Date of Award

August 2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Indigenous Health

First Advisor

Shawnda Schroeder

Abstract

Athletic training, recognized for its role in providing specialized healthcare services focused on prevention, assessment, treatment, and rehabilitation of injuries for the athletic population, represents a growing profession within the healthcare field. As the need and value of athletic training services continues to grow, it is imperative for academic and Federal institutions to adapt programs and policies that reflect the diversity of the communities they serve.

Despite ongoing efforts, which should not be minimized, to promote diversity, equity, and inclusion in the athletic training profession, significant progress remains limited, particularly in increasing representation of American Indian and Alaska Natives (AIANs). Failure to prioritize the recruitment, admission, and retention of a more representative student body in athletic training education programs (ATEPs) will perpetuate existing disparities. This will continue to result in selection of leaders in athletic training who are largely non-Hispanic White, thus continuing a leadership demographic that does not adequately reflect the profession or the populations it serves in terms of cultural, racial, and ethnic diversity.

The disparity in diversity within the athletic training profession emphasizes the broader need for systemic recognition and support, such as Medicare’s recognition of athletic trainers (ATs) as qualified healthcare professionals, to enhance accessibility and quality of care across diverse populations. This recognition would not only enhance healthcare delivery but also support efforts to achieve health equity among AIAN communities. Each of the three products of this dissertation aligns with levels from the social ecological model—personal, relational, community, and societal—providing a comprehensive perspective on the topic.

The first product, grant proposal, focuses on the need to better understand and consider the experiences of AIAN in the profession given that reliable data is either limited or simply nonexistent. This proposal applies a framework inspired by Indigenous teachings of resilience to address gaps in literature on factors that influence the persistence of AIAN in ATEPs. Knowledge used in developing the grant proposal informed the second product, a manuscript. For the second product, a qualitative study was used to identify facilitators and barriers that influence the recruitment, retention, and credentialing of AIAN ATs in ATEPs. Nine individuals who self-identify as AIAN ATs consented to participate in a semi-structure interview. Analysis revealed barriers such as lack of support, insufficient diversity, and cultural insensitivity. In contrast, facilitators included self-efficacy, support network, service orientation, and ceremony or religious faith. The third product, a policy brief, details the dire need to recognize ATs as qualified healthcare professionals under the Medicare program. This change could expand healthcare services, particularly through the Indian Health Service system, in AIAN communities by addressing health provider shortages, insufficient funding, and access to quality health care and services. Collectively, these products address gaps in scholarly literature by highlighting critical steps towards improving AIAN representation in athletic training, fostering inclusivity, and expanding healthcare access.

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