Rebecca Campbell-Montalvo

Abstract
Objective
Chronic kidney disease affects 1 in 7 people in the US, and 1 in 6 US Veterans. Treatment for kidney failure includes home dialysis, which, despite its benefits, is infrequently used. A major barrier to using home dialysis is receiving adequate education about it. This research investigates how patient education affects treatment choices of Veterans with kidney disease.

Methods
As part of a randomized control trial, we interviewed 42 US Veterans with advanced chronic kidney disease. An interview based on the Theoretical Domains Framework elicited on the impact of study education on decision-making. Reflexive thematic analysis attuned to cultural model theory—the beliefs which motivate behavior held by groups—was used for analysis.

Results
There were four themes in the data: 1) Pre-education, patients had a lack of knowledge of kidney disease and treatment. 2) After education, patients reacted with surprise and then coping actions. 3) Patients experienced positive emotions and beliefs from education and coping. 4) Patients dealt with diagnosis and engaged in treatment decision-making. Ten cognitive, emotional, and behavioral subthemes were seen. Themes were found in the interviews of 76 % of participants receiving comprehensive patient education, but only 27 % of those receiving enhanced usual care.

Conclusion
We provide a mechanistic understanding of the process through which education affects cultural models to support patients’ decision-making by preparing and equipping them to confront the future. We note that cultural model changes occur across longitudinal stages, which are recursive with one another and dynamic based on the individual case.

Practice implications
Because optimal dialysis outcomes require time to plan, create, and heal from dialysis access surgery, practitioners should provide patient education 6 months prior to estimated start to account for time needed for cultural model change. Helping patients know what to expect in terms of their own changing understanding may further support.

Based upon research in rural central Florida, The Latinization of Indigenous Students examines how schools perceive and process demographic information, including how those perceptions may erase Indigeneity and impact resource access. Based on multiyear fieldwork, Campbell-Montalvo argues that languages and racial identities of Indigenous Latinx students and families may be re-formed by schools, erasing Indigeneity. However, programs such as the federally funded Migrant Education Program can foster equitable access by encouraging pedagogies that position teachers as cultural insiders or learners. Anchored by pertinent anthropological theories, this work advances our ability to name and explain pedagogical phenomena and their role in rectifying or reproducing colonialism among marginalized and minoritized groups.

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Structural vulnerability illuminates how social positionings shape outcomes for marginalized individuals, like migrant farmworkers, who are often Latino, indigenous, and/or undocumented. Furthering scholarship on negotiating constraints, we explore how school employees (here, Migrant Advocates) broker health care access for migrant farmworker families. Ethnographic research in central Florida showed that Advocates perform similar functions as community health workers while experiencing similar dilemmas. We propose combining medical anthropological insights with the CDC's Whole School, Whole Community, Whole Childmodel, conceptualizing schools as an important site for families' wellbeing, recognizing brokerage roles of staff, and offering new directions for migrant health scholars.