Building a diverse health professions workforce? Changes in enrollment and completion among underserved populations in grant supported health professions pathways

Fox, Heather L

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https://hdl.handle.net/2142/92734 Copy

Description

Title

Building a diverse health professions workforce? Changes in enrollment and completion among underserved populations in grant supported health professions pathways

Author(s)

Fox, Heather L

Issue Date

2016-06-29

Director of Research (if dissertation) or Advisor (if thesis)

Kuchinke, K. Peter

Doctoral Committee Chair(s)

Kuchinke, K. Peter

Committee Member(s)

• Bragg, Debra D.
• Zamani-Gallaher, Eboni Miel
• Robinson-Cimpian, Joseph Paul

Department of Study

Educ Policy, Orgzn & Leadrshp

Discipline

Human Resource Education

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• TAACCCT
• health professions
• health education
• health professions education
• health careers
• health pathways
• educational equity
• equity index
• Latino students
• Black students
• Low-income students
• Underserved students
• Nontraditional students
• Community colleges
• Career pathways
• Retention
• Graduation
• Degree completion
• Federal grants
• Department of labor
• Associate's degrees
• Certificates

Abstract

Disparities in the representation of minoritized populations in health professions is a rising concern for educators, scholars, and policy makers (Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce, 2004; The Sullivan Commission, 2004). This reflects growing evidence of the relationships among utilization of healthcare, patient outcomes, and the diversity of health professionals at healthcare institutions (Crowley, 2010; Chevannes, 2002; U.S. Commission on Civil Rights, 2010; Williams et al., 2014). Additionally, researchers have found that health professionals from underserved populations are more likely to provide care for medically underserved populations, who in turn are more likely to seek care from providers who have the same racial and ethnic background as themselves (Balogun, Sloan, & Hardney, 2005; Brown et al., 2005; Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce, 2004; Smedley et al., 2004). The courts, researchers, and policy makers at the federal level have advocated for strategic action to improve representations and diversity in health professions (Baldwin, et al., 2006; Blagg & Blagg, 2008; Brown, DeCorse-Johnson, Irving-Ray, & Wu, 2005; Committee on Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce, 2004; Smedley et al., 2004). Most of the effort to improve equity in health professions have focused on expanding representation of underserved subgroups in health professions education (Blagg & Blagg, 2008). At the same time, health professions educators are being called on to meet a rapidly growing demand for more graduates across most health occupations (Carnevale, Smith, Gulish, & Beach, 2012). As a result, health professions educators are charged with both increasing the supply and diversity of health professionals by engaging underserved populations in health professions education (Blagg & Blagg, 2008; Smedley, Butler, & Bristow, 2004). While efforts to increase the supply and diversity of health professionals through health professions education have had limited success, the question remains do significant federal human capital investments in health professions education contribute to diversity among health professionals (Carnevale et al., 2012; Smedley et al., 2004). Human capital theory posits that investments in human capital, including those that support education, result in positive returns for both individuals and society (Sweetland, 1996). In addition to the economic benefits there are numerous other benefits associated with human capital investments including: a) improved health (Belfield & Bailey, 2011; Hout, 2012), b) improved access to healthcare and health insurance (Baum et al., 2013), c) improved civic engagement including a higher propensity to vote (Baum et al., 2013), d) increased tax revenues (Baum et al., 2013, Economic Modeling Specialists International, 2014), job security and stability, e) reduced reliance on unemployment (Economic Modeling Specialists International, 2014; Hout, 2012), f) healthier behaviors (Baum et al., 2013; Belfield & Bailey, 2011; Economic Modeling Specialists International, 2014), g) reduced criminal involvement (Belfield & Bailey, 2011, Economic Modeling Specialists International, 2014), h) reduced use of illicit drugs (Economic Modeling Specialists International, 2014), i) reduced reliance on welfare (Baum et al., 2013; Belfield & Bailey, 2011; Economic Modeling Specialists International, 2014), and j) and improved socioeconomic standing (Baum et al., 2013; Organisation for Economic Co-operation and Development, 2013). Moreover it is argued that when human capital investments are made in underserved populations they have the highest potential for economic and social returns (Becker, 1971; Levin 2008). Human capital investments in underserved populations are argued to provide the means for socioeconomic mobility for those directly and indirectly impacted by the investment, including their children and future generations (Becker, 1964; Heckman & Krueger, 2005; Levin 1989, 2008). Levin (2008) contends that the federal government has a strong interest in promoting both the economic benefits and diverse society that are associated with human capital investments. Towards this end, the federal government invests in human capital investments in the form of federal grants that are intended to build a more diverse workforce and improve economic mobility (Levin, 2008). Based on the assertions of human capital theory, researchers have argued that there is a moral and economic imperative that strongly supports federal investments in education that build access and promote successful educational outcomes for underserved student populations (Heckman & Krueger, 2003; Levin, 2008, Levin, Belfield, Muenning, & Rouse, 2007). This study examined one case of a federal human capital investment in health professions education for evidence of a changes in educational equity for underserved student subgroups. Specifically, this study compared enrollment and educational outcomes of students in health professions programs of study in a consortium of community colleges before and after they received a $19.6 million Trade Adjustment Assistance Community College and Career Training (TAACCCT) grant. This was done by comparing characteristics of a sample of students were enrolled at H2P colleges prior to receiving TAACCCT funding with a sample of students who were enrolled at H2P colleges in TAACCCT-funded programs of study. The first sample, referred to as the comparison sample, consisted of 8,673 students who enrolled in health professions programs of study in 2008 or 2009 at H2P colleges. The second sample, referred to as the participant sample consisted of 4,693 students who enrolled in TAACCCT-funded programs of study in 2012. Both samples were drawn from eight of the nine H2P colleges. The ninth college was excluded from the study because a comparison sample was not available. The study compares the demographics of students in the two samples, as well as their retention and awarded credentials over a three year period (2008 - 2010, 2009 - 2011 and 2012 - 2014). Underserved populations in health professions programs of study included in this study were: a) Latino students, b) Black students, c) low-income students who were eligible for Pell grants, d) male students, e) students who were 25 years of age or older, and f) students who completed developmental education coursework. This study addresses the following research question: Were there changes in educational equity for underserved subgroups of students who participated in TAACCCT-funded health professions programs of study at H2P colleges? a. What changes were there in the proportion of underserved students who enrolled in health professions programs of study prior to and after receiving TAACCCT funding? b. What changes were there in the educational outcomes of underserved subgroups of students enrolled in health professions programs of study prior to and after receiving TAACCCT funding? This study utilized two sources of secondary data. The first data source utilized in this study were data gathered by the OCCRL for their third party evaluation of H2P. The OCCRL data included a database of student record data on student demographics, course history, and credentials awarded by the college. Most of the data required for this study were part of this student record database. OCCRL collected data on the health professions programs of study at each H2P college, including those not impacted by TAACCCT funding. This data was used in assigning program length. The second data source utilized in this study are disaggregated enrollment data reported by H2P colleges in their IPEDS 12-Month Enrollment reports. IPEDS data was used in the analysis of enrollment at H2P colleges using Bensimon et al.'s (2003) Equity Index and chi-square analysis, for the following subgroups: a) Latino students, b) Black students, and c) male students. There were three stages of data analysis used in this study. The first stage was an examination of the enrollment of the two samples in comparison to the populations served at each H2P college. Bensimon et al's (2003) Equity Index was used to calculate the proportion of Latino, Black, and male students in each sample as compared to the college-wide enrollment at the college and consortium level. The second stage of analysis used both Equity Indexes and goodness-of-fit chi-square analysis to compare the composition of the two samples. In this stage Equity Indexes were used to compare the proportion of the Latino, Black, and male students in the two samples. Chi-square analysis were used to compare the composition of each of the students in each of the subgroups featured in this study including: a) Latino students, b) Black students, c) students who were eligible for Pell grants, d) male students, e) students who were 25 years of age or older, and f) students who completed developmental education coursework. The final stage of analysis used logistic regression to analyze the likelihood of students in each underserved subgroup being retained or completing their program of study. The outcomes examined for each subgroup in the study were: a) retained without a credential, b) awarded one or more certificates, c) awarded one or more associate’s degrees, and d) awarded one or more credentials. A logistic regression analysis was run for each sample, for each outcomes, that analysis the relative likelihood of each subgroup reaching the outcome. This analysis was done at the consortium level using a fixed-effect technique to account for the variance among colleges.

Graduation Semester

2016-08

Type of Resource

text

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http://hdl.handle.net/2142/92734

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Copyright 2016 Heather L. Fox

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