Despite the lack of Hmong parents’
academic involvement and their intimidation within their
children’s school, they highly value education and want to
understand the Western education system to better provide
a supportive home environment for their children.
Therefore, it is imperative for teachers and other school
professionals to collaborate with Hmong parents in
assisting Hmong students to achieve academic success.
It is important to note there are limitations in this
research study. Snow ball design calls for a cautious
generalization from the sample so it only reflects the
participants in this study. Due to the small sample size,
this study provided little insight about teachers’
perceptions of Hmong American students. Future research
relating to this topic should include a larger population
base to be more favorable. There are implications for future
study where the researcher could explore the educational
perspectives from teachers and both Hmong parents and
students. This will allow the researcher to study more indepth and understand the perspectives of Hmong parents
and students.
CONCLUSION
Through this research, the primary researcher conducted
interviews with six teachers who have taught Hmong
students throughout their teaching career in the Twin
Cities area. It is evident from the study that Minnesota has
a growing population of Hmong students who have
literacy challenges with reading, writing, and verbal
communication in English. The current study identifies
Hmong students are in need of more reading, writing, and
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University of St. Thomas McNair Scholars Program Research Journal
APPENDIX A
Recruitment email/telephone invitation:
Hello,
My name is Mai-Eng Lee and I am a current undergraduate
at the (institution’s name) and Ronald E. McNair scholar.
I am conducting a research project exploring the
perceptions of teachers in regards to the necessary academic
and parental support that will empower Hmong students
to excel in school. I am looking for teachers who have
experience teaching Hmong students in their classroom to
be part of a 30-45 minute interview. Your decision to
participate in this study is entirely voluntary. Please know
that if you do choose to participate in this study, all
information will be kept confidential.
For your participation in the study, you have the
opportunity to be entered into a drawing for 1 of 2 $10
gift cards to Target. If you are interested in participating
in this research or would like more information, please
contact Mai-Eng Lee at (email address).
Thank you for your consideration of this research.
Sincerely,
Mai-Eng Lee
Telephone script:
Hello (potential participant’s name),
My name is Mai-Eng Lee and I am a current undergraduate
at the University of St. Thomas and Ronald E. McNair
scholar. I am contacting you because your name was
recommended by other teachers who thought you would
be interested my study. The reason I’m calling is that I am
conducting a study on exploring teachers’ perceptions in
regards to the necessary academic and parental support that
will empower Hmong students to excel in school. I am
currently seeking teachers who have experience teaching
Hmong students in their classroom as participants in this
study and I wondered if you would be interested in hearing
more about it?
[IF NO] Thank you for your time. Good-bye.
[IF YES] Continue
Participation in this study involves meeting with me for
an interview, which will take approximately 30-45
minutes. I will ask you some questions in regards to your
teaching experiences working with Hmong students and
families. In appreciation of your time commitment, you
will have the opportunity to be entered into a drawing for
1 of 2 free $10 gift cards to Target. I would like to assure
you that this study has been reviewed and received approval
from the University of St. Thomas Institutional Review
Board.
However, your decision to participate in this study is
entirely voluntary.
Would you be interested in participating?
[If NO] Thank you for your time. Good-bye.
[IF YES] Thank you; I appreciate your interest in my
research!
(Schedule a mutually agreeable time to meet for an
interview.)
I look forward to meeting you on (day and time of
appointment). Thank you very much for helping me with
my research!
80
APPENDIX B
INTERVIEW QUESTIONS
Background Questions:
1. What grade levels have you taught in the past?
2. Have you used an interpreter? If yes, what was this
like?
3. What challenges have you experienced working with
Hmong students?
4. What challenges have you experienced working with
Hmong parents?
5. Can you describe what in particular was rewarding
when you work with Hmong students and their
parents? Explain why?
Main Questions:
6. What would be the best school environment to
support Hmong students to achieve academic
success?
7. What would be the best home environment to
support Hmong students to achieve academic
success?
8. What kinds of efforts have you or your school done
to facilitate Hmong parent’s involvement in their
children’s schooling?
a. Please explain
b. Describe what your school can improve on to better
support and welcome Hmong families.
9. What specific learning activities do you think would
help Hmong students to be more successful at
school?
10. What specific learning activities do you think would
help Hmong students to be more successful at home?
Ending Question:
11.Do you have anything else to say? Any final
thoughts?
REFERENCES
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