Running head: MY CULTURE IS MY IDENTITY My Culture is My Identity: Understanding Cultural Aspects that Permeate Ethnic Minorities’ Feelings Regarding Their Bodies A Dissertation submitted by Nicole M. Williams, Ed.D.(c), LPC to College of Saint Mary in partial fulfillment of the requirement for the degree of DOCTOR OF EDUCATION with an emphasis on Health Professions Education This Dissertation has been accepted for the faculty of College of Saint Mary by: MY CULTURE IS MY IDENTITY 2 We hereby certify that this Dissertation, submitted by Nicole M. Williams conforms to acceptable standards and fully fulfills the Dissertation requirements for the degree of Doctor of Education from College of Saint Mary Shari M. Prior, Ph.D. Chair Rebecca Hoss, Ph.D. Committee member Lois Linden, Ed.D., R.N. Committee member MY CULTURE IS MY IDENTITY 3 Copyright © November 30, 2018 Nicole M. Williams MY CULTURE IS MY IDENTITY 4 Dedication Page This dissertation is dedicated to Celeste F. Williams. From day one, your love was always unconditional and I am so blessed to have had you as a grandmother for almost 26 years. Without you, there would have been no me. I miss you Grandma. Rest in Power! MY CULTURE IS MY IDENTITY 5 Acknowledgement Page “I again saw under the sun that the race is not to the swift and the battle is not to the warriors, and neither is bread to the wise nor wealth to the discerning nor favor to men of ability; for time and chance overtake them all.” ~Ecclesiastes 9:11 NASB You are the source of my strength. You are the strength of my life. I LIFT MY HANDS IN TOTAL PRAISE TO YOU! Thank you Lord for ordering my steps and blessing me beyond measure. Thank you to the Blessed Mary, ever Virgin and my patron saint, Saint Mary Magdalene for your unyielding faithfulness both to our Lord and Savior Jesus Christ and to me through my prayers. To my chair, Dr. Shari Prior—words cannot express how grateful I am to you. You have listened to me cry, panic, and get angry, and you have always been the voice of calm and reason. You supported my big ideas and you pulled me out of the deep end when I was drowning. You were my favorite professor from Day one at CSM and I could not have picked a better person to guide me through this process. To my committee members, Dr. Rebecca Hoss and Dr. Lois Linden, thank you for your time, feedback, and support which allowed me to be successful in this endeavor. A special thank you to Dr. Linden for stepping in at the last minute for my dissertation defense—I am so grateful for you! Thank you to Dr. Mirna Mejia for your early contributions to this project. Thank you to my parents who constantly encouraged my academic pursuits and taught me that anything that I want is attainable as long as I never give up. Thank you all for making my last two semesters as stress-free as possible and ensuring that my document was edited. To Angelie Esquivel and Trina Blue, my A-1s, since Day 1, thank you for always having my back and being there at my highest highs and lowest lows. You two are my best friends and life Running head: MY CULTURE IS MY IDENTITY wouldn’t be worth living without you in it. To Johanna Lopez, you have been so supportive, especially during this last year with everything that I have gone through. Thank you for loving and accepting me the way that you do, and always keeping me laughing. Thank you to all of my family and friends who have supported me from Honolulu to Austin to Chapel Hill to Kent to Omaha. A special shout-out to my College of Saint Mary cohort, especially Dr. Kristen McNulty, for taking this journey with me. Thank you Kristen for always reaching out and never forgetting about me despite our distance and our life circumstances. Finally, to my protector, my future husband, and my best friend…thank you for sharing this life journey with me and showering me with unconditional love and understanding. Colt, you are my backbone, and everything that I have given to this project is because you have encouraged me to never give up despite the setbacks. I could not have finished this without your love, your drive, and your guidance. Tú eres mi inspiración y mi mundo. ¡Te amo…más! MY CULTURE IS MY IDENTITY 7 Table of Contents Abstract…………………………………………………………………………………………..13 Chapter I: Introduction…………………………………………………………………………...14 Background and Rationale.………………………………………………………………14 Purpose of the Study…………………………………………………………………......18 Research Questions………………………………………………………………………18 Assumptions, Limitations, and Delimitations…………………………………………....19 Assumptions……………………………………………………………….…......19 Limitations…………………………………………………………….….……...20 Delimitations………………………………………………………..……………21 Definition of Terms………………………………………………………………..…......21 Summary…………………………………………………………………………..…......23 Chapter II: Review of Literature…………………………………………………………...….....24 Historical Context……………………………………………………………...………...24 Cultural Identity………………………………………………………………….............24 Cultural Identity and Body (Dis)satisfaction………………………………..……….......26 Cultural Identity and Self-Esteem………………………………………………..………31 Self-Esteem and Body (Dis)satisfaction………………………………………...…….....34 Thin Ideal Internalization and Black and Latina Women………………………...……...38 Summary and Conclusion……………………………………………………...………...41 Chapter III: Methods and Procedures……………………………………………………………45 Qualitative………………………………………………………………………….….....45 Quantitative……………………………………………………………………………....46 MY CULTURE IS MY IDENTITY 8 Research Design……………………………………………………………………….....46 Identification of Participants…………………………………………………….…….…48 Population………………………………………………………………….….…48 Sample…………………………………………………………….………….…..48 Inclusion Criteria……………………………………………………..….48 Exclusion Criteria…………………………………………………….….49 Description of the Setting…………………………………………………………….….50 Data Gathering Tools……………………………………………………………….…...50 Qualitative……………………………………………………………………….50 Quantitative……………………………………………………………………...52 Data Gathering Procedures………………………………………………………….…..54 Data Analysis Plan………………………………………………………………………56 Qualitative………………………………………………………………….……56 Quantitative………………………………………………………………...……58 Data Quality Measures…………………………………………………………………..59 Qualitative……………………………………………………………………….59 Quantitative……………………………………………………………...………61 Ethical Considerations…………………………………………………………………...62 Summary………………………………………………………………………………....63 Chapter IV: Results………………………………………………………………………….…...64 Qualitative Interviews…………………………………………………………………....64 Coding…………………………………………………………………………………....66 Central Phenomenon: Body Image………………………………………………….…...71 MY CULTURE IS MY IDENTITY 9 Weight…………………………………………………………………………...71 Breast Size……………………………………………………………………….74 Hair……………………………………………………………………………....77 Category: Interpersonal Impacts………………………………………………………....78 Family……………………………………………………………………………79 Peers……………………………………………………………………………...80 Relationship Partners…………………………………………………………….82 Category: Cultural Expectations…………………………………………………………83 Mixed Messages…………………………………………………………………84 Food……………………………………………………………………………...85 Ideal Woman……………………………………………………………………..87 Category: Mainstream Values……………………………………………………………89 Thin Ideal………………………………………………………………………...89 Quantitative Findings…………………………………………………………………….91 Characteristics of the Sample…………………………………………………….91 Relationships among the Variables………………………………………………92 Influence of Body Satisfaction on Self-Esteem……………………………….....93 Chapter V: Discussion…………………………………………………………………………...95 Introduction……………………………………………………………………………....95 Qualitative Research Discussion…………...………………………………………….....95 Quantitative Research Discussion…………..…………………………………………..104 Implications for Clinical Practice………………………………………………………105 Limitations and Future Directions……………………………………………………...106 MY CULTURE IS MY IDENTITY 10 Summary………………………………………………………………………………..108 References………………………………………………………………………………………109 Appendix A: Standardized Email Recruitment Script………………………………………….119 Appendix B: Participant Letter…………………………………………………………………120 Appendix C: Informed Consent………………………………………………………………...121 Appendix D: IRB Approval…………………………………………………………………….126 Appendix E: Demographic Data………………………………………………………………..127 Appendix F: Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ- AS), Body Areas Satisfaction Subscale (BASS)…………………………...…….128 Appendix G: Rosenberg Self-Esteem Scale (RSES)…………………………………………...129 Appendix H: Unstructured Interview Guide Questions………………………………………...130 Appendix I: Confidentiality Agreement for Undergraduate Research Assistants……………...131 MY CULTURE IS MY IDENTITY 11 List of Tables Table 1: Age Ranges of Unstructured Interview Participants…………………………………...65 Table 2: Means and Standard Deviations of the Measures……………………………….……...92 Table 3: Intercorrelations Between Variables……………………………………………………93 MY CULTURE IS MY IDENTITY 12 List of Figures Figure 1: An adapted paradigm model……………………….………………………………...68 Figure 2: The conceptual model based on the formulated theory………...……………….…...70 MY CULTURE IS MY IDENTITY 13 Abstract The purpose of this grounded theory mixed method research study was to ascertain and understand the cultural experiences of Black and Latina women and how these cultural concepts influenced their body dissatisfaction, body satisfaction, and self-esteem. In order to investigate these concepts, twenty women who self-reported their race/ethnicity as Black or Latina participated in unstructured qualitative interviews in order to understand their lived experiences. Additionally, one hundred and fifty Black and Latina women were administered an online quantitative