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The emerging majority in the United States health professions: a gap analysis innovation model for Latinx recruitment planning within higher education

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The emerging majority in the United States health professions: a gap analysis innovation model for Latinx recruitment planning within higher education

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THE EMERGING MAJORITY IN THE UNITED STATES HEALTH PROFESSIONS: A GAP
ANALYSIS INNOVATION MODEL FOR LATINX RECRUITMENT PLANNING WITHIN
HIGHER EDUCATION
by
Astor J. Suriano

A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION

August 2022

Copyright 2022 Astor J. Suriano

ii
Dedication
To the Lord, my everlasting God and Savior, for what is built herein remain strong.
To my beautiful and lovely wife, Priscilla. you are the strongest person I know, physically,
mentally, and spiritually. You are the only reason I made it to the finish line. I will always love
you in this lifetime and the next. You are my heart, my soul, and my treasure. You are my
everything.
To Celeste, Mattias, and Skylan, develop a passion to learn so you will never cease to grow.
Always be honest and respectful with everyone. Always love and forgive from the bottom of
your heart. If you fail build courage to continue forward and try again. Listen to the passions of
your heart, go after what you believe in, place it in God’s hands, and HE will do the rest. Share
your love with others and always strive to build a better community around you. Always walk
with God in the light of your life. You are the world to my heart.

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Acknowledgements
It is with immense gratitude that I acknowledge the mentorship, coaching, and
encouragement of my research advisor Dr. Adrian J. Donato. Thank you deeply for believing in
the development of my research and providing me with a lifelong skill in the field of
organizational change and leadership. Your advice throughout the process helped me build
personal and professional growth in my lifelong learning journey.
It is with great pleasure that I acknowledge the support, guidance, and advice of my
dissertation committee, Dr. Kenenth A.Yates and Dr. Eric A. Canny. I am greatly appreciative of
the time, expertise, and commitment you both provided in helping me frame a thoughtful and
meaningful study to address diversity, equity, and inclusion issues using the KMO model.
I would also like to acknowledge the HU institution (a pseudonym to maintain
confidentiality) that provided me with the site resources, accessibility to documentation, and
participation of the administration to bring the study to fruition. Thank you to the staff, faculty,
and students who were welcoming, responsive, and most of all, open, transparent, and forthright
throughout the process.
I would like to acknowledge all the professors at USC for their dedication in sharing your
expertise. Thank you for allowing me to learn so much from you all through the doctoral
program. I would like to acknowledge my Cohort 9 colleagues for their inspiration and
motivation to complete the program at USC. Thank you for the memories and friendship
throughout the years together.
I would like to thank my mother and father who taught me the importance of education
and the family values that I share with my family today. Thank you for your prayers and for
always believing that I can overcome the challenges that life may bring. I would like to also

iv
thank my brother, Ulises, who has always been there for me throughout this journey and for all
your support through the toughest of times. I would like to thank my Madrina and Tia Tita, who
always shared your love, prayers, and blessings with me to bring the best out of me to share with
the world.
I would like to acknowledge my family for all your love, support, and prayers through
this incredible journey. Thank you to my wife, Priscilla, for your strength, patience, and prayers
that helped me get through this program. Thank you to my daughter Celeste and my two sons,
Mattias and Syklan, for bringing me joy, laughter, and happiness. You all are at the center of my
world, and I will always love you!
Lastly, I would like to acknowledge God for blessing me with a beautiful family, spiritual
strength, wisdom, and love in my life. Thank you for making me an instrument of your work and
for providing me with the opportunity to share these life experiences with others. I promise to
always acknowledge your presence in my life and to apply what I have learned in this graduate
program for the goodness of our world.

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Table of Contents
Dedication ....................................................................................................................................... ii
Acknowledgements ........................................................................................................................ iii
Abstract ........................................................................................................................................ xiv
Chapter One: Introduction of the Problem of Practice ....................................................................1
Organizational Context and Mission ...................................................................................2
Organizational Performance Status ......................................................................................3
Related Literature .................................................................................................................4
Importance of Addressing the Problem ...............................................................................7
Organizational Performance Goal ........................................................................................8
Description of Stakeholder Groups ......................................................................................9
Stakeholders Groups’ Performance Goals .........................................................................11
Chapter Two: Review of the Literature .........................................................................................16
Literature on the Problem of Practice ................................................................................16
Clark and Estes’s Gap Analysis Framework .....................................................................28
Stakeholder Knowledge, Motivation, and Organizational Influences ...............................28
Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation
and the Organizational Context .........................................................................................57
Conclusion .........................................................................................................................61
Chapter Three: Methods ................................................................................................................63
Methodological Approach and Rationale ..........................................................................63
Participating Stakeholders .................................................................................................65
Interview Sampling (Recruitment) Strategy and Rationale ...............................................67
Data Collection and Instrumentation .................................................................................68
Data Analysis .....................................................................................................................74
Credibility and Trustworthiness .........................................................................................77

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Validity and Reliability ......................................................................................................78
Ethics..................................................................................................................................81
Limitations and Delimitations............................................................................................83
Chapter Four: Results and Findings ...............................................................................................84
Participating Stakeholders .................................................................................................84
Data Validation ..................................................................................................................94
Results and Findings for Knowledge Needs ......................................................................95
Results and Findings for Motivation Needs.....................................................................132
Results and Findings for Organization Needs .................................................................180
Summary of Validated Influences ...................................................................................226
Chapter Five: Discussion and Recommendations........................................................................230
Organizational Context and Mission ...............................................................................230
Organizational Performance Goal ....................................................................................231
Description of Stakeholder Group ...................................................................................233
Goal of the Stakeholder Group of the Study ....................................................................233
Purpose of the Project and Questions ..............................................................................234
Knowledge Recommendations ........................................................................................234
Motivation Recommendations .........................................................................................243
Organization Recommendations ......................................................................................251
Integrated Implementation and Evaluation Plan ..............................................................263
Summary ..........................................................................................................................290
Strengths and Weaknesses of the Approach ....................................................................291
Limitations and Delimitations..........................................................................................292
Future Research ...............................................................................................................293
Conclusion .......................................................................................................................294

vii
References ....................................................................................................................................298
Appendix A: Survey Protocol ......................................................................................................337
Appendix B: Student Survey Protocol .........................................................................................348
Appendix C: Interview Protocol ..................................................................................................354
Appendix D: Student Interview Protocol .....................................................................................360
Appendix E: Information Sheet For Exempt Research ................................................................364
Appendix F: Document Analysis Protocol ..................................................................................366

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List of Tables
Table 1: Organizational Mission, Global Goal, and Stakeholder Performance Goals 11
Table 2: Knowledge Influences 37
Table 3: Motivation Influences 47
Table 4: Organizational Influences 57
Table 5: Senior Administration Demographics by Gender 85
Table 6: Staff and Faculty Demographics by Gender 86
Table 7: Senior Administration Demographics by Race and Ethnicity 86
Table 8: Staff and Faculty Demographics by Race and Ethnicity 87
Table 9: Senior Administration Demographics by Employment Tenure 87
Table 10: Staff and Faculty Demographics by Employment Tenure 88
Table 11: Senior Administration Demographics by Age Groups 88
Table 12: Staff and Faculty Demographics by Age Groups 89
Table 13: Administration Demographics, Bilingualism 89
Table 14: Staff and Faculty Demographics, Bilingualism 90
Table 15: Administration, Staff, and Faculty Position 90
Table 16: Student Demographics by Gender 91
Table 17: Student Demographics by Race and Ethnicity 92
Table 18: Student Academic Tenure 92
Table 19: Student Academic Age Groups 93
Table 20: Student Bilingual Language 93
Table 21: Student Secondary Language Type 94
Table 22: Administration Survey Results for Factual Knowledge 97
Table 23: Staff and Faculty Survey Results for Factual Knowledge 97
Table 24: Student Survey Results for Factual Knowledge 98

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Table 25: Emerging Factual Knowledge Themes 100
Table 26: Administration Survey Results for Conceptual Knowledge 104
Table 27: Staff and Faculty Survey Results for Conceptual Knowledge 105
Table 28: Student Survey Results for Conceptual Knowledge 105
Table 29: Emerging Conceptual Knowledge Themes 107
Table 30: Tool Kit Sequence and Survey Item Step Description 110
Table 31: Administration Survey Results for Procedural Knowledge 111
Table 32: Administration Survey Results in Ranking Order for Procedural Knowledge 112
Table 33: Staff and Faculty Survey Results for Procedural Knowledge 113
Table 34: Staff and Faculty Survey Results for Procedural Knowledge 114
Table 35: Comparison of Administration vs Staff and Faculty Survey Results for Procedural
Knowledge 116
Table 36: Emerging Procedural Knowledge Themes 119
Table 37: Administration Survey Results for Metacognitive Knowledge 124
Table 38: Staff and Faculty Survey Results for Metacognitive Knowledge 124
Table 39: Student Survey Results for Metacognitive Knowledge 125
Table 40: Emerging Metacognitive Knowledge Themes 129
Table 41: Administration Survey Results for Motivation, Self-Efficacy 134
Table 42: Staff and Faculty Survey Results for Motivation, Self-Efficacy 134
Table 43: Student Survey Results for Motivation, Self-Efficacy 135
Table 44: Emerging Self-Efficacy Themes 139
Table 45: Administration Survey Results for Motivation - Utility 142
Table 46: Staff and Faculty Survey Results for Motivation, Utility 143
Table 47: Student Survey Results for Motivation, Utility 143
Table 48: Emerging Motivation Themes on Utility Values 147
Table 49: Administration Survey Results for Motivation, Attainment 150

x
Table 50: Staff and Faculty Survey Results for Motivation, Attainment 151
Table 51: Emerging Attainment Value Themes 154
Table 52: Administration Survey Results for Motivation - Goals 157
Table 53: Staff and Faculty Survey Results for Motivation, Goals 158
Table 54: Student Survey Results for Motivation, Goals 158
Table 55: Emerging Goal Themes 171
Table 56: 2021 Demographic Description of Matriculants 172
Table 57: Administration Survey Results for Motivation,-Goal Orientation 175
Table 58: Staff and Faculty Survey Results for Motivation, Goal Orientation 176
Table 59: Emerging Goal Orientation Themes 178
Table 60: Administration Survey Results for Cultural Model Influence 1 182
Table 61: Staff and Faculty Survey Results for Cultural Model Influence 1 183
Table 62: Student Survey Results for Cultural Model - Influence 1 183
Table 63: Emerging Cultural Model Themes 187
Table 64: Administration Survey Results for Cultural Setting Influence 2 190
Table 65: Staff and Faculty Survey Results for Cultural Setting Influence 2 191
Table 66: Emerging Cultural Setting Themes, Establishing Partnerships 194
Table 67: Administration Survey Results for Cultural Setting Influence 3 196
Table 68: Staff and Faculty Survey Results for Cultural Setting Influence 3 197
Table 69: Emerging Cultural Setting Themes, Alternative Criteria 201
Table 70: HU Analysis on Applicants Matriculated in the MSPA Program 203
Table 71: HU Analysis on Total Applications to the MSPA Program 204
Table 72: HU Analysis Application Process vs Census Population for 2018 204
Table 73: HU Analysis Application Process vs Census Population for 2019 205
Table 74: HU Analysis Application Process vs Census Population for 2020 205

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Table 75: HU Analysis Application Process vs Census Population for 2021 206
Table 76: HU Analysis Application Process Versus Census Population for 2022 206
Table 77: Administration Survey Results for Cultural Setting Influence 4 208
Table 78: Staff and Faculty Survey Results for Cultural Setting Influence 4 209
Table 79: Emerging Cultural Setting Themes, Periodic Audits 213
Table 80: Administration Survey Results for Cultural Setting Influence 5 215
Table 81: Staff and Faculty Survey Results for Cultural Setting Influence 5 216
Table 82: Student Survey Results for Cultural Setting Influence 5 216
Table 83: Emerging Cultural Setting Themes – Sociocultural Interactions 223
Table 84: Assumed Knowledge Influences: Validation of Assets or Needs 226
Table 85: Assumed Motivation Influences: Validation of Assets or Needs 227
Table 86: Assumed Organizational Influences: Validation of Assets or Needs 228
Table 87: Organizational Mission, Global Goal and Stakeholder Performance Goals 232
Table 88: Summary of Knowledge Influences and Recommendations 236
Table 89: Summary of Motivation Influences and Recommendations 244
Table 90: Summary of Organization Influences and Recommendations 252
Table 91: Outcomes, Metrics, and Methods for External and Internal Outcomes 266
Table 92: Critical Behaviors, Metrics, Methods, and Timing for Evaluation of HU
Administration 271
Table 93: Required Drivers to Support Critical Behaviors of HU Administrators 274
Table 94: Evaluation of the Components of Learning for the Program 283
Table 95: Components to Measure Reactions to the Program 285
Table A1: Survey Items 338
Table B1: Survey Protocol Questions 349
Table C1: Interview Protocol Questions 355
Table D1: Interview Protocol Questions 361

xii
Table F1: Influences and Assessment 366
Appendix G: Immediately Following the Program Implementation 368
Appendix H: Delayed Blended Evaluation 370

xiii
List of Figures
Figure 1: Zone of Proximal Development with Cooperative-Based Learning 55
Figure 2: Conceptual Framework for the Representation of Latinx Students in the MSPA
Program at HU 59
Figure 3: Phase I: Open Coding Strategy Example for Knowledge Dimension 75
Figure 4: Phase II & III: Axial Coding Strategy for Emerging Themes & Validation of
Influences 76
Figure 5: Proposed Zone of Proximal Development for the HU Administration 270
Figure 6: Sample Report of HU Administration on Recruitment Planning Performance. 290

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Abstract
In California, there is a large disparity between the representation of Latinx healthcare
professionals and the demographics of the state. It is critical to examine the organizational
leadership to understand the barriers and challenges they may have in projecting diversity,
equity, and inclusion initiatives. An innovative approach is presented in this study to examine the
senior administration’s perspectives in the recruitment strategy for Latinx minorities, who
represent the emerging majority in the healthcare profession across the nation. The evaluation
involves a gap analysis in the organization’s senior administration at Health University (HU) to
identify factors under the knowledge (K), motivation (M), and organizational (O) influences that
pose a challenge to increase Latinx representation in the Master of Science in Physician Assistant
(MSPA) program. A mixed-methods approach is used to study and examine the senior
administrators by using interviews, surveys, and documentation analysis to evaluate the gaps in
organizational performance based on literature reviews and evidence-based practice. The
perspectives of the administration is presented and largely supported and reinforced with the
perspectives of the staff and faculty and their students, making this study unique and novel. The
results of the study revealed critical gaps that were validated using the gap analysis framework.
The triangulation of data analysis in the conceptual framework reveals barriers in the conceptual,
procedural, and metacognitive knowledge, motivational factors in self-efficacy and goals, and
organizational cultural setting that are affecting the organization’s performance toward diversity
initiatives. The study uncovers the need for the full engagement of the administration toward
developing a new recruitment plan for the representation of Latinx students. Recommendations
for the administration were provided using the New World Kirkpatrick model to employ an
implementation and evaluation plan around increasing knowledge, motivation, and

xv
organizational resources to better assist the administration in meeting DEI initiatives in
particular, but not restricted to Latinx minority students. The outcome of this study is intended to
provide best practice in organizational change and leadership and to extend the model and
structure to other underrepresented groups of interest.

Keywords: administration, diversity, gap analysis, health disparities, health equity, health
professions, higher education, Latinx, PA, minorities, physician assistant, program evaluation,
recruitment plan, underrepresented minorities.

1
Chapter One: Introduction of the Problem of Practice
The low representation of Latinx active physicians continues to be a growing problem in
the United States. There were only 5.3% of medical school graduates who identified as Latinx in
2019 (Association of American Medical Colleges (AAMC), 2021a). The AAMC has launched
initiatives to improve diversity and inclusion efforts through strategic planning to shape an
organization that values diversity, equity, and inclusion (AAMC, 2021b). The Latinx physician
shortage is important to address as the Latinx community is an emerging majority with an
expected growth of 44.5% of California’s population by 2050 (Bustamante et al., 2020; State of
California Department of Finance, 2016). Despite efforts to improve the recruitment of minority
students traced to as early as 1991 by the AAMC (Bergen, 2000), the Latinx ethnic group in
medicine continues to fall behind (Pelham, 2020).
The physician shortage impacts the efforts to create diversity in the health professions.
Studies show that patients prefer physicians who share the same language or the same culture
(Fernandez et al., 2004; Saha et al., 2003). Historically, the physician assistant (PA) was
considered an extra right hand for the doctor originally designed in the military to help with the
shortage of physicians (Carter, 2001). Over the years, the utilization of the PA in medical centers
has increased, enhancing communication by discussing and providing direction for patient care
(Moote et al., 2011). Today, professional schools and programs for the PA training continue to
fail to increase the intake of underrepresented minority (URM) students (Coplan et al., 2021).
There is very little research on actionable steps to promote diversity in graduate medical
education (Gonzaga et al.,2020). Failure to adopt strategies that promote diversity, equity, and
inclusion will slow down the progression of improving Latinx representation in the health
professions. The AAMC (2021c) states that a strategic plan shapes and guides an organization to

2
what it is, whom it serves, and what it does, and why. In higher education, administrators are
considered stakeholders with a high degree of influence across the implementation of strategic
plans to align with the institution’s objectives (Falqueto, 2020). Thus, it is important to examine
the level of involvement university administrators have toward adopting a new strategic plan for
recruiting Latinx students to a PA health professions program.
Organizational Context and Mission
Health University (HU), a pseudonym, is an institution in the state of California that
offers an MSPA. The campus is a health professions university accredited by the Western
Association of Schools and Colleges, offering a wide range of training in the health sciences.
The Accreditation Review Commission on Education for the Physician Assistant, Inc. (ARC-PA)
granted the university with accreditation.
At HU, leadership is organized into the board of regents, president, executive board
administration, deans, chairs, directors, faculty, staff, the alumni association, and the alumni
board of directors. The organization has a highly centralized structure overseen by the HU’s
board of regents, followed by the president, the administration, faculty, and staff. Each
department has administrative chairs and directors that report to the college deans, who report to
the president. The faculty consists of tenured professors, professors emeritus, professors,
assistant professors, and adjunct professors. The staff includes program managers, project
managers, project coordinators, counselors, secretaries, registrar, assistants, and program
specialists. The entire workforce is 57% female and 43% male.
HU is in a predominantly Latinx (65.7%) community in Southern California (U.S.
Census Bureau, 2019). The organization has diversity as one of the guiding principles that
embraces various ideas, beliefs, and cultures and provides a supportive, safe, and welcoming

3
campus. The MSPA program conferred titles to their 2020 cohort, with only 10% represented by
Latinx students. The full-time faculty are 54.2% White, 19.7% Asian-American, 17.2% Latinx,
5.1% African American, 1.7% Native Hawaiian or Pacific Islander, and 2.6% other (College
Factual, 2020). The mission and vision for HU is to educate students through the successful
integration of health-building competency and focusing on patient care.
Organizational Performance Status
The HU organizational performance goal is to develop a recruitment plan geared toward
Latinx students for the MSPA program. This study was intended to better understand the needs
of the HU administration to implement the strategic plan to increase diversity through the
number of Latinx students admitted to the program. At the national level, the 2016–2017 data
showed that overall acceptance rates were 74.4% for White applicants, 13.7% for Asian
applicants, 7.3% for Black/African American applicants, and 10.5% for Latinx/Hispanic
applicants (Physician Assistant Education Association, 2017). In comparison, at HU, about 50
PA students were admitted for 2020, of whom 8% are Hispanic. The focus of this study was to
assess administrators’ knowledge, motivation, and organizational (KMO) needs to develop a new
recruitment plan for Latinx students. Currently, no such plan exists. The performance gap is
100%.
There are several challenges the HU administration will encounter with efforts to increase
the number of Latinx students, particularly in the areas of diversity, equity, and inclusion (DEI).
The three most common barriers to the recruitment of minority students are academic
performance, lack of minority faculty, and lack of minority role models (Agrawal et al., 2005).
Other common barriers include the complexity of the recruitment and admissions process,
financial expense, lack of information, inadequate guidance, and lack of social support

4
(Hadinger, 2017). In addition, there are historical and perceived barriers (Nivet, 2010) that may
influence the culture within the organization. Multiple complex dimensions make it difficult for
the administration to understand the current level of performance in the recruitment of Latinx
students. Thus, HU must develop a new strategic recruitment plan to overcome these challenges
and barriers. This innovation study focused on the needs of the HU administration to design a
new Latinx recruitment plan that will improve organizational effectiveness toward initiatives
promoting diversity within the program.
Related Literature
The Latinx community lacks a representative number of Latinx physicians and PAs. In
California, Sanchez et al. (2015) noted there are only 50 Latinx physicians for every 100,000
people compared to 390 Non-Hispanic White (NHW) physicians for the same number. Two
factors point to a growing disparity. First, In 2015, Latinx students represented only 4.6% of all
medical school graduates (AAMC, 2020a). Second, the Latinx community accounted for 52% of
the population growth in the United States (United States Census Bureau, 2020).
Specifically, within California, the Latinx community’s growth outpaced all other race or
ethnicity demographics to become 40% of the state’s population (Diaz et al., 2019). The medical
provider preferences of Latinx and NHWs populations compound the problem of
underrepresentation of Latinx physicians (Sanchez et al., 2015). Although improving cultural
competence is an effective strategy allowing physicians to optimize their interactions with
minority patients and improve patient care (Betancourt et al., 2003), research indicates minority
patients prefer physicians of their own ethnicity or who are fluent in their native language
(Fernandez et al., 2004; Saha et al., 2003).

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Census
In the United States, Latinx make up the largest ethnic minority group at 17%, with
expectations to increase to 30% by 2050 (Ortega et al., 2015a). In 2015, the U.S. Census Bureau
reported nearly 15 million Latinx in California, surpassing the 14.92 million Whites in the state
(Panzar, 2015). According to the UCLA Latino Policy and Politics Initiative, the Latinx
community represents over 40% of California’s population (Diaz et al., 2019). The U.S. Census
Bureau estimates the Latinx population will reach 111.2 million by 2060, and at the state level,
Latinx in California will have the lowest rate of Latinx physicians at 50 per 100,000 people,
while the NHW population experiences a range of 390 per 100,000, which is 24% higher than
the national NHW physician rate of 315 (Sanchez et al., 2015). These statistics indicate a
shortage of Latinx physicians and the need for Latinx physicians assistants in the state of
California (Coffman et al., 2017; Diaz, 2019).
Latinx Physicians
In 2000, only 4.8% of Latinx physicians were licensed to practice medicine in a
population of 30.4% Latinx in California (Hayes-Bautista et al., 2000). In 2015, the AAMC
(2019) reported the rate of Hispanics or Latinx graduating from medical school was 4.6%. A
shortage of Latinx primary care physician representation exists in relation to the overall
population (Walker et al., 2010).
In Latinx communities, physician-patient interactions involving high Spanish-language
fluency and cultural competency are important in the interpersonal processes of care (Fernandez
et al., 2004). Research indicates that minority patients prefer physicians of their own
race/ethnicity, yet the contribution of the patient-physician relationship to disparities in
healthcare calls for cross-cultural patient-physician interactions (Saha et al., 2003). Bustamante

6
et al. (2019) has proposed new policies in medical education to mitigate the physician shortage,
which includes training in language, interpersonal skills, and cultural competency.
Latinx Physicians Assistants
Physician assistant (PA) programs are one type of bridge to closing the minority patient
and medical provider gap. A PA acts as a liaison between the patient and the primary care
physician and serves a key role in patient care communication. According to the National
Commission on Certification of Physician Assistants’ 2018 report, 13.8% of certified PAs spoke
Spanish as a second language, making it the top secondary language in the field (NCCPA, 2019).
The PA works as a healthcare professional to demonstrate social responsiveness by focusing on
primary care practice to improve access to healthcare for populations in rural, inner-city, and
other medically and underserved areas (Mittman, 2002).
Ortega et al. (2015b) indicated that Latinx “have the worst patterns of access and
utilization of healthcare than other ethnic and racial groups,” which poses a problem for
policymakers (p. 1). Latinx encompasses the nation’s largest minority group and thus affects the
economics of our healthcare system if the health of the community is compromised (Elder et al.,
2009). It is important to investigate the pipeline of students to understand how improved Latinx
student representation can be realized in the health professions field.
Most Hispanic students in the United States experience accumulated disadvantages that
form barriers to educational attainment, making them among the least educated populations in
the United States, despite being the fastest-growing subgroup (Schneider et al., 2006). In a study
by Odom et al. (2007), many Black and Hispanic students felt it would be more difficult for them
than for some of their peers to succeed in academic medicine because of a lack of experience and
information on career paths. Black and Hispanic respondents believe racial and ethnic minorities

7
have a harder time succeeding in medical school (Sanchez et al., 2013) indicating a level of
competency anxiety in this minority group. Additionally, similar perceived barriers in PA
programs were noted per DiBaise et al. (2015), calling for a need in recruitment strategies to
increase diversity.
A survey by DiBaise et al. (2015), indicated financial barriers are much larger of an issue
in PA programs than in medical school for prospective students. Valentine et al. (2016) described
the inadequate academic preparation of socioeconomically disadvantaged students and students
of color is partially attributed to systematic inequalities in the educational system. The effort of
educational systems to improve diversity in health professions calls for a need to revisit
admissions processes to enhance student success for admission, matriculation, and completion.
Importance of Addressing the Problem
The HU administrators need to consider recruiting Latinx minorities to the PA program
to improve DEI initiatives and develop trained health professionals to support a diverse
community. A diverse task force with health professionals can communicate effectively and
increase cultural awareness to improve health disparities within underserved communities (Nair
& Adetayo, 2019). Wagner (2018) suggested that developing diverse and culturally competent
practitioners cannot happen in homogeneous racial and ethnic environments. Thus, increasing
Latinx student intake through recruitment will position the organization as a strategic
differentiator in the industry.
Deville et al. (2015) found that out of more than 688,000 practicing physicians in 2012,
5.2% were Hispanic, and of the 16,800 medical school students who graduated, only 7.4% were
Latinx. This shortage of Latinx physicians within the last decade will place the role of PAs in
high demand (Moote et al., 2011). Successful implementation of recruitment planning per

8
Santiago (2008) for Latinx students may lead to HU serve as an institution that can supply
trained PAs to help assist underserved communities. According to Falqueto (2020), university
administrators must focus on stakeholders tailoring strategies to help align them to institutional
goals to avoid risking a failure in strategic planning implementation. It is important to focus on
the administrative leaders because they shape the general climate and expectations around
diversity, recruitment, and retention of minority students by providing internal support and
fostering a commitment to enhancing diversity (Vick et al., 2018).
Furthermore, very little research examines university administrators and their institutional
support for minority recruitment and retention (Bond et al., 2015). By addressing this problem,
the administration can apply recommendations in Latinx recruitment efforts to other programs
within the institution. They may also collaborate externally and build relationships with other
medical training institutions, such as medical schools, nursing programs, and pharmacy schools
for continuous improvement.
Organizational Performance Goal
The organizational goal is to develop a recruitment plan for the intake of Latinx students
within its MSPA program by December of 2022. The program intake rate of Latinx MSPA is at
8% for 2020. Historically, the program experienced an intake rate of less than 5% in 2018, 25%
in 2019, and 8% in 2020. This representation brings the average to 13% in the last 3 years. This
study focused on efforts to understand how to improve the intake of Latinx students into the
MSPA program at HU and package these into a recruitment plan. This study focused on efforts
to understand what the HU administrators need to know to recruit more Latinx students.
Currently, no recruitment plan exists. The performance gap is 100%.

9
Description of Stakeholder Groups
There are four stakeholder groups in this study that represent the MSPA program: HU
administration, faculty, staff, and the students. Administration is the primary focus for this study
due to the level of influence they have on projecting business targeted goals that align with the
mission and vision of the organization. According to Morphew et al. (2006), an institution’s
mission statements are known to guide decision making around key issues in programs by
leaders and stakeholders. Since the administration may not be actively participating in
recruitment strategies, the data gathered may not be as effective in determining organizational
performance gaps. Thus, additional stakeholders will be evaluated to support the findings on the
gap analysis in this study and strengthen recommendations for the administration.
Morphew et al. (2006), also indicated that mission statements may serve to motivate
those within the institution. Based on this premise, staff, faculty, and students were included in
this study to gather their perspectives to help provide a comprehensive gap analysis for the senior
administration at HU. The staff and faculty are defined below in the context of influence they
have on recruitment planning for the program. The students are defined in this study as those
individuals enrolled in a program that experience the mission and values of the organization
represented within the community of the university. These additional stakeholders are likely to
provide knowledge and experience in strategic planning to help find the needs and gaps
associated with the under-representation of Latinx students in the MSPA program for the
administration as the primary stakeholder for this study. Therefore, the intent was to focus on the
administration to examine how they project the initiatives of diversity and their participation
toward developing recruitment plans for Latinx student representation in the MSPA program.

10
HU Administration
This stakeholder group involves the board of regents, president, executive board, deans,
chairs, and directors. These individuals are the gatekeepers of the organization’s mission
statements and vision that funnels it through the entire organization. They collaborate to
formulate strategic plans for the organization.
Faculty
This stakeholder group consists of emeritus professors, tenured professors, professors,
assistant professors, associate professors, adjunct professors, and teaching associates. These
individuals interact with incoming students and practice implementing the mission and vision of
the organization and serve as models for the organization. They practice implementing the
strategic plans and sharing feedback with the administration.
Staff
The stakeholder group involves the registrar, secretaries, program managers, project
managers, project coordinators, and specialists. These individuals are involved in sustaining the
organization and supporting its operations. They help with continuous improvement and
implementation of strategic plans. They also provide the resources for faculty to effectively put
the practice into the organization’s initiatives.
Students
The stakeholder group involves all students in every active cohort that is currently
matriculated and participating actively in the MSPA program. The students are those that have
been selected by the admissions process and receiving the delivery of the MSPA curriculum at
HU. They have experienced the interview process, acceptance, and the principles of the

11
organization as it pertains to the MSPA program. They are also the outcome of any diversity
initiatives the organization supported through its the mission and values.
Though they have a goal, the HU administration is currently unaware of its actual
performance in recruiting Latinx students. There is currently no dedicated recruitment plan in
place for this ethnic group.
Stakeholders Groups’ Performance Goals
Table 1 indicates the stakeholder goals for each group in the MSPA program at HU and
presents the organizational mission, global goal, and stakeholder performance goals.

Table 1
Organizational Mission, Global Goal, and Stakeholder Performance Goals
Organizational mission
The mission of HU is to educate students as competent, caring, and successful integrative
healthcare practitioners.
Organizational global goal
The HU organizational performance goal is to have a recruitment plan for the intake of Latinx
students within its MSPA program by December of 2022.
Administration
By December 2022, 100% of the HU administration will develop a new Latinx MSPA
recruitment plan.

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Stakeholder Group for the Study
In this study, a complete analysis would involve all stakeholder groups to develop a
recruitment strategy plan for the intake of Latinx minorities to the MSPA program. For practical
purposes, this study focused on the administration at HU, consisting of C-suite and program
directors. The administration was chosen based on the leadership’s influence on all the programs
at HU. It is important to identify the needs of the administrators that will help guide them to
create a recruitment plan in alignment with the diversity mission and vision of the organization.
The stakeholder goal is to develop a new Latinx MSPA recruitment plan by December of 2022 to
intake Latinx students within its MSPA program. The administrators are leaders at HU that can
support and influence diversity initiatives. Without developing this plan, the MSPA program will
fall behind in meeting the increasing community demand for Latinx PAs.

Purpose of the Project and Questions
The purpose of this project was to conduct a needs analysis in the areas of knowledge and
skill, motivation, and organizational resources necessary to develop a recruitment plan for Latinx
students into the MSPA program by December 2022. The analysis began by generating a list of
possible needs for systematic examination to focus on actual or validated needs. While a
complete needs analysis would focus on all stakeholders, for practical purposes, the primary
stakeholder in this analysis is HU administrators. The scope of the analysis covers the knowledge
and skills, motivation, and organizational factors related to administrator performance goal
achievement. The questions that will guide the study are as follows:
1. What are the administrators’ knowledge, motivation, and organization needs related to
the development of a new Latinx MSPA recruitment plan?
2. What are the recommended knowledge, motivation, and organizational solutions?

13
Methodological Framework
Clark and Estes (2008) gap analysis framework helps to identify whether stakeholders
have adequate KMO support to achieve the organization’s goal. This conceptual framework is
the system of concepts, assumptions, expectations, beliefs, and theories supporting and
informing goal achievement (Maxwell, 2013). This framework will draw upon Merriman and
Tisdell’s (2016) concept terms, definitions, models, and theories to better understand MSPA
program enrollment strategies. These elements will be diagnosed through surveys and
interviews. Research-based solutions will be recommended and evaluated comprehensively.
Definitions
Emerging Majority: Minority; Refers to various racial groups and the Hispanic ethnic
group. Obsolescence of minority terms is in recognition that the United States has become more
diverse (Rose, 2018).
Cultural, or Cultural Representation: Refers to an integrated pattern of learned beliefs
and behaviors that can be shared among groups, including thoughts, styles of communicating,
ways of interacting, views on roles and relationships, values, practices, and customs (Rose,
2018).
Health disparities: Preventable differences in the burden of disease, injury, violence, or
opportunities to achieve optimal health that are experienced by socially disadvantaged
populations (CDC, 2020a).
Health equity: Achieved when every person has the opportunity to “attain his or her full
health potential” and no one is “disadvantaged from achieving this potential because of social
position or other socially determined circumstances” (CDC, 2020b).

14
Health inequities: Are reflected in differences in length of life; quality of life; rates of
disease, disability, and death; severity of disease; and access to treatment (CDC, 2020b).
Hispanic (origin): Refers to a group of people from Spanish-speaking origin. For
example, Spain is included, but Brazil is not because Brazilians speak Portuguese (Department
of Organizational Strategy, Initiatives, and Culture [OSIC], 2020).
Latino/a (individual): Someone who is a native of, or descends from , a Latin American
country. (Generating Engagement and New Initiatives for All Latinos [GENIAL], 2017).
Latino (general): refers to people of Latin American descent living in the United States.
The term includes Brazilians and excludes people from Spain. (Department of Organizational
Strategy, Initiatives, and Culture [OSIC], 2020).
Latinx: A gender-neutral word for people of Latino/a person (GENIAL, 2017).
Socioeconomic determinants: Factors (social determinants) that impact the health and
well-being of people and communities such as education, occupation, or income (CDC, 2019).
Underprivileged: (of a person) people having less money and fewer possessions and
opportunities than other people in their society (Collins Dictionary, 2020).
Underrepresented in Medicine: Racial and ethnic populations who are underrepresented
in the medical profession relative to their numbers in the general population (AAMC, 2020b).
Underrepresented minority (URM): African Americans, American Indians/Alaska
Natives, and Latinos who have historically comprised a minority of the U.S. population
(National Action Council for Minorities in Engineering [NACME], 2013).
Medically Underserved Community and Medically Underserved Populations
(MUA/MUP): Identifies geographic areas and populations with a lack of access to primary care

15
services, high infant mortality, high poverty, or a high elderly population (Health Resources &
Services Administration, 2020).
Organization of the Study
Five chapters organize the study. This chapter provided the key concepts and terminology
commonly found in a discussion about health disparities experienced by Latinx communities in
California and the shortage of physicians. It introduced HU’s MSPA program, the organization’s
mission, goals, stakeholders, the need to increase the number of health professionals due to the
shortage of Latinx physicians in California. Chapter Two provides a review of literature
surrounding the scope of the study. Topics of health disparities issues in Latinx communities,
shortage of physicians, and barriers to increasing Latinx student representation in health
professions will be addressed. Chapter Three details the assumed interfering elements and
methodology when it comes to the choice of participants, data collection, and analysis. In
Chapter Four, the data and results are assessed and analyzed. Chapter Five provides solutions,
based on data and literature, for closing the perceived gaps and recommendations for an
implementation and evaluation plan for the solutions.

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Chapter Two: Review of the Literature
This literature review will examine the low representation of Latinx health professionals
in the United States and the consequences of health disparities in the Latinx community. This
chapter first reviews the literature on the low acceptance rates of Latinx students in the health
professions, the barriers and challenges they face, and the monocultural healthcare system. Then,
the chapter explains Clark and Estes’ (2008) KMO influences lens used in this evaluation study.
Next, the chapter defines the types of knowledge, motivation, and organizational influences
examined and assumed administration’s KMO influences on increasing Latinx minority
admission to the MSPA program. The chapter ends with a presentation of the conceptual
framework guiding this work.
Literature on the Problem of Practice
Underrepresented racial and ethnic minorities (URMs) comprise no more than 11.5% of
people within the health profession (Valentine et al., 2016). Hispanics in the United States face
socioeconomic and academic barriers making it more difficult to enter academic programs in the
health professions field (Schneider et al., 2006). Although strategies that include recruitment for
minority medical students, as indicated by Vela et al. (2010) and diversification of faculty staff
by Peek et al. (2013), have been explored to maintain workforce diversity, the percentage of
Latinx minorities in healthcare remains low. Failure to understand these factors, variables, and
causes will continue to have a striking impact on pronounced health disparities due to a
monocultural healthcare system.
Representation of Latinx Students in Healthcare
This section presents the representation of Latinx students across medical schools,
nursing schools, and physician assistant programs. This literature review captures the low

17
representation of Latinx minorities in the United States that play a major role in patient care and
interaction. There is an opportunity to diversify the healthcare system with Spanish-speaking
healthcare professionals to pave the way for Latinx students. According to Fernandez et al.
(2004), minorities have a larger connection through language and culture that is valuable in
patient communication. Guzman (2018) indicated the low representation of Latinx students in
healthcare is attributed to the lack of role models, the quality of education, financial constraints,
and social identity theory. Three major medical education training programs for healthcare
professionals with direct patient care were reviewed to explore minority representation.
Statistics show that 6.4% (5,881) Hispanic or Latinx students were enrolled in U.S.
medical schools out of 91,391 students for the 2018–2019 school year (AAMC, 2018a).
According to Walker et al. (2010), there is a shortage of primary care physicians that are
available to help treat underserved communities. In their study, some physicians cited their self-
identity, such as their language and culture, as a driving force in working in an underserved
community, reminding them of their family members (Walker et al., 2010).
Among registered nurses (RNs), only 4.8% are Hispanic or Latinx minorities (Minority
Nurse, 2021), which is less than this population’s representation in medical school. In California,
Hayes-Bautista et al. (2016) found that, for every 100,000 NLWs, there were 1,186 NLW RNs
compared to 248 Latino RNs, yielding the lowest growth in Latinx in the last 30 years.
Additional barriers in nursing programs for minority students are lack of finances, limited
proficiency in the English language, the pressure to support the family financially, and the lack
of role models in the profession (Haynes et al., 2015).
Additional health professionals, such as dentists and pharmacists, are also involved in
patient care and deal with health disparities. The problem of low Latinx representation in

18
healthcare is a growing problem, especially in Southern California, and reform is needed to
improve it (Bustamante et al., 2019). The physician assistant's role is critical in serving the
communication between the patient and the physician. This historical background leads to
evaluating the diversity of students in the MSPA program at HU and how it can increase the
minority representation among students.
Latinx Minorities in Physician Assistant Programs
Latinx accounts for only 3.4% of all PAs (Smith et al., 2016). In addition, Latinx students
in the first year of PA programs experience deceleration, lower graduation rates, and
disproportionate withdrawal rates (Physician Assistant Education Association, 2017). Sturges
(2018) found that the imposter phenomenon, the internal conviction that one is intellectually
inferior, is experienced by URMs, causing decreased retention of students, faculty, and staff
(Parkman, 2016; Sturges, 2018). It is important to retain this group since language barriers have
adverse effects on the quality of Latinx patient care (Gonzalez et al., 2005).
Recently, maintaining communication with patients requiring cultural competency
training and addressing social determinants of health disparities is critical in health professions
(Buchs et al., 2016). Komaromy et al. (1996) reported that the community responds to the
relationship between the physician and the patient. In addition, California has Latinx residents
considered to have limited English proficiency, and teaching medical Spanish to primary care
physicians could improve patient interaction with them (Bustamante et al., 2019). The results
presented by Bustamante et al. (2019), indicate that patients of minority groups seek to consult
with physicians who share the same cultural background. Increasing minority representation
among healthcare professionals increases the likelihood of improving communication with

19
Spanish-speaking patients to help reduce health disparities among this population per
Bustamante et al. (2019).
Recruitment Barriers of Latinx Students in Health Professions Programs
Kenya et al. (2019) called for more physicians of color to help decrease health disparities
observed among ethnic populations and emphasized medical pathway programs to increase
program diversity. According to DiBaise et al. (2015), the decreasing representation of URMs in
the PA health professions field has led to several recruitment programs. Figueroa (2014)
indicated that institutions will need skilled professionals who understand how to develop
outreach programs for URMs with a holistic approach to creating an environment that supports
the recruitment strategy. Amaro et al. (2006) identified four major student perceived barriers
toward recruiting for diversity initiatives: personal, academic, language, and cultural.
There are multiple recruitment strategies for URM outreach, and many of these activities
have very little support with limited follow-ups and activities within the year (Dibiase et al.,
2015; Pomeranz et al., 2010; Rohrbaugh et al., 2011). Recruitment strategies can be designed
effectively by modeling Hispanic serving institutions (HSI) as examples of improving Latinx
student success in higher education (Santiago, 2008). Organizations such as Kerux Group
indicate adopting a multicultural approach in education marketing for prospective students in the
Generation Z or iGen demographics for higher education institutions (Kerux Group, 2016).
Healey (2013) identified a need for a Hispanic college representative, increased marketing, and
community education as important factors to enhance recruitment for nursing programs. Smith
(2008) emphasizes engaging parents in the recruitment process using a family centered approach.

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Socioeconomic Constraints
Numerous socioeconomic constraints affect Latinx communities’ economic success
(Rios-Ellis et al., 2005). Expanding and shifting research to include social determinants of
health, institutional barriers, and structural inequality will help understand health disparity issues
among Latino-based communities (Zambrana et al., 2010). In this literature review, the focus is
on factors that directly impact the preparation of students for medical professions education.
These factors include quality of education, financial constraints, and racial and ethnic
discrimination (Guzman, 2018; Lucey et al., 2020). It is important to understand these
socioeconomic constraints to find alternative methods for a holistic admissions process that
evaluates the URM applicant through a flexible and individualized lens (DiBaise et al., 2015).
The Importance of Educational Attainment in Latinx Minority Students
According to Rincon (2020), the growing Latinx population affects many aspects of
society and has implications for higher education. Arellano (2020) indicates that Latinx degree
attainment is a national, economic, and equity imperative, expressing the need for
transformational change in the higher education system. Thomas (2014) found that the most
powerful socioeconomic determinant of good health and longevity was educational attainment,
which is largely determined by income, neighborhoods, and access to healthcare. Schneider et al.
(2006) declared Hispanics in the United States were the least educated, with only 11% of Latinx
minorities over age 25 having earned a bachelor's degree. Since then, there has been tremendous
growth in Latinx educational levels, particularly among Latinx immigrants, but it remains lower
than other non-Hispanic immigrants (Bustamante et al., 2020).
Although growth among Latinx immigrants is rising, Latinx students are experiencing
slower growth in STEM-related programs (Rincon, 2020). Carethers (2016) indicated that some

21
students may not be well prepared for hard science education. Winterer et al. (2020) performed a
systematic review showing that students of lower socioeconomic status succeeded at lower rates
in higher education. They stated that Latinx students are placed into less rigorous educational
tracks due to implicit biases (Meier et al., 1991; Winterer et al., 2020). The 2020 Equity
Indicators Report (Cahalan et al., 2020) indicates “higher education opportunity and outcomes
remain highly inequitable across family income groups” (p. 8). With racial and ethnic minorities
underrepresented in the health professions, pipeline programs are needed to help address the
shortage of URMs (Smith et al. 2009).
Financial Burden Associated with Medical School Education
One socioeconomic barrier that reduces access to healthcare and leads to health disparity
issues is education (Rios-Ellis et al., 2005). Steinbrook (2008) noted that the prospect of
$200,000 or more in debt dissuades some students from low-income families from applying to
medical school. Latinx students will carry more debt than students considered privileged
(Steinbrook, 2008). In addition to the financial burden of the high cost of medical school,
Carethers (2016) stated that some students help care for family members and provide financial
support to them, thereby limiting the ability to fund their education. According to Guzman
(2018), parents of Latinx students have limited education earning jobs with low income making
it difficult for Latinx students to pay for their education and dependent upon the financial aid
award. Ginnochio et al. (2020) stated their concerns that the high medical school education costs
reduce plans to diversify the physician workforce since it would be difficult for URMs to apply.
Hadinger (2017) stated financial factors often lead Latinx students to apply to fewer schools and
commonly have a limited understanding of the financial aid process. Having fewer applicants for
health professions will mean having less representation of minorities in the healthcare system.

22
There is a need to understand the financial debt concerns associated with medical education to
overcome the financial barrier to diversity.
Discrimination of Latinx Minority Students and Faculty
According to Betancourt et al. (2003), organizational, structural, and clinical barriers
shape the cultural competence of leadership and the workforce to reflect the racial and ethnic
composition of the population. The Affordable Care Act initiated actions to reduce health
disparities to improve both the healthcare workforce’s diversity and its competency in treating
patients from different cultural and linguistic backgrounds (Koh et al., 2011). Lucey et al. (2020)
made a case that structural racism and unequal opportunities have contributed to the ethnic
disparities and economic disadvantages that impact the minority population. There have been
reports of Latinx minorities feeling discouraged by the monocultural educational institution and,
in some cases feeling alienation and discrimination (Guzman, 2018). An organization called
“White Coats for Black Lives (WC4BL) called for a demand that medical schools create a
physician workforce that reflects the nation’s diversity” (Charles et al., 2015, p. 1008). In a study
by Chatterjee et al. (2020), Latinx minorities had a higher likelihood of reporting discrimination
than non-Latinx students with a lower frequency of reporting the incident. H incidents of ethnic
harassment and racial/ethnic bias and ethnic disparities has been observed in faculty promotion
within academic medicine (Price et al., 2005).
The recruitment of Latinx students must overcome racial and ethnic discrimination lines.
Lucey et al. (2020) indicated that racial and ethnic disparity in medical schools is attributed to
centuries of structural and interpersonal racism, which has concentrated minority populations in
low-income neighborhoods, negatively affecting economic prosperity in minority populations.
The 1994 National Comparative Survey of Minority Health Care found that Black and Hispanic

23
Americans sought care from physicians of their own race because of personal preference and
language (Saha et al., 2000). It is important to consider the preparation of a diverse physician
workforce that can serve diverse communities (Lucey et al., 2020). Hadinger (2017) noted in a
survey study that medical schools rated the importance of applicant demographics such as race
and ethnicity as low in the admissions process. Unconscious bias in academic medicine with
respect to race and ethnicity is still a challenge that can compromise the degree to which an
institution can implement diversity initiatives (AAMC, 2017).
Academic Barriers to Latinx Minority Students
This section examines the literature review on academic barriers most common to the
medical school admissions process. The three major components of the admissions process for
medical schools are the grade point average (GPA), graduate record examination (GRE) scores,
and the medical college admissions test (MCAT) scores. Higgins et al. (2010) pointed out that
MCAT scores were reported in lieu of GRE scores for PA programs. Butina et al. (2017) found a
weak association between the GRE scores and successfully passing thexamination Physician
Assistant National Certifying Examination (PANCE). Lucey et al. (2020) explored how the
“MCAT exam neither over-nor underpredicts performance among racial and ethnic groups” (p.
351). Ganjoo et al. (2020) found relationships between MCAT scores among post-baccalaureate
pre-medicine students but not in GPA. Davis et al. (2013) noted that Whites perform above
expectations in terms of MCAT scores and GPAs but are also admitted on the basis of attributes
and competencies. It is important to understand the performance of Latinx students in these areas
to determine the need for holistic approach considerations for medical school applicants.

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GRE Performance in Student Minorities
Most PA schools require a GRE, which is a standardized test required for applying to
higher education programs. The GRE scores are typically used as a way to decrease the applicant
pools and filter out students to manage the high volume of applications in the review process
(Posselt, 2016). Hocking et al. (2010) noted that the use of GRE and its relation to the
requirements of the program are unknown, and further research is needed on its use and
predictability for program success. Bleske-Rechek et al. (2014) noted a half standard deviation
higher in White and Asian examinees in comparison to those of underrepresented groups.
Additionally, they noted that Hispanics are the only minority ethnic group that was
underrepresented in graduate programs (Bleske-Rechek et al., 2014). Massey et al. (2020) argued
that although the minimum GRE requirements are set for admissions to the PA program, there
are limited publications on the validity of GRE scores demonstrating and predicting performance
in PA programs. Cahn (2014) notes that the complete elimination of the GRE does not guarantee
diversity, but programs with specific recruitment strategies to promote diversity would be
beneficial.
MCAT Performance in Student Minorities
According to AAMC (2018b), the MCAT is a standardized exam to assess scientific
principles and reasoning knowledge. In 2013, a study indicated that the Black and Latinx
examinees’ average mean MCAT scores were significantly lower than White examinees.
Although the MCAT may appear to be biased, there is no evidence that it is biased regarding
race, but possibly other factors such as family, neighborhood, and school conditions relate more
to academic achievement than the MCAT alone (Davis et al., 2013). Although URMs score
lower on the MCAT, studies indicate that clinical performance was equivalent across all races

25
(Veloski et al., 2000). The MCAT is a good predictor for licensing exams, and a selectivity
adjustment analysis could apply for applicants that come from urban underserved areas, but an
assessment of the overall impact on the selection process and relative ranking must be considered
(Basco et al., 2002).
Since few adjustments are expected across the selection process due to MCAT scores and
licensing success, they do not point to achievement in medical training or success in practicing
medicine (Ferguson et al., 2002). In 1978, a student, Allen Bakke, was rejected twice from
medical school despite having average GPA and MCAT scores that were higher than minority
students admitted through special programs (Lakhan, 2003). In this respect, “an institution
cannot constitutionally implement a race-based quota system, but may pursue race-based
preference in the admissions process to seek diversification on campus” (Lakhan, 2003, p. 3).
Strategically, educational systems must incorporate MCAT preparation into outreach
programs. The outcomes of a specific outreach program, Undergraduate Science Students
Together Reaching Instructional Diversity and Excellence (USSTRIDE) had significant
acceptance rates versus students that were non-USSTRIDE; however, the MCAT scores were
still lower (Campbell et al., 2014). Since MCAT scores are good predictors for licensing, there is
a risk that these students will complete medical training but potentially struggle to pass the
licensing exams (Campbell et a., 2014). Objective evidence of this prediction is based on the
United States Medical Licensing Examination (USMLE) performance by Caribbean Medical
School Graduates, who perform less on the exam than U.S. graduates (van Zanten et al., 2009).
This comparison is made here because these students are more likely to practice medicine in
underserved communities (van Zanten et al., 2009). Additionally, this finding also implies that
rankings of the U.S. medical schools may be dependent on the range and frequency of MCAT

26
scores by the entering cohorts. Lucey et al. (2020) indicated the lower mean MCAT scores of
underrepresented groups present a challenge in diversifying efforts.
GPA Performance in Student Minorities
According to the AAMC, Latinx students fall behind in science and total GPA (Hadinger,
2017). Ford et al. (2019) found that race and ethnicity were a predictor of both weighted and
unweighted GPAs, with students of color having significantly lower GPAs than White students.
Barr et al. (2010) noted that undergraduate chemistry courses discourage students from pursuing
premedical studies, especially in the case of URM students. DiBaise et al. (2015) highlighted the
use of GPA as criteria for admission and the lack of recruitment of URM students decreases
diversity in the PA profession. According to Barr et al. (2010), chemistry courses are the turning
point for premedical schools resulting in URMs abandoning their hopes to become physicians.
Dalen et al. (2009) also found that advisors do not help by encouraging students who receive less
than a B in organic chemistry to look for other careers. Kaufman et al. (2008) explored how
personality and motivation, as predictors of first-quarter GPA, indicate the success students can
have in their GPAs that begins early in their academic career. Cruz et al. (2019) expressed the
need for first-year Latinx STEM students to achieve academic success in college through
mentorship.
Diversification of Leadership
There has been an emphasis on the increase in leadership diversity at medical schools
(Vick et al., 2018). The AAMC has stated its commitment to increasing diversity, equity, and
inclusion. Sanchez et al. (2013) indicate that “additional efforts are needed to develop,
implement, and evaluate programs that promote diverse medical students’ interest in academia
with the goal of diversifying the academic medicine workforce” (p. 1306).

27
Additionally, a study by Price et al. (2005) on diversity climate in academic medicine
revealed that “ethnic differences in prior educational opportunities lead to disparities in exposure
to career options, qualifications for and subsequent recruitment to training programs and faculty
positions” (p. 569). They were able to confirm through focus groups that minority faculty
describe structural barriers (poor retention efforts, lack of mentorship, and cultural
homogeneity), which impede their success and professional satisfaction after recruitment (Price
et al., 2005, p. 569). A study by Morphew et al. (2006) evaluated mission statements in over
1,106 four-year educational institutions and found diversity as a common element in 34 private
institutions. In addition, Morphew et al. (2006) indicated that mission statements that reflect
institutional diversity may be a way to establish uniqueness to prospective students and serve as
the basis of evaluation for an accrediting body.
Diverse Role Models
Pololi et al. (2010) expressed the value of URM faculty inclusion and proposed having
more URM faculty in senior and leadership roles in medical schools to support the training of
diverse physicians and increase cultural awareness. The effectiveness of cultural competency
practice in medical schools is low, and policies proposed by American Public Health Association
sought to increase the proportion of underrepresented U.S. racial/ethnic minorities in the health
professions to overcome institutional barriers and structural inequality (Zambrana et al., 2010).
Rios-Ellis et al. (2005) noted that one factor limiting the supply of Latinx healthcare
professionals was the lack of role models to attract new recruits, lack of mentors, and a decrease
in institutional commitments to affirmative action. They noted that the healthcare system faces a
severe shortage of Latinx healthcare professionals, particularly in California, furthering barriers
that lead to health disparities (Rios-Ellis et al., 2005).

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Clark and Estes’s Gap Analysis Framework
Clark and Estes’s (2008) gap analysis framework focuses on identifying specific
organizational and stakeholder goals and bridging the gaps between the actual and desired
performance of the organization. The model examines stakeholders’ knowledge and skills (K),
their motivation (M) to achieve their goals, and organizational (O) barriers as part of the KMO
analysis. This section presents on the literature review of stakeholder influences using the Clark
and Estes (2008) model as it relates to the barriers around the KMO framework in producing
satisfactory performance goals. This problem-solving process is based on first understanding the
alignment between the organizational goal in the MSPA program at HU and the stakeholder
goal. Second, factors that affect the assumed performance influences in the KMO framework are
explored based on general theory, context-specific literature, and an existing understanding of
the organization. Third, the analysis of factors identified in the literature is used to determine if
the organization is structured to support the stakeholder in their performance goal. Fourth, a gap
analysis is performed to understand the critical factors in the framework and their overall impact
on organizational performance. Finally, an evaluation of the gaps within the organization can be
used to determine root causes and provide an implementation strategy for improving
organizational performance.
Stakeholder Knowledge, Motivation, and Organizational Influences
The Clark and Estes (2008) KMO model will be used to evaluate the administration’s
performance goal in achieving 100% participation in developing a new Latinx MSPA
recruitment plan by December of 2022. The stakeholder performance goal will be examined in
its alignment with the organizational global goal of having a recruitment plan for the intake of
Latinx students within the MSPA program by the given year. In this section, the literature on the

29
stakeholder specific KMO assumed influences are presented and used to identify critical factors
affecting the organizational performance in the MSPA program at HU.
Knowledge and Skills
Clark and Estes (2008) described knowledge as an “engine and transmission” system that
is the main driver in an individual to achieve their performance goal (p. 53). The four types of
knowledge and skills purported by Krathwohl (2002) are factual, conceptual, procedural, and
metacognitive and will be utilized to determine the administrations’ knowledge of the
performance achievement goals for the MSPA program at HU. Understanding the how, what,
when, why, where, and who is essential in the gap analysis of knowledge (Clark & Estes, 2008).
According to Clark and Estes’s (2008) model, there are four different types of knowledge and
skills enhancements that are required for job performance: (a) information about their jobs, (b)
job aids that are self-guided and cost-effective, (c) training on acquiring knowledge and skills for
high impact learning, and (d) education that can be used as current research-based knowledge.
Knowledge and skills enhancements support the achievement of performance and business goals
and can be used to help close performance gaps in this gap analysis framework (Clark & Estes,
2008). The literature review presented in this section examines knowledge influences of factual,
procedural, conceptual, and metacognitive types to determine performance gaps in the
representation of Latinx minorities in the MSPA program at HU.
Factual Knowledge
Declarative knowledge is considered “knowledge of facts” and considered part of a logic-
linguistic subsystem (Burgin, 2014). Krathwohl et al. (2002) further divided declarative
knowledge into factual and conceptual knowledge. According to Anderson et al. (2001), the
factual knowledge dimension involves the basic elements such as facts, information, and

30
terminology that must be known to be acquainted with a discipline or solve problems in it.
According to Warschauer (2000), “language has always played an important role in the
formation and expression of identity” (p. 151). Herbig et al. (1998) indicated that most Spanish-
speaking consumers continue to speak in their native tongues and prefer to speak Spanish at
home. Amaro et al. (2006) discussed cultural differences as obstacles in their nursing program
around language and cultural alienation. Administrators need to know the language and cultural
context necessary to build information and terminology that can help develop a recruitment plan
and market its use toward Latinx students.
The factual knowledge influence examined in this study was that HU administrators need
factual knowledge of language for recruitment planning. Health disparities in the United States
are largely discussed as racial and ethnic disparities associated with socioeconomic constraints
(Dehlendorf et al., 2010). Rose (2018) highlighted barriers to Black patients seeking medical
care manifest in a lack of cultural competence by the medical task force and a shortage of Black
physicians. Similarly, Komaromy et al. (1996) indicate that the community responds to the
relationship between the physician and the patient. Their study shows that Hispanic physicians
cared for more Hispanic patients than did other physicians. The study results indicate that
patients of minority groups seek to consult with physicians who share their same language and/or
cultural background.
Studies have found that language was the biggest perceived barrier for the majority of
participants in the study involving ethnically diverse students in a nursing program (Yoder, 1996;
Amaro et al., 2006). Williams et al. (2012) explored the relevance of food culture and marketing
activity in health disparities around obesity and found effective marketing practices by
embedding cultural relevance. The use of ethnic symbols and linguistic styles linked to cultural

31
values, beliefs, and norms are known to be used as advertisement tools (Bragg et al., 2019; Grier,
2009). It is important for HU administrators to be aware of the language used in recruitment
strategies to avoid cultural and language alienation. Morphew et al. (2006) specified that
“language in mission statement is intended to evoke an all-purpose purpose” (p. 458).
Additionally, language may appear generic to some, but may be full of meaning to a particular
community (Hartley, 2002; Morphew et al., 2006). The lack of awareness in the choice of
language that is needed to target Latinx students may have an underlying impact on
organizational performance.
Conceptual Knowledge
The second component of declarative knowledge is conceptual knowledge which is the
knowledge of theories, models, and structures (Anderson et al., 2001; Krathwohl et al., 2002).
Conceptual knowledge is the interrelationships among the basic elements within a larger
structure that enables them to function together, thereby knowing how things work (Anderson et
al. 2001). Immanuel Kant defined human knowledge as representations of intuitions and
concepts, which provide perceptions and conceptual knowledge facilitating understanding
(Burgin, 2014). Conceptual knowledge is an understanding of the definitions, rules, and
principles in an area of knowledge (VanScoy, 2019). Administrators need to know the different
strategies that identify with Latinx students.
The conceptual knowledge influence examined in this study was that HU administrators
need conceptual knowledge of the different types of plans utilized for Latinx minority students.
Strategic planning consists of vision, mission, strategy, and action, which places the mission and
vision statement formulation as the most important step (Aktan, 2003; Ozdem, 2011). A mission
statement is an expression of how the social environment creates the identity of the institution

32
(Grbic et al., 2013). Ozdem (2011) argued universities are institutions that lead efforts for social
transformation, and they need to be the initiators of change. This requires strategic planning that
involves the identification of the aims and objectives of an organization and the methods to reach
these goals (Ozdem, 2011). AAMC lists diversity increase in the health professions field as the
primary goal, and PA programs were found to use the term diversity more frequently than
medical schools (Orcutt et al., 2018). In addition, research shows how HSIs can serve as models
in supporting Latinx student success through effective leadership, institutional practices, and
guiding principles (Santiago, 2008). Contreras et al. (2008) recommended Hispanic-Serving
Institutions consider its relation to the following:
(1) mission and values that guide academic decision making and resource allocation; (2)
roles and responsibilities of faculty members, administrators, staff, and trustees; (3)
knowledge and competencies that are expected of academic leaders, faculty members,
staff, and trustees; (4) criteria for appointing and evaluating the performance of
institutional leaders, faculty members, and staff; (5) assessment of institutional
performance and effectiveness and student outcomes; (6) the needs of the regional
economy with respect to contributing to the development of sustainable communities. (p.
87)
In 2019, HSIs had enrolled 66% of all Latinx students in the country (Excelencia in Education,
2019; Garcia, 2019). Garcia (2019) recommended the following for HSI leaders in their practice
of serving their community:
1. Approach HSI grant opportunities as a vehicle to enable institutional leadership,
faculty, and staff to proactively think about what servingness looks like in practice,
and fully embrace and outwardly articulate the value of an HSI identity.

33
2. Define and enact servingness through a race-conscious lens and seek out a campus
environment that is positive and affirming of the race, ethnicity, language, and
cultural experiences of Latinx and other minoritized students.
3. Embrace the great diversity within your student body, and seek ways to identify,
recognize, and enhance the cultural wealth and knowledge students bring to campus.
4. Prioritize and measure numerous academic and nonacademic outcomes of interest
along the spectrum of servingness.
5. Disrupt negative racialized experiences on campus before they happen, using
strategies including ongoing training for faculty and staff on how to be anti-racist in
policy and practice.
6. Seek to transform all structures that affect the institution’s ability to serve students—
governance, leadership, curricular and co-curricular offerings, decision-making
processes, incentive structures, training and development, assessment and evaluation,
and community engagement, to name a few. (p. 5)
Furthermore, Garcia et al. (2019) explored servingness as a multidimensional and conceptual
way to understand what it means to go beyond enrolling and serving them. Administrators need
to know the different types of plans utilized for Latinx students.
Procedural Knowledge
Procedural knowledge is focused on knowing how to do something (Levin, 2018).
Procedural and conceptual knowledge have a unique relationship in that procedural knowledge is
the know-how, and conceptual knowledge is the know-that (McCormick, 1997; Plant, 1994).
According to Anderson et al. (2001), procedural knowledge is how to do something and involves
subject-specific skills, algorithms, techniques, methods, or criteria for determining when to use

34
appropriate procedures. VanScoy (2019) described procedural knowledge as knowledge of
specific strategies or actions that are used to accomplish tasks and solve problems.
The Affordable Care Act initiated actions to reduce health disparities to improve the
healthcare workforce's diversity and its competency in treating patients from different cultural
and linguistic backgrounds (Koh et al., 2011). Ortega et al. (2015b) indicated that despite the
efforts to improve healthcare through the Affordable Care Act, Latinx communities continue to
have problems accessing and using high-quality care. Historically, pre-admissions programs
have helped produce positive outcomes in improving diversity in the physician workforce
(Strayhorn, 2000). There are multiple strategies for achieving diversity in the health professions,
and it is important that the administration knows how to apply the steps in the effective
recruitment of Latinx students.
The procedural knowledge influence examined here was that HU administrators need
procedural knowledge on the steps to recruit Latinx minorities. Despite efforts to remove
organizational barriers, the low percentages of minorities in healthcare persist. Kreiter et al.
(2013) performed a 25-year examination on restructuring the selection process for medical
school. The five elements of organizational barriers found by Kreiter et al. (2013) are the
interview techniques, admissions tests, measures of personal competencies, the decision process,
and defining and measuring the criterion for admission to improve the selection process. There is
a need to understand the barriers in recruitment strategies that directly affect the enrollment of
minority students. In addition, Capers et al. (2018) proposed efforts to help in recruitment
strategies, such as crafting mission statements geared towards diversity, adopting a holistic view
in the admissions committee, and reducing individual biases through the selection process.

35
Furthermore, Healy (2013) focused on development plans to improve the recruitment and
retention of Hispanic nursing students using three steps:
(1) Complete a needs assessment to understand the disproportionately low number of
Hispanic students enrolled in the practical nursing program as compared to other majors.
(2) Identify best practices nationally that have proven to be successful in recruiting and
retaining Hispanic students.
(3) Develop specific recruitment and retention strategies. (p. 10)
Scott et al. (2015) explored a holistic approach to increasing diversity in a nursing program by
recognizing multiple dimensions of diversity, integrating diversity into the institutional mission
statement, principles of a holistic admissions process, translating the mission to admissions
criteria, and shaping a diverse class. Similarly, administrators need to know how to strategically
plan the development of a recruitment strategy that identifies with the Latinx students.
Metacognitive Knowledge
Metacognitive knowledge is knowledge of cognition in general as well as awareness and
knowledge of one's own cognition (Anderson et al., 2001; Krathwohl et al., 2002). Zimmerman
(1990) indicates that the metacognitive processes of self-regulated learners can be characterized
by planning, setting goals, organizing, self-monitoring, and self-evaluating. Hartman (2001)
believes that metacognitive knowledge and strategies can be used automatically in skilled
performance after practice and experience. Cotterall (2009) described metacognitive knowledge
in the context of language learning through self-directed environments. Metacognitive
knowledge is a form of strategic knowledge that includes contextual and conditional knowledge
and self-knowledge (Nemetz, 1957; Vukic, 2019). Baker (2006) discussed that metacognition is
thinking about thinking, which provides insight into oneself as a learner and one’s performance.

36
Mayer (2011) refers to metacognition as awareness and control of one’s cognitive process.
Administrators need to know self-knowledge in their leadership effectiveness in promoting the
recruitment of Latinx students.
The metacognitive knowledge influence examined in this study was that HU
administrators need self-awareness in their effectiveness to collaborate with others in shaping a
recruitment plan that promotes student diversity. Northouse (2016) described self-confidence as
a trait that allows a leader to believe they can make a difference using competencies and skills.
Leadership is defined as a process by an individual that influences a group to achieve a common
goal (Northouse, 2016). Activities that involve planning and monitoring are components of
metacognition followed by monitoring the performance leading to self-regulation and thus
learning (Medina et al., 2017). Ganz et al. (1990) addressed teachers and administrators who
recognize the importance of metacognitive learning and understand the importance of developing
the framework of the person. Morris (2012) followed a study involving MBA students and their
cultural differences, highlighting that those individuals with higher cultural metacognition did
better in creative collaboration and building trust with their peers, thereby bridging intercultural
gaps. Orlova-Alvarez (2017) indicated that metacognition is a basic element of emotional
intelligence and defines it as a process and skill about self-awareness and strategic management
of self. Butters et al. (2002) stated that administrators should be aware of African American
students’ motivations for pursuing a health professions career to better guide recruitment
strategies. Reflecting on one’s own leadership effectiveness is important to support changes that
promote institutional improvement in diversity. Thus, administrators need to reflect on one’s
own leadership effectiveness in collaborating cross-culturally to shape a recruitment plan that
promotes student diversity.

37
Table 2
Knowledge Influences
Knowledge influence Knowledge type Knowledge influence assessment
HU administrators need knowledge
of language for recruitment
planning.
Factual HU administrators asked to identify
language content that can relate
to the Latinx communities.
HU administrators need conceptual
knowledge of the different types of
recruitment plans utilized for
Latinx students.
Conceptual HU administrators asked to identify
key drivers in the recruitment
strategy intended to increase
program diversity.
HU administrators need procedural
knowledge on the steps to recruit
Latinx minorities.
Procedural HU administrators asked to
describe the recruitment process
for underrepresented Latinx
minorities.
HU administrators need self-
awareness in their effectiveness to
collaborate with others in shaping
a recruitment plan that promotes
student diversity.
Metacognitive HU administrators asked to show
how their leadership is effectives
in the cross-collaboration efforts
in promoting the intake of
minority students.

Motivation
Motivation is the second dimension of improving the development and performance of an
organization per Clark and Estes’s (2008) gap analysis model. Rueda (2011) described
motivation as “the process whereby goal-directed activity is instigated and sustained” (Schunk et
al., 2008, p. 4). Rueda also highlights that motivation is inherently cultural, and our motivational
beliefs stem from our environment (Rueda, 2011, p. 39). Clark and Estes (2008) portrayed
motivation as the internal, psychological process that gets one going, keeps one moving, and
helps one get the job done. Motivation consists of three influences: working towards a goal,
persisting until the goal is achieved, and mental effort investment in completing the work (Clark
& Estes, 2008).

38
Mayer (2011) described motivation as an internal state that initiates and maintains goal-
directed behavior and breaks it into four components: motivation is personal, activating,
energizing, and directed. Amabile et al. (1994) indicated that motivation can be experienced by
personal interest (intrinsic motivation) or external inducements. Intrinsic motivation reflects
behavior that is associated with enjoyment and interest with perceived internal control, while
extrinsic motivation reflects an activity or behavior for some instrumental value or external
reason (Pintrich, 2003). Furthermore, Pintrich (1994) introduced the idea that human behavior is
multifaceted, complex, and requires the diversity of multiple disciplines to understand the
interest of motivation, such as theories, constructs, and methods, and requires a scientific
approach to understand it better.
Personal motivation is characterized by what occurs within the learner, activating
motivation is what instigates the behavior, energizing motivation is what fosters persistence and
intensity, and directed motivation is aimed at accomplishing the goal (Mayer, 2011). Dweck
(1999, 2002, 2007; Dweck et al., 1983; Elliot et al., 2017) indicated that an individual’s
motivation enhances their intellectual skills. Morphew et al. (2006) noted that an institutions’
mission provides a sense of purpose to inspire and motivate those within the organization.
Sternberg (1998) stated that motivation drives metacognitive skills, which help activate learning
and thinking skills. Additionally, self-regulation in people allows them to maintain motivation
and develop the resilience needed to overcome barriers to goal accomplishment (London, 2002).
Eccles (2006) described the expectancy-value motivational theory is specified as the
relation of beliefs to cultural norms, experiences, and aptitudes associated with achievement-
related goals. The two fundamental questions from this theory are “Can I do the task” and “Do I
want to do the task?” (Eccles, 2006). In this theory, there are four fundamental values: attainment

39
value, which confirms or disconfirms something important to a self-schema; intrinsic value,
which is subjective interest; utility value, which is usefulness to meeting future goals; and cost-
belief, which is perceived as the effort required (Eccles, 2006).
In this section, the literature review focuses on motivation-related influences that can
affect the stakeholder goals. The main motivation-related influences discussed in this section will
be used to consider goal achievements and the mental efforts associated with recruitment
planning to increase student diversity.
Self-Efficacy: HU Administrators Need to Increase Self-Efficacy Measures to Improve
Recruitment Plans for Latinx Minorities.
According to Bandura (1982), self-efficacy relates to how well one believes one can
execute courses of action for prospective situations. Bandura described human behavior and
motivation under social cognitive theory as a set of beliefs that provide the foundation for human
motivation, well-being, and personal accomplishment (Pajares, 2006). Cleary et al. (2006)
indicated that individuals with high self-efficacy beliefs set higher standards for self-evaluation
and perceive their performance outcomes as more personally controllable. Usher et al. (2008)
indicated those who lack confidence in self-regulating capabilities are less likely to implement
adaptive strategies, and thus, identifying, challenging, and altering low self-efficacy is important
to successful and adaptive functioning. Bandura (2012) stated that self-efficacy beliefs affect the
quality of human functioning through cognitive, motivational, affective, and decisional
processes.
Van Hoye et al. (2019) evaluated job search self-efficacy in ethnic minority women and
found that network and internet self-efficacy were main predictors of job offers. They further
applied self-efficacy as a general construct that defines behavior and beliefs that project

40
confidence in engaging in a successful job search (Van Hoye et al., 2018). Their findings
indicated that networking and the use of the internet require more specific knowledge and skills,
which is why self-efficacy in these areas can be better predictors of the overall confidence in
conducting a job search (Van Hoye et al. 2018). Thus, individual knowledge, attitudes, and
beliefs are important and can serve as predictive models in participation in recruitment strategies.
In a study by Pohl et al. (1998) regarding smoking cessation, low-income women who
had a higher intention to quit with lower self-efficacy were predictive in their participation. This
indicated that perceptions of trial efficacy and knowledge of the disease may implicate the
enrollment process for the study. In a separate study by Millon-Underwood et al. (1993),
participants that were willing to participate in a cancer prevention treatment trial were correlated
with the perceived efficacy of the trial. In a study by MacQueen et al. (1999), patients that were
educated about the HIV virus and the vaccine were more willing to participate in the trial.
Lyons et al. (2018) indicate that high self-efficacy beliefs are critical inputs in task
engagement and desired results. They indicate that continually assessing perceived capabilities to
perform consistently leads to appraisals that are needed to maintain success in tasks and
mobilizing efforts (Lyons et al., 2018). Cora-Bramble (2006) calls for a resilience-based
theoretical framework in the recruitment of minority faculty, indicating self-efficacy as an asset
for them to thrive and advance academically. Caprara et al. (2006) found a correlation between a
teacher’s self-efficacy beliefs in their job satisfaction and students’ academic achievement.
Mireles-Rios et al. (2018) found that feedback from administrators influenced teachers’ self-
confidence indicating the usefulness of administrators to conduct teacher evaluations to enhance
teacher self-efficacy. Additionally, Cobanoglu et al. (2018) indicated that an administrator must
have a health perception of being an effective administrator to demonstrate expected roles

41
successfully. They found that administrators’ self-efficacy beliefs and leadership are related and
important in transformational and transactional leadership styles (Cobanoglu et al., 2018). Thus,
administrators need increased self-efficacy as part of a transformational process in innovating
recruitment plans.
Utility Value: HU Administrators Need to See the Usefulness of a Recruitment Plan To
Increase Student Diversity
The expectancy-value theory comprises the achievement values constructed to show how
expectancies and values interact to influence outcomes under four components: interest,
importance, utility, and cost (Eccles, 1983, 1984, 2005; Elliot et al., 2017). Pintrich (2003) and
Eccles (2006) described utility as the usefulness of the work necessary for goal attainment.
Rueda (2011) described utility value as how useful one believes a task or activity is for achieving
a future goal; thus, the higher an individual values an activity, the more likely they will engage in
the task. Expectancy-value theory indicates that the amount of effort applied to a task depends on
the expectation of the value placed on success (Pintrich et al., 2002). A task with utility value can
be a means to an end and can reflect important goals that the person holds deeply, thus
connecting to personal goals and a sense of self to attain value (Elliot et al., 2017; Ryan et al.,
2009). Therefore, motivation increases when individuals complete tasks that are perceived as
having high value (Eccles, 2006).
Stegers-Jager (2018) found that the expectation of evaluating students based on non-
academic personal qualities would lead to a representative health workforce because of adverse
impact in relation to nongraded-based selections. They found that the task of predicting who will
be a good doctor is complex and requires more understanding, and it is important to share and

42
build on the evidence gathered around the combination of weighting academic and nonacademic
factors in selection criteria when promoting diversity (Stegers-Jager, 2018)
In a study by Luscombe et al. (2013), essential elements of value were explored by
administrators in defining techniques for the recruitment and retention of Generation Y students.
Wang et al. (2013) showed how recruitment leaders used the expectancy-value theory as a
guiding framework to determine characteristics of individual and gender differences in STEM
interests and identified barriers and factors that can be a key focus through intervention strategies
to help motivate women to pursue these fields. Crisp et al. (2009) explored student
characteristics as predictors in majoring in STEM degrees with a particular analytical focus on
HSIs to increase interest in STEM-related careers. Similarly, a study in the administration of
Northern Arizona University used the expectancy-value theory to predict students’ choice of a
major (Crisp et al. 2009; Sullins et al. 1995). The mission statement of an organization
communicates the institution’s values and characteristics to key external constituents (Drucker,
1973, Harley, 2002; Keller, 1983; Morphew et al., 2006; Parekh, 1977; Smith, 1979).
Administrators need to see the usefulness of a recruitment plan in their efforts to increase student
diversity that aligns with the organization’s mission and vision.
Attainment Value: HU Administrators Need to Increase Attainment Value to Promote
Innovative Behavior for the Development of a Recruitment Plan
Eccles (1983) defined attainment value as the importance of doing well on a given task.
This construct falls under expectancy-value theory, which incorporates identity issues and views
tasks as important aspects of self (Elliot et al., 2017). Symes et al. (2016) evaluated value-
promoting messages and found that the characteristics of these messages were not the issue but

43
rather the motivational beliefs and values of individuals. Motivation increases when an
individual is connected to a task through self-identity (Pintrich, 2003).
Lett et al. (2018) called for more aggressive faculty recruitment, retention, and promotion
measures to reach equity in academia and healthcare. The importance of considering the career
goals and daily work expectations translated into valued aspects in identifying recruitment and
retention strategies (Luscombe et al., 2013). Ibrahim et al. (2017) used the McGill Attainment
Value for Inquiry Engagement Survey instrument to measure attainment values for scientific
inquiry engagement in STEM disciplines and validated findings that attainment values influence
student achievement-related choices and performance (Ibrahim et al., 2017). Pukkeeree et al.
(2020) found positive thinking was an encouragement and motivational aspect in perceived
attainment value. Managers and human resources can encourage and motivate based on
increasing perceived attainment value to promote innovative work behavior (Pukkeeree et al.,
2020). Furthermore, Soleas (2020) expressed the importance of increasing attainment value
through articulating goals can lead motivation to innovative behaviors. Evaluation of the
attainment value in motivational influence examines administrators' personal meaning regarding
the importance of developing a recruitment plan for Latinx students. Thus, attainment values are
important components of task values as factors that influence motivation and lead to innovative
behaviors essential for developing a recruitment strategy.
Goals: HU Administrators Must Have Clear Goals in Increasing Diversity in the MSPA
Program
Pintrich (2000) discussed a clear distinction in goal theory constructs as goals and goal
orientation. He called target goals standards by which individuals can evaluate their performance
but not really address the reasons or purpose in achieving those goals (Pintrich, 2000). Pintrich

44
(2000) described general goals as those that do not fall under a level of specificity for standards
or criteria, but, rather, as a construct for personal strivings and life tasks that reflect a more
general perspective on goals and reflections on different goal contents in various contexts. It is
important to establish goals and clarify the tasks associated with achieving these goals. Chait
(1979) argued that college mission statements were too ambiguous and difficult to assess the
progress on set goals for the institution. Posthuma et al. (2012) referred to goal setting as a
process whereby targets and objectives are established. A goal is “something that the person
wants to achieve” (Locke et al., 1990, p. 2). Rueda (2011) indicates that, at times, people tend to
give up trying to achieve their goals because they may be too vague or difficult to tackle. Goal
setting is a vital function through which individual goals can be transformed into organizational
policies and actions (Cyert et al., 1963; Kotlar et al., 2013; Simon, 1964). According to Dowd et
al. (2007) and Levy et al. (2012), there is greater production in driving performance and
accountability when goal setting and benchmarking are assessed.
Saha et al. (2000) call for the admissions criteria to be based on diversity goals. Diversity
goals have been established in pharmacy schools with a focus on institutional goals, objectives,
and Accreditation Council for Pharmacy Education standards (Nkansah et al., 2009). Nkansah et
al. (2009) warn about the risks associated with achieving diversity goals and political hurdles; if
the goals are not clearly described, this may create confusion with quota systems. Therefore, it is
important to set goals clearly with the institutional objectives and accreditation standards and
ensure the goals are clearly stated.
Townsell et al. (2007) expressed the importance of administrators empowering their
faculty and holding them accountable for setting personal and specific goals. Patterson (2001)
regards goal setting as an essential part of university administration that needs to be adapted and

45
modified to make it applicable to the university setting. Doran (1981) introduced specific,
measurable, achievable, realistic, and timely (SMART) goals, which are a form of management
by objectives (Drucker, 1954; Sull et al., 2018). Posthuma et al. (2012) proposed a model in
which SMART goals will help academic administrators achieve better results to guide and
improve their organization. Morris et al. (2015) suggest that academic administrators must work
toward establishing more refined and sensitive metrics to track short-term goals that will lead to
long-term success.
The findings show the importance of how to create goals in a clear way for individuals to
follow. Having unclear goals makes it difficult for individuals to follow, reducing motivational
influences on continuing with the targeted goal. Thus, it is important that HU administrators have
clear goals in increasing diversity in their MSPA program.
Goal Orientation: HU Administrators Possess Mastery Orientation in Relation to New
Recruitment Strategies for Latinx Minority Students
Pintrich (2000) represented an achievement goal as “goal orientation” and includes
beliefs about purposes, competence, success, ability, effort, errors, and standards. There are four
aspects to goal orientations, according to McCollum (2007), which are mastery-approach,
performance-approach, mastery-avoidance, and performance-avoidance. Anderman et al. (2010)
indicate that mastery goals are associated with the individual being interested in self-
improvement, engaging with the task, and defining the achievement. Individuals with
performance goals are interested in their ability relative to that of others (Anderman et al., 2010).
Cerasoli et al. (2014) noted mastery goals mediated the relationship between intrinsic motivation
and performance through the lens of self-improvement. Artino et al. (2012) indicated that several
instructional practices encourage adopting mastery-oriented goals and using adaptive self-

46
corrections. This type of practice involves a deeper passion for learning and is best described as
achievement goals (Elliot et al., 2017). Thus, adopting goal-orientation constructs to increase
diversity goes beyond just meeting the goal but developing personal adaptability to improve
through self-regulated learning (Artino et al., 2012).
In this section, goal orientation is explored in the context of a mastery approach to better
understand motivational constructs in recruitment strategies for minority students. According to
McCollum et al. (2007), administrators who hold a mastery orientation will be the most self-
efficacious. They proposed this model to evaluate and measure goal orientations that allow for
better understanding of motivational constructs. Research indicates that goal orientations can
serve as motivational variables in recruitment (Allen et al., 2006; DeGeest et al., 2011; Rynes et
al., 1990). DeGeest et al. (2011) suggested that by altering goal orientations, leaders can acquire
skills and assist organizations in meeting their needs and effective management skills. Krome
(2016) looked at the effects of goal orientation and measured efficacy supporting the recruitment
of female applicants to STEM programs by incorporating feminine words to promote
attractiveness and perceptions of institutional belonging. A separate study by Anderman (2003)
presented goal orientation based on classroom task goals that provided a sense of community
through the encouragement of cooperative learning activities. Emery et al. (2018) examined how
the concept of mastery was envisioned and communicated by administrators in the educational
system and found misalignment across the administrative vision, teacher implementation, and
student perception of the school’s mastery-learning system. Seijts et al. (2004) referenced that
performance goal orientation focuses on the end-result, whereas a mastery goal orientation seeks
challenging tasks that create the opportunities to develop competencies. Thus, it is important to

47
evaluate the motivational influence under the construct of mastery-goal orientation to increase
administrators’ development competencies toward new strategies for recruitment planning.
Table 3 illustrates the motivational influences on improving minority student
representation in the HU MSPA program. Assessments for the motivational gaps that may
impact the stakeholders and organizational performance goals are also presented. The
motivational influences shown below are an effort to align the stakeholder’s goal with the
organization’s mission and goal.

Table 3
Motivation Influences
Motivation influence Motivation type Motivation influence assessment
HU administrators need to increase
self-efficacy measures to improve
recruitment plans for Latinx
minorities.
Self-efficacy
HU administrators were asked
about their confidence in
increasing the intake of Latinx
students.
HU administrators need to increase
utility value for a recruitment plan
to increase student diversity.
Utility value
HU administrators were asked
about the usefulness they see in
the intake of Latinx students.
HU administrators need to increase
attainment value to promote
innovative behavior for the
development of a recruitment plan.
Attainment value
HU administrators were asked
about the importance of the
intake in Latinx students.
HU administrators must have clear
goals in increasing diversity in the
MSPA program.
Goals
HU administrators were asked
about their perceptions on the
goals associated with increasing
diversity within the MSPA
program.
HU administrators possess mastery
orientation in relation to new
recruitment strategies for Latinx
students.
Goal orientation
HU administrators were asked
about mastery-orientation around
procedures to enhance
motivation in increasing diversity
within the MSPA program.

48
Organization
The organizational influences on stakeholder performance are based on cultural models
and cultural settings, and this was examined with the administration at HU. The organizational
influences based on Clark and Estes’s (2008) framework can be used to identify the performance
gaps in HU to increase the pipeline of Latinx representation. Gallimore and Goldenberg (2001)
purported two types of units of analysis in an organization: cultural settings and cultural models.
The cultural models of an organization are the shared mental schema of how the world works or
ought to work (Gallimore et al., 2001). The cultural setting is defined as a setting by which
people come together, over time, to accomplish a task (Gallimore et al., 2001).
This section examines organizational culture, how leaders think, and how resources are
used within the organization to accomplish the goals set by the organization. The first
organizational influence pertains to the culture, goals, and incentives aimed at increasing Latinx
student admission, as part of the cultural model. The next organizational influence explores the
needs for the administration to form partnerships in developing recruitment planning in a cultural
setting. The third organizational influence evaluates the need for alternative criteria in the
assessment of minority applicants as a part of the cultural setting. The fourth organizational
influence in cultural setting pertains to the administrations’ willingness to change in response to
periodic audits in recruitment planning. The final organizational influence examined under the
cultural setting construct is the administration’s need for confidence to overcome socioeconomic
determinants in the context of developing a recruitment plan.

49
Cultural Model: The Administration Needs the Organization to Value Cultural Representation
to Support the Recruitment Plan for Latinx Students
Gallimore et al. (2001) suggested that cultural models represent shared ways of
perceiving, thinking, and storing possible responses to adaptive challenges and changing
conditions. According to Clark and Estes (2008), all organizational goals are achieved by a
system of interacting processes that require special knowledge, skills, and motivation to operate
successfully. Therefore, processes that fail present an opportunity to identify and fix barriers to
the organization’s performance (Clark & Estes, 2008). It is important to understand that cultural
models are living up to the internal and external aspects of the organization with respect to
recruitment strategies. Bright et al. (1998) pointed to the administrator's conscientious effort in
hiring qualified underrepresented minority faculty members to foster growth in diversity.
Agrawal et al. (2005) suggested diversifying academic faculty can serve as symbols of leadership
and useful models to undergraduate students. In general, there is an absence of role models and a
lack of minority faculty members to help recruit underrepresented minorities in health
professions education (Cora-Bramble, 2006). Price et al. (2005) indicate challenges in poor
recruitment efforts can be attributed to a lack of leadership to recruit minority students.
Therefore, it is important to evaluate administrators on cultural representation in the recruitment
process as a barrier that may impede organizational performance.
Cultural Setting: The Administration Needs Partnerships in Developing a Recruitment Plan
for Minorities
Clark and Estes (2008) indicated that effective organizations ensure that organizational
messages, rewards, policies, and procedures that govern the organization's work are aligned with
or are supportive of organizational goals and values. Clark and Estes (2008) also suggest that

50
clear work goals accompanied by effective work procedures, motivational support for everyone,
and the assessment of results increases the likelihood of achieving improvement and efficiency
in the organizational change effort. Rueda (2011) suggested making structural changes to support
organizational goals is one way to strengthen performance. Rueda (2011) indicated that cultural
models help shape how an organization is structured, including the values, practices, policies,
and reward structures. Thus, it is important to evaluate organizational influences by assessing the
level of support that organizational goals lend to achieving the performance goal.
Erwin et al. (2004) evaluated collaboration between academic administration and
community partners in the recruitment of African Americans into the health professions and
found that it improved their enrollment by building trust among academic-community
partnerships. Albanese et al. (2003) demonstrated a criterion set by the administration to select
minority students that served successfully in promoting diversity in the medical program.
Additionally, Campbell et al. (2014) provided a partnership support system for increasing
acceptance rates for minority students through outreach programs. Rios-Ellis et al. (2005)
established a Latinx Healthcare Professionals Project as a privately funded initiative to provide
healthcare management training to improve diversity efforts. In Georgia, a partnership between
the administrations in Medical College of Georgia Schools of Medicine and Nursing helped
increase the number of underrepresented minority residents in healthcare (Fincher et al., 2002).
The administration’s collaborative efforts and partnerships were evaluated for their alignment
with a recruitment plan that promotes student diversity.

51
Cultural Setting: The Organization Needs Alternative Criteria for the Assessment of Minority
Applicants
Clark and Estes (2008) suggested effective change efforts in an organization’s culture are
best implemented when organizations practice evidence-based research and solutions. When a
particular policy is not supported by an organization’s process or procedure, conflicts between
the organizational culture and performance goals may arise (Clark et al., 2008). An example by
Lucey et al., (2020) proposed overcoming MCAT associated barriers by integrating its review
using a holistic approach. In addition, Stegers-Jager (2018) proposed considering personal
qualities in admissions. Coplan et al., (2021) noted that a holistic review not applied effectively,
may be attributed to a lack of recourse or a conceptual framework that can guide its
implementation and calls for further research in examining critical factors.
In a separate report, Capers et al. (2018) provided insight into eight strategies that can
help improve admission policies: (a) crafting admissions mission and vision statements, (b)
anonymous voting, (c) a screening task force, (d) adopting a holistic review, (e) blind interviews,
(f) evaluating committee bias through implicit association tests, (g) removing pictures from
student profiles, and (h) appointing minorities and younger members to the committee. Wright
(2014) warned admissions committees that student personal statements can work inadvertently to
favor cultural privilege rather than student potential and recommends policy reviews. DiBaise et
al. (2015) called for reforms in the PA admissions process to a more holistic approach that may
allow for a more flexible individualized review of applicants. Thus, it is important to assess the
influence regarding admissions policies and criteria to understand gaps and improve admissions
rates for Latinx students.

52
Cultural Setting: The Administration Needs a Willingness to Change in Relation to Periodic
Audits of Recruitment Plans
Clark and Estes (2008) indicated that organizational structures and policies can hinder
performance and goals, so audits of written plans can help bring the policies in alignment with
the organizational goal. According to Elmore (2002), accountability is increased when
individuals’ roles and expectations are aligned with the organization's mission statement and
business objectives. Rummler et al. (1995) found a mapped organization helps ensure
organizational accountability on resources and ensure processes produce productivity on
deliverables. Similarly, written plans can be used to align structures and the processes of the
organization for accountability purposes (Rueda, 2011).
Lakhan (2003) explored the effectiveness of affirmative action leading to the
diversification of U.S. medical schools strictly based on race-conscious and race-blind policies
and found that GPA and MCAT scores do not lead to racial and ethnic diversity. He purported
that implementation of race-conscious affirmative action programs results in diversifying the
medical field and improvements in underserved communities as well as increases biomedical
research and engagement in a multicultural society (Lakhan, 2003). Administrators who design
cultural audits are most successful when the following are incorporated (Chesler, 1998):
• Create a cultural audit or assessment “team,”
• Prepare the school for open assessment and discussion of issues and problems,
• Design the audit itself,
• Set the stage for the “audit,”
• Gather the information,
• Prepare the information for analysis,

53
• Analyze the data,
• Prepare a preliminary report or reports, and
• Prepare a public report and action plans. (pp. 174–188)
According to Fischer et al. (2005), an internal audit function is intended to provide the
organization’s management with information about the effectiveness of the organization’s
system of internal administrative and accounting controls. Morphew et al. (2006) indicated that
mission statements are the basis for evaluation by accreditation agencies and critical for strategic
planning. Thus, higher education institutions are constantly revisiting and revising mission
statements in addition to their goals, curricula, and general education courses to align with
accreditation standards (Association of American Colleges, 1994; Morphew et al., 2006).
Therefore, an evaluation of the periodic audits performed on recruitment plans is needed to
determine the organizational influence under the cultural setting construct.
Cultural Setting: HU Administrators Need the Confidence to Overcome Socioeconomic
Determinants in the Context of Developing a Recruitment Plan
According to Scott et al. (2013, p. 1), the sociocultural theory is a form of interaction in
which the “individual’s mental functioning is related to cultural, institutional, and historical
context.” It is an extension of Vygotsky's definition that “the social dimension of consciousness
is primary in time and in fact...the individual dimension of consciousness is derivative and
secondary” (Vygotsky, 1979, p. 30). In addition, Scott et al. (2013) indicated that the individual's
mental functioning is based on specific structures and processes of social interactions.
Daly (2006) described behaviorism as the scientific study of observable behavior of
living organisms in relation to environmental events. To this effect, Zambrana et al. (2010)
indicated that health disparities in Latinx communities are attributed to socioeconomic

54
determinants. Understanding these socioeconomic determinants can help recruitment strategies
under the sociocultural theory through Vygotsky’s model of the zone of proximal development
(ZPD) as it is presented by Scott and Palincsar (2013). This level of learning is essential to
promote learning and transfer of knowledge through the individual’s cultural setting (Gallimore
et al., 2001). Sanders et al. (2005) presented the use of Vygotsky’s ZPD to enhance faculty
teaching skills in the presence of difficult and complex challenges in the nursing profession that
involves a social context and interactive learning in clinical areas.
The ZPD model proposes that social interactions lead to cognitive development and
involves scaffolding techniques such as modeling, feedback, questioning, instructing, and
cognitive structuring (Dunphy et al., 2003; Sanders et al., 2005; Vygotsky, 1978). Clapper
(2015) proposed that cooperative-based learning and goal structures create the conditions for a
zone to develop that allows an individual to learn new information with guidance of a facilitator.
Johnson et al. (1991) provided five steps by which cooperative-based learning may be
• Specify learning objectives.
• Decide on the type of cooperative-based learning techniques and the composition of
groups.
• Explain the task and objectives to the learners.
• Monitor and observe.
• Evaluate student achievement and how well they collaborated (p. 154).
Opportunities to take the learner to the next challenge in learning is the zone of proximal
development and depends on guidance and facilitation (Clapper, 2015). There are multiple
models in the application of ZPD and Figure 1 illustrates a generic example with cooperative
learning adopted from Clapper (2015) and Vygotsky (1978).

55
Figure 1
Zone of Proximal Development with Cooperative-Based Learning

Note. Adapted from Clapper, T.C. (2015). Cooperative-based learning and the zone of proximal
development by T. C. Clapper, 2015, Simulation & Gaming, 46(2), 148158, and Mind and
society: The development of higher mental processes by L. S. Vygotsky, 1978, Cambridge
University Press.

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According to Karimi-Aghdam (2017), Vygotskian’s ZPD draws from a dynamics system
theory and a cultural-historical theory that are treated as emergent properties in defining human
development in a social context. He refers to the different levels of organization in human
development occurring over time, changing as the human mind is engaged simultaneously
through dynamic cultural, social, historical, and situational contexts (Karimi-Aghdam, 2017).
This emergent property in ZPD draws a relationship between the socio-historical environment
and the internalized higher-order functions of human consciousness over time, which can be used
in this study to evaluate the importance of cultural setting in an organization and the effects it has
on the level of the consciousness in the individual. It is important to examine the administration's
confidence in overcoming socioeconomic determinants in developing a recruitment plan for
minority students.
Table 4 presents five different influences that fall under cultural models and cultural
settings that are the subject of evaluation for organizational influences. The table illustrates the
overview of the organizational influences on the representation of minority students in health
professions schools and how to assess organizational gaps.

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Table 4
Organizational Influences
Organizational influence Organizational type Organizational influence assessment
The administration needs
partnerships in developing
a recruitment plan for
minorities.
Cultural setting HU administrators were asked about
their partnerships and collaborative
efforts in the community that are
integrated into recruitment planning
for Latinx students.
The administration needs
alternative criteria for the
assessment of minority
applicants.
Cultural setting
HU administrators were asked about
alternative methods for selecting
minority students.
The administration needs
periodic audits of
recruitment plans.
Cultural setting
HU administrators were asked about the
frequency of internal audits in existing
recruitment plans.
The administration needs
cultural representation to
support the recruitment
plan for Latinx students.
Cultural model
HU administrators were asked about the
diversity of the staff working on the
recruitment plans.
The administration needs the
confidence to overcome
socioeconomic
determinants in the context
of developing a recruitment
plan.
Cultural setting
HU administrators were asked about the
level and depth of training in their
diversity initiatives

Conceptual Framework: The Interaction of Stakeholders’ Knowledge and Motivation and
the Organizational Context
Clark and Estes’s (2008) gap analysis model is intended to identify whether the
stakeholders have adequate KMO support to achieve important work goals for the organization.
The KMO conceptual framework model is used to understand the stakeholders' knowledge at HU
in diversifying through a Latinx MSPA recruitment plan by December of 2022. This framework
draws upon the concept terms, definitions, models, and theories of literature per Merriam and

58
Tisdell (2016) as a general presentation of the low representation of Latinx students in the MSPA
program. In this conceptual framework, the KMO influences of the administrators are the main
drivers to promoting the diversification of Latinx student representation.
It is important to evaluate HU administrators using the KMO model to better understand
the barriers associated with their application process and recruitment strategies. It is critical for
the administrators to obtain the knowledge and skills necessary to implement strategies for the
intake of Latinx students. Administrators’ knowledge of barriers that exist in minorities for
research participation can be used to improve population-specific recruitment and retention
strategies per George et al. (2014) and similarly can be applied in efforts to diversify the MSPA
program at HU.
According to Jayne et al. (2004), a diverse workforce can yield benefits to improve
business performance if it is effectively managed. Therefore, the administrator’s efforts to
engage with diversity initiatives would also require effective management to meet the
organization’s goals. The administrators must also familiarize themselves with the resources
available for Latinx students to help increase competence levels. For example, Lee et al. (2020)
mentioned great outreach value through the Annual Biomedical Research Conference for
Minority Students, where students engage directly with trainees, nurturing a growing mentorship
network and reaching out to students early in their academic path to promote their success. The
administrators may also consider the incorporation of health disparity education through cultural
competency training and academic-community programs that can reduce and prevent health
inequality, as “increasing underrepresented groups within the healthcare workforce supports the
diversity of values and beliefs and heightens cultural awareness in healthcare service delivery
(Jackson et al., 2014, p. 129).

59
The conceptual framework is presented to organize the ideas and develop methodologies
to design a study on improving Latinx student representation in the MSPA program at HU. The
conceptual framework is outlined in Figure 2, which shows the administrators’ goal and the
relationship between the administration and HU as the organization.

Figure 2
Conceptual Framework for the Representation of Latinx Students in the MSPA Program at HU

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Conceptual knowledge is associated with understanding the gaps between the mission
and vision of the organization. The conceptual knowledge includes the administrators’ awareness
of the representation of minority students at HU. Additionally, it also refers to the skills
necessary to overcome challenges in health disparity issues present in Latino-based communities
in the context of recruitment planning.
The administrators’ motivational influences regarding the performance goal are important
to identify areas of intervention and improvement. The HU administrators’ ability to accurately
assess the competency levels of Latinx students is critical in assessing the recruitment process. It
is also important to explore the administrators’ motivation to understand if they support the work
that diversification entails. This motivation can be measured as the administrators’ effectiveness
in promoting an increase in MSPA applications and exerting the pressure to assess Latinx
applicants.
The administrators must be involved in internal and external programs to learn more
about reforming requirements for recruitment and admissions. The involvement of administrators
in the recruitment and admissions process enables a cultural setting that ensures the organization
provides accurate information that leads to increased minority student representation. The
cultural setting can allow administrators to apply academic-community programs to help
diversify the community as an organizational influence. Most importantly, the administrators can
use the campus as a source of engagement to increase network capabilities for minority students
and guidance for recruitment efforts.
Finally, the administrators can generate plans and reforms within the organization to
improve the cultural model and setting of HU. The administrators are key in operating and
delivering the interest of diversification to the academic staff and student body. The cultural

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model here pertains to understanding if collaborative efforts can assist in defining requirements
for a higher rate of Latinx students. The cultural model for HU can be examined as a core value.
Thus, incorporating this core value into the culture can help feed the pipeline that promotes
minority student representation. The cultural setting of HU is evaluated for the resources
necessary and the type of environment the administration needs to overcome recruitment
planning challenges.
In summary, the knowledge dimensions examined will be the stakeholder’s knowledge in
terms of factual, conceptual, procedural, and metacognitive influences. The motivation
dimension will be used to determine the gaps relating to self-efficacy, utility value, attainment
value, goals, and goal orientation influences to meet the performance goals. Lastly, the context of
the cultural setting and cultural models as influences of the organization dimension will be
examined for their role in the stakeholders’ attainment of the performance goal. Although these
influences require examining critical factors that affect the performance goal, they do not
necessarily stand alone and may generate a relational influence between the critical factors and
the KMO influences. This conceptual framework is built to recognize that KMO influences do
not remain in isolation from each other.
Conclusion
The literature review shows the barriers administrators face in Latinx recruitment in the
health professions field. It is important that administrators understand the barriers in recruitment
strategies that impact the Latinx minority pipeline to develop a new strategic recruitment plan.
The empirical research indicates the barriers that exist in recruitment are attributed to
socioeconomic constraints on the quality of education, financial barriers, and discrimination.
Additionally, the administrators’ involvement is important in developing strategies to recruit new

62
minority students and overcome institutional barriers. There are also academic barriers that
present a challenge for administrators to set metrics that do not compromise the integrity of the
program. Administrators need proficiency in recruitment strategies of Latinx students that
provide systemic support as it relates to project goals, mission, and values of the organization.
Finally, the literature notes the organization’s limitations in the preparation of recruitment
plans for increased diversity, low levels of leadership diversification, lack of collaborative
engagement within the organization, and the lack of resources that can support administrators in
achieving their performance goals. The KMO conceptual framework model is used to understand
the knowledge and skills needed for administrators to motivate the organization in creating a
recruitment plan specific to the intake of Latinx students into the MSPA program at HU. In the
next chapter, a gap analysis using the KMO framework will be used to evaluate the factors that
act as barriers to the organization's improved performance.

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Chapter Three: Methods
There is a shortage of Latinx healthcare professionals in general to address the issues of
health disparities in Latinx communities in the United States (Walker et al., 2010). The aim of
this study was to identify factors preventing Latinx representation in the MSPA program at HU
toward diversifying the medical field to respond to growing health disparities (FamiliesUSA,
2014). According to Rose (2018), diversity efforts may fail with the absence of recruitment
plans, retention, plans, mentoring models, and resources or lack of involvement and if activities
are done in isolation (p. 82). These failures may potentially hinder the strength of an applicant in
particular those from Latinx communities. Student activities such as volunteer work or
community engagement may potentially bring value in a holistic approach especially if it is
related toward overcoming health disparity related issues. A leader’s awareness in these barriers
and challenges may have an increased role in the selection of candidates for the MSPA program
at HU.
Clark and Estes (2008) described three critical factors examined during the analysis
process. These factors formed the causes of performance gaps in an organization and were
placed and aligned to meet successful goal achievements. The questions that guided the
innovation model study to increase Latinx representation in medical schools were the following:
1. What are the administrators’ knowledge, motivation, and organization needs related
to development of a new Latinx MSPA recruitment plan?
2. What are the recommended knowledge, motivation, and organizational solutions?
Methodological Approach and Rationale
This innovative study sought to identify the KMO influences on the HU administration in
their goals of increasing student diversity in the MSPA program. The examination of the

64
stakeholders involved a gap analysis framework using a mixed-methods design to draw
inferences from quantitative and qualitative data to better understand the role of the administrator
as it pertains to increasing diversity. Qualitative data was gathered through interviews, and
quantitative data was gathered through Likert scale surveys. Additional documents such as
program pamphlets, historical admissions records, and institutional effectiveness plans were also
utilized to help better understand the role of the administration looking to meet the needs of
diversifying the program.
Stringer (2014) refers to action research as a systematic and rigorous inquiry that helps us
understand an event characterized by a focus, process of inquiry, and the development of
explanations. This study is regarded as a summative evaluation research (Alkin, 2011) that deals
with organizational gaps at HU and in terms of administrators’ commitment to diversifying
MSPA enrollment.
Qualitative data were utilized in this research project to describe and characterize
administrators' ability to support the development of a Latinx recruitment plan for the MSPA
program. Qualitative data was also used to determine factors in this study (Creswell et al., 2018).
Interviews and surveys were used to describe the process by framing questions per McEwan et
al. (2003) to focus on the administrator’s support for a new Latinx recruitment plan.
Overall, this study used a mixed-methods approach to understand and correlate
qualitative data and quantitative data. The assessments are based on surveys, documents, and
interviews with research questions designed to identify gaps in the administrators’ performance
in designing a plan to increase Latinx student representation. This analysis was used to develop
an integrated implementation and evaluation plan for administrators to improve the
representation of Latinx students at HU. In the next section, the administrative stakeholders are

65
described in detail, along with sampling techniques and rationale for sampling and recruitment
specifically for interviews and surveys that are linked to the research questions for this study.
Participating Stakeholders
The stakeholders in this study are the administrators at HU and the population of focus is
the MSPA program. The leadership at HU consists of individuals who oversee the business
aspect of the medical program and the translation of the mission, values, and virtues to the
educational community.
Survey Sampling Criteria and Rationale, Simple Random Cluster Sampling
Criterion 1
The participants must hold an administrative position, such as an executive board
member, board of directors, dean, assistant dean, chair, and directors at the institution. The
leadership position is independent of ranking and serves as a basis for understanding the
organizational culture and its connection to the HU mission statement.
Criterion 2
The participant must hold at least one year in the position in the organization. The level
of experience by the administrators is independent in understanding the administrators’
perception of diversification of the MSPA program as it represents the present-day culture
experienced by the administration as an organization.
Criterion 3
The participant must have a level of engagement with the admissions process. The
engagement in the admissions process can vary as someone counseling, interviewing, reviewing,
or establishing records for incoming students. This criterion is important because it will help

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determine how HU enforces mission values through the admissions process from a general and
organizational point of view.
Survey Sampling (Recruitment) Strategy and Rationale
The survey sampling strategy was designed to gather quantitative data following a simple
random cluster sampling approach with the intent to look at HU administrators as an
organization rather than as individuals. The goal of Salkind’s (2014) simple random cluster
sampling technique was to determine if there were significant differences in perceptions. Under
the quantitative approach, the recruitment strategy was dependent on a simple random cluster
sampling (Fink, 2013). The cluster effect was satisfied by looking for a position in the
administration not specific to the dean but included admissions counselors, chairs, directors, and
medical student leaders.
The recruitment strategy for HU administrators depended on contact information, such as
email addresses and phone numbers found on the organization’s websites. The timing of the
survey the end of the 2021–2022 school year. The goal was to evaluate HU administrators’
awareness of diversity.
Interview Sampling Criteria and Rationale
Criterion 1
The participant must hold a leadership position at HU. The higher-ranking position
makes a stronger connection to the medical program’s mission statement and how they enforce
those values through the admissions process.
Criterion 2
The participant must hold at least one year in the position at HU. The level of the
administrator’s experience is critical in understanding the leader’s perception of the program and

67
the barriers that exist in the selection process that affects the pipeline for Latinx student
representation.
Criterion 3
The participant must be engaged with the admissions process of incoming medical
students. Engagement in the student pipeline and the selection process is critical to understanding
if the leader is operating in an environment that supports diversification.
Interview Sampling (Recruitment) Strategy and Rationale
The purpose of the interview group sampling in this study was to gather qualitative data,
per Merriam and Tisdell (2016), to explore the awareness of administrators on diversity. The
interview group sampling strategy followed a random sampling approach to understand and
describe the perceptions of Latinx student representation. This allowed for the minimization of
bias in the selection process. The random sample included five out of 10 administrators using
Random.org.
The number of participants depended on the number of administrators at HU. The
recruitment strategy for this study was designed as part of a cluster sampling plan that selected
the administrators as a cluster and sampled using interviews and surveys. This helped reduce the
total number of interviews conducted for administrators at HU due to access limitations and
restrictions. The focus of this study was to identify gaps within the KMO framework in the
development of a Latinx recruitment plan for the MSPA program. Under this qualitative
approach, the sample size was N=5 from the administration group for interviews and a sample
size of N=16 for a total of 16 participants for surveys that included staff and faculty. Each
participant was interviewed once. The interviews were held during the summer of 2021 through
the Zoom communication platform.

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Data Collection and Instrumentation
Survey respondents captured all senior administrators of the administration clustered
group. This experimental design was intended to capture the entire MSPA program’s
administration at HU to evaluate administrator knowledge and motivation in relation to
developing a recruitment plan for Latinx students. The selection of the interview group was
intended to gather qualitative data that determined the depth of awareness of administrators
regarding diversification. The information gathered from an interview group sample described
the perceptions of administrators as it relates to the development of a new MSPA recruitment
plan for Latinx minorities. The input was intended to help identify the barriers associated with
the development of the Latinx recruitment plan.
The observation sampling technique was not selected due to COVID-19 pandemic
limitations on resources for traveling, costs, and access to observe the admissions process from
the medical education facility. This study followed an innovation model using Merriam and
Tisdell’s (2016) quantitative and qualitative methodologies to help describe the overall
perceptions of the stakeholders and organizational leaders on the representation of Latinx
students in the MSPA. The qualitative data collection method aimed to describe the overall
perception of the stakeholder and organizational leaders on the representation of Latinx students.
According to Merriam and Tisdell (2016), “qualitative researchers are interested in
understanding how people interpret their experiences, how they construct their worlds, and what
meaning they attribute to their experiences” (p. 6).
This study used interviews to describe the stakeholders’ awareness of diversity and
minority representation for Research Question 1 (Merriam & Tisdell, 2016). The interview also
described the stakeholders’ perceptions of barriers to developing a new recruitment strategy for

69
minority students, which identified gaps in the administrators’ KMO needs (Research Question
1). The interview data examined KMO factors within the organization to determine the
performance gap regarding creating a new recruitment plan to support Latinx student
representation in the MSPA program at HU.
In addition, quantitative research evaluated the relationship between health disparities
knowledge and Latinx student enrollment. This information characterized the problem
descriptively per Creswell et al. (2018) to verify the KMO influences. A survey was the best
approach to collect data to validate the gaps in the organization’s performance to address
recommended KMO solutions (Research Question 2). The survey data collection method verified
the gaps found in KMO factors within the organization in the low acceptance rate of Latinx
students (Clark & Estes, 2008).
Survey Protocol
The survey approach quantified motivational factors regarding the organization’s mission
and its influence on Latinx student representation to address recommended solutions under the
KMO construct (Research Question 2). The survey also identified gaps between the
organization’s resources and its capability to improve Latinx student representation to address
Research Question 2. The survey data verified the gaps found in KMO factors within the
organization regarding the low Latinx student acceptance rate (Clark & Estes, 2008).
Survey Instrument
The survey instrument was designed to gather information using a 100% sampling
approach (sampling the entire population) in which the analysis of administrators’ responses
identified potential differences in their perceptions of minority student representation at the
medical training institution. The survey consisted of no more than 30 questions for the

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participants and mainly involved Likert scale questions. It lasted no more than 15 minutes. There
were 1–2 multiple-choice questions and demographic characterization questions such as gender,
age, years of experience, and position. The survey captured respondents’ views on student
diversification to reveal trends on the topic of diversity and captured ontological realism and
epistemological constructivism adopted by an approach used by Maxwell (2013). The survey
verified gaps in KMO influences to identify the factors affecting Latinx student representation.
Appendix A outlines the survey protocol for the administration, staff, and faculty. Appendix B
outlines the survey protocol for students used to triangulate responses to the administration and
documentation analysis.
Survey Procedures
The surveys were administered within two weeks of the interview, and this timing was
critical because it allowed the participants to reassess their perceptions from the interview and
verify their perceptions on the survey (Robinson et al., 2019). If the survey were administered
weeks later, it may not have captured any reflections the participant had after the interview and
makes it difficult for retrieval (Robinson et al., 2019). Thus, the survey related to the interviews
because it verified the influences that drew from theories, models, and conclusions about the
complex reality per Maxwell (2013) of low representation of Latinx students.
The surveys were administered online through Qualtrics, provided respondents with
increased flexibility in their daily schedules, and allowed for anonymity in their responses.
Additionally, the management of the information was encrypted to ensure privacy, a critical
factor for protecting study participants (Glesne, 2011). This approach was best suited for the
organization that was involved in more critical work-related events, such as the treatment of

71
patients and saving lives. Therefore, the quick administration of the survey was a convenient
method for leaders who may be too busy.
Interview Protocol and Procedures
It is important for the administrators to obtain the knowledge and skills to understand the
extent of minority student representation. The administrators’ motivation to help minority
students overcome application barriers is important to drive the mission and vision of the
organization. The organizational influences identified in this interview helped determine core
values within the organization that can improve minority student representation. Appendix C
outlines the interview protocol for the administration, staff, and faculty. Appendix D was used to
outline the interview protocol for the students to support HU administration responses.
The interview protocol outlined the KMO factors related to the Latinx representation in
the HU MSPA program. The interview began with probe questions and led to a mixture of open-
ended and semi-structured questions (Patton, 2002). Most probe questions examined the
interviewees’ knowledge and skills toward the development of a Latinx recruitment plan for the
MSPA program. Student diversity is a vague description of underrepresented students, such as
gender, ethnicity, race, age, and disability. Therefore, the interview followed a semi-structured
approach around the development of a recruitment plan to allow new ideas that were explored as
a framework for themes. It began with the organization’s mission statement, followed by the
overall representation of minority students in the organization. This part of the interview satisfied
the conceptual framework for knowledge influences that are important for the organizational
leaders to understand the community of underserved Latinx students.
The interview then transitioned to open-ended questions to examine the motivational
factors in terms of respondents’ personal experience with health disparities and minority students

72
within the organization. The information in this section characterized the leaders’ level of
engagement with student diversification in the organization. The questions were designed to
identify application process barriers that impact Latinx students' selection. This section of the
interview bridged the conceptual framework to motivational influences and described the
barriers encountered by Latinx students.
Finally, the interview closed with an open-ended question on values regarding student
diversification and a probe question on organizational resources on current plans to improve
minority representation. The sequence format was intended to collect data to characterize the
respondents’ perceptions of diversity and their capability through resources in improving the
Latinx student intake rate using Patton’s (2015) qualitative approach for interviews. This
approach structured the conceptual framework for organizational influences on resources to
identify whether additional support was needed.
It is important for the administrators to obtain the knowledge and skills necessary to
understand the extent of awareness of minority student representation. The administrations’
motivation to help minority students overcome application barriers is equally important to drive
the mission and vision of the organization in serving the community. The organizational
influences identified in this interview helped determine core values within the organization that
can improve the process capability in minority student representation. Please see Appendix C,
which outlines the interview protocol for the administration, staff and faculty, and Appendix D,
which outlines the student interview protocol.
Interviews were designed for one-on-one delivery over the Summer of 2021. The target
was 100% of the administrators for the interview. The interviews lasted approximately an hour,
with follow-ups as needed to clarify any responses after the interview. The participants were

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provided with a few questions to help prepare them for the interview. This preparation helped
prevent unintended responses that did not add value to the study.
The interviews were both formal and informal, where the content had a level of formality,
but the setting was informal, such as the participant’s office, conference room, remote access
from home, or lunch table. However, due to the COVID-19 pandemic, the interviews were
administered through a Zoom meeting.
The interviews were video recorded using the Zoom feature for each participant. The
participant was asked to agree to the recording a few days before to avoid surprises. Notes were
taken during the interview to capture important behaviors, gestures, points, and observations that
may added value to the transcript (Bogdan et al., 2007). Video recording helped capture
behavioral responses that were leveraged into the analysis.
Documents and Artifacts
American Academy of Physicians Assistants (AAPA) documents for statistical analysis
were used to draw comparisons between the rates of representation of minorities in the MSPA
program at HU and the national average provided by HU. Additionally, a comparison was drawn
between PA schools in California and HU. This information was used as descriptive statistics
using methods presented by Salkind (2016) to help connect the conceptual framework as
objective evidence of the diversity of the program. In addition, documents such as pamphlets,
meeting minutes, seminars, conferences, and publications were used as documents and artifacts
to supplement this evaluation study. Appendix F outlines the document analysis protocol for data
triangulation with surveys and interviews.

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Data Analysis
This study involved quantitative and qualitative data analysis. In general, frequencies and
percentages for the responses were quantified depending on the type of data. It is expected that
there were only a total of five administrators; thus, the descriptive statistics formed the basis of
the analysis. The questions were designed to the type of influence and KMO construct per Clark
and Estes (2008). Data cleaning was performed with the survey and interview questions to
properly code the responses and frame frequency, ranking statements, and reference to resources.
In the data, exclusions were identified in the cleaning process by identifying the position and role
of the interviewer. Also, gender and other demographic-related data were asked to characterize
the pool of respondents.
Descriptive statistical analysis was conducted once all survey results were submitted. The
descriptive statistics involved coding for gender, ethnicity, race, language, years at the
organization, and years in the role. Descriptive statistics were prepared in tables. Any variation
with a sizable range may indicate areas requiring a follow-up with analysis.
For interviews, data analysis began during data collection. Analytic memos were written
after each interview and each observation as field notes per Bogdan et al. (2007). Thoughts,
concerns, and initial conclusions about the data in relation to the conceptual framework and
research questions were documented appropriately. Once the interviews were completed, the
content was transcribed using the Zoom transcription capabilities and cleaned. The transcripts
were then analyzed and coded for language, patterns, and trends per Corbin et al. (2008). The
interview protocol was decoded and used to identify patterns, concepts, and themes that stood
out from the study per Harding (2013). In general, codes were designed to characterize the
frequency of usage of terms or the emergence of terms that helped support themes found in the

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study (Creswell et al., 2018). In the first phase of analysis, open coding per Corbin et al. (2008)
was utilized by looking for empirical codes and applying a priori codes from the conceptual
framework. Similar approaches by Harding (2013) was utilized to help categories themes and
building theories using an open coding format. An example of the open coding for the studies is
indicated below in Figure 3.

Figure 3
Phase I: Open Coding Strategy Example for Knowledge Dimension

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A second phase of analysis was conducted where empirical and a priori codes were
aggregated into analytic/axial codes per Corbin et al. (2008). In the third phase of data analysis,
pattern codes and themes were identified that emerged in relation to the conceptual framework
and study questions per Creswell et al. (2018). All documents and artifacts were analyzed per
Bowen (2009) for evidence consistent with the concepts in the conceptual framework and to
obtain empirical data and strengthen the knowledge gathered around the study. An example of
the analytical coding and validation of influences is indicated below in Figure 4.

Figure 4
Phase II & III: Axial Coding Strategy for Emerging Themes & Validation of Influences

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The data limitations were set on administrators only who provided informed consent by
notifying them the study was voluntary and confidential, and they could stop participating at any
time, per Kreuger et al. (2009). Other aspects of minority representation such as religion,
political, and financial backgrounds were excluded from the study to protect and keep the right to
privacy per Glesne (2011). Nurses, PAs, Laboratory Technicians, CNAs, and patients in the field
were also excluded from the study.
Credibility and Trustworthiness
There were two factors to consider when increasing the credibility and trustworthiness of
this study. The first was to know the willingness and ability of the participant to answer
questions, and the second was the context or cultural factors in the survey that may influence the
respondent (Robinson et al., 2019). These considerations apply to the qualitative components,
which were based on different assumptions about reality and can easily be misinterpreted by
different world views (Merriam et al., 2016). Thus, strategies were developed for this study to
assess the validity under the notion of credibility (Guba et al., 1981). The three strategies
included in this study were triangulation, respondent validation, and peer review.
The first strategy, triangulation, used multiple sources of data to confirm emerging
findings (Denzin, 1978). Any data from interviews/focus groups, surveys, and document analysis
were triangulated to increase the study’s internal validity, per Merriam et al. (2016). The second
strategy employed respondent validation, which was referred to as member checks (Bryman,
1988; Lincoln et al., 1985), which is the process of soliciting feedback on emerging findings.
These respondents were identified as directly involved in the admissions process (Merriam et al.,
2016). The third strategy was performing a peer review on the data collection, which was the
process by which information was carefully examined by a qualified peer (Merriam et al., 2016).

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The information from interviews was triangulated with survey and document data to
ensure the perspectives were standardized. The feedback strategy allowed to clarify
misinterpretation in the participants’ responses (Maxwell, 2013). The peer examination, which
consisted of the committee chair and members, ensured there was trustworthiness in how the
information was gathered, eliminated bias, and included a professional scan of the raw material
(Maxwell, 2013). All these strategies were implemented in the design, data collection, and data
analysis to ensure the information was credible and trustworthy.
Validity and Reliability
In this study, it was important for respondents to understand, process, and answer survey
questions and consider the cognitive load to ensure validity and reliability in responses
(Robinson et al., 2019). Thus, organizing the survey following the Psychology of Survey
Response around the four major components of a survey response ensured validity and
reliability. This incorporation allowed the validation of the gaps present in KMO influences
(Tourangeau et al., 2000).
The survey was designed to be clear and simple to read to satisfy the comprehension
component. The instructions on the survey were clearly illustrated for the reader and
commonplace language was utilized. All words and phrases were clearly defined in the survey.
Complex questions were presented in a sequential format. Ultimately, the structure of the survey
brought levels of measurement such as nominal, ordinal, interval, and ratios that provided a score
and used as a reliability tool (Salkind, 2016).
The retrieval component was presented in specific terminology in relation to minority
representation and health disparities. In this component, it was important to familiarize the
survey with relevant jargon to incorporate the experience of the respondent. Appendix A

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contains the survey protocol, Appendix B describes the student survey protocol, Appendix C
provides the interview protocol, Appendix D describes the student interview protocol, Appendix
E contains the information sheet for exempt research, and Appendix F provides the document
analysis protocol.
The judgement component addressed factual questions, dates, durations, and frequencies
(Tourangeau, 2003). The survey incorporated clarity at a level to reduce confusion or
indecisiveness by the participant when recalling information. A level of detail in the questions
was presented to reduce misinterpretation and ensure validity and reliability in the responses by
the participant.
The last component was response and required selecting and reporting an answer to a
survey question (Robinson et al., 2019). Respondents tend to over-analyze questions and spend
lots of time answering questions; thus, poorly constructed questions could lead to less engaged
surveys (Schwarz et al., 2001). Thus, it was critical to map the survey questions around groups of
processes in a format of a multiple-choice, and the answers were edited to meet the criteria
desired for the respondent to reduce ambiguity (Robinson et al., 2019). This ensured reliability in
the interpretation of available responses by the respondent and standardized analysis.
The consideration of cognitive load and the incorporation of the four components to
organize survey items were implemented to validate KMO factors that influence the organization
(Robinson et al., 2019). The survey was piloted by the committee chair and the organizational
stakeholder and went through a few rounds of pretesting to revise and finalize the survey
(Robinson et al., 2019). Feedback was integrated into the survey to improve the content and
ensure the questions were clear and comprehensible (Collins, 2003). The strategies of

80
considering cognitive load and the four components to organize a survey instrument increased
the confidence in the data gathered.
The survey was administered in a standardized form for all questions and answer
selection. A target of five administrators to take the survey was attempted. The 11 regents were
not involved in order for this study to focus on the senior administrators. The response rates were
captured in a database, and emails were used to send reminders weekly. Finally, to mitigate bias
in the validity of data gathered, it was important to consider the conclusions established by the
selection of the data that fit the research theory and the data that stood out (Miles et al., 1994;
Shweder, 1980). Thus, explaining the possible biases and delineating them in the research
proposal helped mitigate the threat. For example, health disparity is one issue, and Latinx student
representation is another issue that cannot be forced together. Rather, comprehension of these
two issues must be presented in a way that neither reflects positively nor negatively for the topic
of study. Outlining the strategies in the proposal helped drive away validity threats. Intervention
also helped explain questions to assist the respondent in finding the response that best resembles
their perception (Merriam et al., 2016).
In conclusion, the qualitative and quantitative data collection methods and instruments
were presented. The interview was used for qualitative descriptive characterization of leadership
perceptions, and the survey was the quantitative data collection instrument to validate the
organization’s KMO influences. The design of the questions was critical to ensure their
reasonable cognitive load and organization for clarity. Triangulation, respondent validation, and
peer reviews helped increase credibility and trustworthiness. The four components
(comprehension, retrieval, judgement, and response) organized the survey and increased the level
of validation and reliability.

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Ethics
The aim of this study was to extract information from individuals that may be used as
objective evidence of the organization’s performance. The stakeholders in this study were the
administrators at HU. The study involved human interaction in the form of asking questions in
person or through a survey. The questions evaluated the administrators’ KMO needs related to
their revision of procedures within the admissions process. These questions may have appeared
invasive, obtrusive, uncomfortable, bold, and controversial to the organization. As such, it was
important that an ethical strategy is clearly outlined to mitigate the risks associated with these
scenarios. A specific ethical plan was presented on the approach for human participation
protection, informed consent, voluntary participation, the confidentiality of data, permissively
recording information, data storage, and data security.
In this study, the human participants were protected by the institutional review board
(IRB), which was a way to ensure their protection from harm, right to privacy, informed consent,
and issues of deception (Merriam et al., 2016). The informed consent was delivered through
written consent forms and explained in detail to ensure their participation was voluntary, that
they understood the research could affect their well-being, and that they could choose to
discontinue the study (Glesne, 2011). To meet the effectiveness of the IRB process, the
researcher completed the Collaborative Institutional Training Initiative requirements.
My relationship with HU is that of a research student through the organizational change
and leadership program at the USC Rossier School of Education. The goal was to gain access to
the HU administrators who are integrated into the admissions process. This was important
because they hold an interest in selecting new students. I do not hold a position that conflicts
with the MSPA program at HU. Therefore, I hold no personal or potential interest in any project

82
associated with the MSPA program besides the project in this dissertation. This disclosure
clarifies the primary researcher’s position with no risk associated with interest in this study.
The administrators may also have felt afraid of possibly exposing information that may
affect their job performance, leadership status, or employment altogether. To mitigate this
problem, I notified the administrators that the organization was assigned a pseudonym.
Furthermore, the interview questions were based on qualitative data capture and were intended to
describe the nature of the problem. Answers were recorded anonymously. The identification of
the individual was coded in a way that was not traceable and kept separate in the data storage
organization to ensure the security of the information was not breached. This requires the
interview to be highly structured and standardized to follow the proper code of the interview
(Merriam et al., 2016).
Individuals were asked for permission to record and informed that it could be stopped at
any time at their request. In all instances, the audio recording was incorporated into the video
recording, and the questions were phrased as open-ended (Patton, 2002). The participants were
respected, unpressured, unharmed, and had their rights protected throughout this study, per
recommendation by Rubin et al. (2012).
I am a former pre-med student at Loyola Marymount University and a first-generation
Latino college student who grew up in a socioeconomically constrained neighborhood in
Southern California. I was also involved as the primary recruitment chair for various on-campus
organizations during my undergraduate studies. My personal bias did not weigh into assumptions
when asking questions. I also ensured the questions asked were neutrally in a sense to understand
and not exploit.

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Limitations and Delimitations
There were limitations and delimitations associated with this study that had implications
for the data, such as the framing of questions. There are limitations in gathering data for
statistical analysis. Due to limited responses, data did not allow for inferences using statistical
tools, and this area of analysis was restricted to percentages, characterization, and frequency of
usage. There is also a concern of race bias since the study was evaluating the representation of
Latinx students.
The delimitations for this study vary on multiple factors that considered the time,
triangulation of data between documentation, interviews, and surveys. Additionally, the
administrators were interviewed individually to gain a leadership perspective. It was important to
know that this study focused on decision-makers around the MSPA program and did not involve
support staff, human resources, or other people who, although important to the university, were
not in a position to make substantive changes. Considering the limitations and delimitations in
this study, acknowledging them and maintaining a mutual agreement on its execution with the
test subjects provided an adequate environment to extract the necessary data for analysis in this
study.

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Chapter Four: Results and Findings
The purpose of this study was to evaluate the need for the development of a recruitment
plan for the intake of Latinx students to the MSPA program at HU. The focus of this study was
centered on a need analysis geared to identify factors essential for the administration to support
the development of a recruitment plan. The strategy for this study utilized the application of a
gap analysis framework on the assumed KMO factors using a mixed-methods approach. This
chapter presents the research findings conducted at HU to address the following research
questions:
1. What are the administrators’ knowledge, motivation, and organization needs related
to the development of a new Latinx MSPA recruitment plan?
2. What are the recommended knowledge, motivation, and organizational solutions?
The data were based on 17 individual interviews and 40 survey responses from
administrators, staff and faculty, and students. All administrators participated in the study, and
the rest of the groups were captured through a random sampling technique for each cluster group.
After each cluster group completed the interviews, the survey was sent out to the entire group.
The data collected for the interviews was performed through a recorded Zoom meeting that took
45–60 minutes, and the survey was performed by the respondents online with an estimated time
of 7–10 minutes. In this chapter, the results are presented and analyzed to identify themes,
patterns, ideas, and concepts that emerged from the study as it relates to the research questions.
Participating Stakeholders
The participating stakeholders for this study are the senior-level administrators: the
cabinet of the organization, staff and faculty, and the PA student cohorts. All senior-level
administrators participated in this study (N = 5, 100%) through interviews and surveys. Included

85
in the study were participants from the academic administration, consisting of deans, chairs, VPs,
and provosts. There are 13 members of the administration, of whom five make up senior-level
administration. The senior administration population makes up 40% of the overall administration
population and is the focus of this study.
To further support research findings, the study was opened to the staff and faculty of the
PA program. The participants involved adjuncts, assistants, principal professors, program
directors, and tutorial staff. This group consisted of 12 out of 16 (75%) identified members in the
MSPA department who participated in both the interview and survey study. The survey for the
administrators was the same for staff and faculty. However, the results were separated as data in
an effort to validate the influences as a need or an asset for the senior-level administration.
Tables 5–15 show the demographic data for all employee participants.

Table 5
Senior Administration Demographics by Gender
Gender Count Percentage
Male 3 60
Female 2 20
Other 0 0
Do not wish to identify 0 0
Total 5 100

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Table 6
Staff and Faculty Demographics by Gender
Gender Count Percentage
Male 6 50
Female 5 41.7
Other 0 0
Do not wish to identify 1 8.3
Total 12 100

Table 7
Senior Administration Demographics by Race and Ethnicity
Race and ethnicity Count Percentage (%)
Hispanic or Latino of any race 0 0
American Indian or Alaska Native, not Hispanic or Latino 0 0
Asian, not Hispanic or Latino 0 0
Black, not Hispanic or Latino 0 0
Native Hawaiian or Other Pacific Islander, not Hispanic or Latino 0 0
White 4 80
Two or more races, not Hispanic or Latino 1 20
Nonresident Alien 0 0
Not Reported (Race & Ethnicity Unknown) 0 0
Prefer not to say 0 0
Total 5 100

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Table 8
Staff and Faculty Demographics by Race and Ethnicity
Race and ethnicity Count Percentage
Hispanic or Latino of any race 4 33.3
American Indian or Alaska Native, not Hispanic or Latino 0 0
Asian, not Hispanic or Latino 0 0
Black, not Hispanic or Latino 1 8.3
Native Hawaiian or Other Pacific Islander, not Hispanic or Latino 1 8.3
White 4 33.3
Two or more races, not Hispanic or Latino 0 0
Nonresident Alien 0 0
Not Reported (Race and Ethnicity Unknown) 0 0
Prefer not to say 2 16.7
Total 12 100

Table 9
Senior Administration Demographics by Employment Tenure
Years Count Percentage
1 year or less 0 0
1–5 years 2 40
6–10 years 1 20
11–15 years 1 20
16–20 years 0 0
20+ years 1 20
Total 5 100

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Table 10
Staff and Faculty Demographics by Employment Tenure
Years Count Percentage
1 year or less 1 8.3
1–5 years 8 66.7
6–10 years 1 8.3
11–15 years 2 16.7
16–20 years 0 0
20+ years 0 0
Total 12 100

Table 11
Senior Administration Demographics by Age Groups
Age Count Percentage
18–24 0 0
25–34 0 12.5
35–44 1 20
45–54 1 20
55–70 3 60
70+ 0 0
Total 5 100

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Table 12
Staff and Faculty Demographics by Age Groups
Age Count Percentage
18–24 0 0
25–34 2 18.2
35–44 2 18.2
45–54 4 36.4
55–70 3 27.3
70+ 0 0
Total 11
a
100

a
One respondent did not select an age group.

Table 13
Administration Demographics, Bilingualism
Bilingual Count Percentage
Yes 0 0
No 5 100
Total 5 100

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Table 14
Staff and Faculty Demographics, Bilingualism
Bilingual Count Percentage
Yes 5 41.7
No 7 58.3
Total 12 100

Table 15
Administration, Staff, and Faculty Position
Position Count Percentage
Faculty 4 23.5%
Staff 6 35.3%
Senior administration 5 29.4%
No Answer 2 11.8%
Total 17 (100%)

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The study was reinforced with active student participation in the PA program, with three
out of 118 (2.5%) students who participated in interviews and 22 (18.6%) students who
completed the survey for all active cohorts. The student survey was provided in a context that
was intended to help support any gaps associated with the KMO framework for the
administration. Tables 16–21 show the student demographic information gathered from surveys.
Not all student respondents answered all questions and were noted in their respective tables.

Table 16
Student Demographics by Gender
Gender Count Percentage (%)
Male 9 39.1
Female 13 56.5
Other 0 0
Do Not Wish to Identify 1 4.3
Total 23 100

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Table 17
Student Demographics by Race and Ethnicity
Age Count Percentage (%)
Hispanic or Latino of any Race 6 27.3
American Indian or Alaska Native, not Hispanic or Latino 0 0
Asian, not Hispanic or Latino 3 13.6
Black, not Hispanic or Latino 2 9.1
Native Hawaiian or Other Pacific Islander, not Hispanic or Latino 0 0
White 9 40.9
Two or more races, not Hispanic or Latino 0 0
Nonresident Alien 0 0
Not reported (Race & Ethnicity Unknown) 0 0
Prefer not to say 2 9.1
Total 23 100

Table 18
Student Academic Tenure
Years Count Percentage (%)
1 year or less 7 50
2 years 6 42.9
3+ years 1 7.1
Total 14
a
100

a
Not all respondents answered this question.

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Table 19
Student Academic Age Groups
Age Count Percentage (%)
18–24 3 13.1
25–34 15 65.2
35–44 4 17.4
45–54 1 4.3
55–70 0 0
70+ 0 0
Total Count 23 100

Table 20
Student Bilingual Language
Bilingual Count Percentage (%)
Yes 12 52.2
No 11 47.8
Total Count 23 100

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Table 21
Student Secondary Language Type
Secondary Language Count Percentage (%)
Spanish 6 42.9
Vietnamese 2 14.3
Chinese 2 14.3
Romanian 1 7.1
Somali 2 14.2
Russian 1 7.1
Total 14
a,b
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a
Some students were trilingual.
b
Not all respondents answered this question.

Data Validation
The survey and interview data were organized and analyzed to validate each influence as
an asset or a need. The data from the survey followed a Likert Scale format with five distinct
choices translating to a score of 1–5 from strongly agree to strongly disagree, respectively. The
total count in the survey was calculated to determine the percentage of respondents that fell
within each score. The cut score is calculated by taking the positive results of “strongly agree
and agree on percentages” and summing them together. If the sum of the percentage is greater
than 75%, the influence is regarded as an asset, as it represents 75% of the total respondents are
efficacious, whereas 25% are considered not efficacious to the influence. Any response below
75% is considered a need that provides an opportunity for improvement.

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The data obtained from interviews were organized into an open codebook using the
empirical codes as it relates to the KMO influences. The interviewee transcripts were analyzed
using axial coding to determine patterns and themes by examining specific trending words that
may be shared across all respondents or unique to a few. The information was used to
characterize the assertions and present propositions as it relates to the influence as an asset or
need. In the event that the data gathered in interviews completely contradicts the survey results,
the influence is considered partially validated. When applicable, documentation analysis was
integrated into the analysis to further support the validation of the KMO influence as an asset or
a need.
Results and Findings for Knowledge Needs
In this section, the survey and interview results are compiled and presented to address the
research questions in this study. According to Krathwol (2002), there are four categories in the
knowledge dimension. Factual Knowledge represents the basic elements an individual must
know to be acquainted with a particular problem. Conceptual Knowledge is the interrelationships
of Factual Knowledge within a larger functional structure. Procedural Knowledge is the
application of knowledge as a procedure, method, skill, algorithm, or technique on how to do
something (Krathwol, 2002). The last category is Metacognitive Knowledge which is the
knowledge of cognition and awareness of one’s own cognition. The results from the survey
provide a quantitative measure of how the influences are projected by the participants, followed
by the qualitative themes and patterns found from interviews that represent the participant’s
beliefs, experiences, and thoughts. A summary concludes the validation of the influence as a
need or as an asset to the organization. The interviews participants are referred to as respondents
and coded by a number (i.e., R1–R17).

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Factual Knowledge
Factual Knowledge is the type of knowledge that one must know or be familiar with to
understand how things function to solve a particular problem (Rueda, 2011). One example of
Factual Knowledge is applying terminology, which is the application of words specialized with
meaning to a subject area. It is important to understand the language in the context of a specific
area to apply the correct terminology. In this study, language is explored in the context of
recruitment planning for Latinx students to understand if the terminology is adequately applied.
Language barriers are known to cause challenges in health disparity issues in Latinx
communities (Figueroa, 2014). Additionally, language in a mission statement can share
particular elements that provides different “flavors” at different institutions and may appeal to
prospective students (Morphew et al., 2006, p. 468). Therefore, understanding the application of
language will identify gaps related to the terminology used in the recruitment of students from
the Latinx community. The factual knowledge influence discussed here was that HU
administrators need factual knowledge of language for recruitment planning.
Survey Results
In this survey, the Spanish content was examined as it relates to the recruitment of
students from Latinx communities. According to the survey, 80% of the administrators agreed
that Spanish content is important in the recruitment of Latinx students to the MSPA program
(Table 22). The staff and faculty roughly validated this finding with a response rate of 75% in
agreement (Table 23). A student survey on the importance of awareness of Spanish content in
recruitment strategies had a response rate similar to that of the administration of 77% (Table 24).
This result indicates that the administration is fully aware that Spanish content in recruitment is
important for developing a Latinx-directed recruitment plan.

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Table 22
Administration Survey Results for Factual Knowledge
Survey # Item Count Percentage
Q10

I am aware that Spanish content is
important for recruiting students from
Latinx communities.
5 80%

Table 23
Staff and Faculty Survey Results for Factual Knowledge
Survey # Item Count Percentage
Q10

I am aware that Spanish content is
important for recruiting students from
Latinx communities.
12 75%

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Table 24
Student Survey Results for Factual Knowledge
Survey # Item Count Percentage
Q7

I am aware that Spanish content is
important for recruiting students from
Latinx communities.
22 77%

Interview Results
The survey was further supported by asking the participating administrators individual
questions on how they view language used in developing recruitment plans for minorities. The
question was framed using Patton’s (2015) approach on experience to elicit behaviors,
experiences, actions and activities. In this study, the approach was intended as a probe-style
question to determine if the participant has experience in recruitment planning geared toward the
use of language incorporated in recruitment activities.
When asking the senior administrators, R1 did expressed a level of knowledge in the
importance of language in the recruitment process:
I think I’ve seen a multitude of schools try to go through the processes to be culturally
sensitive to language that they’re putting into the recruitment process, both literature and
verbal as well as having those available in a variety of languages.
Surprisingly, four out of five senior administration respondents (R2–4, R9) could not directly
respond to how language is used in the recruitment planning for the MSPA program.
In contrast to the administrators, there was more input provided by faculty and staff, with
R8 indicating that, historically, they have not had a specific focus on recruiting minorities: “To
my knowledge, the university has not provided any specific resources or language or events or

99
anything for the program that focuses specifically at minorities.” Interestingly, R10 requested to
draw the distinction between language as being spoken or utilized. The focus of R10’s response
was based on how language was utilized in the recruitment process:
When we talk about language, it's not just the words that are written; it's also the images
that we convey as well. I'm doing a note that several of our faculty members identify
where they're from [and] where they grew up because that is a force students [can]
connect on entirely different levels. What they believe to be their ability to attain the
same thing, so in terms of language that's an image that gets conveyed, that's the language
that we use, and we have to be very intentional about that.
A response from R11 indicated that “our language is similar to the standards of PA recruitment,
so we have to follow those standards. So, we don’t really deviate from that.” Another faculty
member, R12, felt language can act as a barrier in reaching out to the community and felt that
language must be translated through a compilation of experiences, indicating the inclusiveness
that is reflected in the institution’s branding: “Diversity could be where you live, what your
socioeconomic status, type of upbringing, gender, or ethnicity. It includes all of those
experiences.”
Students were also asked about the importance of language in recruitment and were
aligned with the survey. While the administration was not so familiar with the usage of language
in the recruitment process, students were able to relate to the language that they experienced as
an applicant. R14, a student, indicated, “I think the words like diversity and inclusion just make
me think, this is not a discriminating institution. It was just language that gave me the feeling
there was an accepting and nondiscriminatory environment.” Another student, R15, felt she was
able to relate to the website content as a minority: “When I checked out their website, they talked

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about diversity, especially in the healthcare field. There has to be diversity in the healthcare
system, and I think that was very important to me personally.” Table 25 shows other themes that
emerged from the interviews associated with factual knowledge across all respondents.

Table 25
Emerging Factual Knowledge Themes
Theme description Transcript evidence
Marketing and business materials may
overlap.
Marketing pieces often look at particular trends going
into the websites.
How extensive is language on the marketing and
business materials.
Marketing department works on recruitment material.
Photos show a diverse group of students.
Marketing department use key terms as best practices
to attract students from various groups.
The accrediting body expects delivering on
advertising content.
Promotional materials use language that conveys the
program.
Language can cross multiple channels. Language is needed for specific populations.
We have a new campaign that expresses who we are
as a university, and everything is meant to be very
inclusive.
Language should follow a standard. Language follows standards of PA recruitment.
The program does not deviate from standards
because it has to be uniform.

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Document Analysis Results
The MSPA program student handbook, faculty handbook, and employee staff handbook
were extensively investigated for the use of language related to strategic enrollment and
recruitment for Latinx students. Keywords that were evaluated were Latinx, Latino/a, Latin,
Hispanic, underserved, underrepresented, health disparities, and diversity.
The program overview did not provide any relevant words in the content of the MSPA
program student handbook. The program overview did include content related to the preparation
of students to provide care to diverse populations: “The MSPA program will prepare students to
participate in integrative healthcare teams and deliver healthcare with a primary care focus to a
diverse population while focusing on evidence-based instruction.” Another general statement
was found in the program learning objectives indicating the following: “demonstrate
collaboration with other professionals as an effective member of an interdisciplinary team to
improve patient outcomes including community health and disease prevention.” Under the
professionalism statement, it does include that PA students, “must demonstrate a high level of
responsibility, ethical practice, sensitivity to a diverse patient population, and adherence to legal
and regulatory requirements.”
There was no other content related to diversity, inclusion, and equity under student
support services observed relating to clauses in working with underserved or underrepresented
populations. Although there was no language associated with Latinx communities, the program
objective does imply the improvement of patient outcomes through community health. The
MSPA program handbook was not found under Spanish translation and did not elaborate on
diversity initiatives within the program.

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The HU faculty handbook was also investigated thoroughly for the same content to see
the application of language under the construct that faculty can be aware of terms focused on
diversity initiatives, particularly for Latinx students. The faculty handbook does have an
inclusivity statement indicating, “We believe inclusivity leads to more diversity in our reasoning,
better representativeness in our conclusions, more ingenuity in our problem solving, and greater
equity in our care.” The faculty handbook also includes a section on values for health equity,
“We value people equally. We strive to educate graduates who are prepared to improve
individual and community health.” The faculty program handbook also did not elaborate on
diversity initiatives within the program.
In addition to the faculty program handbook, the employee staff handbook was also
examined, and it provided no research support for the context of the language used in strategic
enrollment and recruitment initiatives to increase diversity. The data analysis of these documents
supports the lack of language application critical for students, faculty, and staff to have adequate
knowledge for strategic enrollment and recruitment efforts for Latinx students.
Summary
The results indicate the factual knowledge influence is partially validated as a need for
the HU senior administrators. Although the survey shows favorable agreement with the Spanish
content as an important application in a recruitment strategy, the interviews show a different
perspective. During the interviews, only one senior administrator indicated the sensitivity of
language to students, and the rest were not clear on the importance of language in the recruitment
plans. The responses from faculty, staff, and students clearly indicated the importance of how
language is utilized or applied in the recruitment process. Since there is not complete alignment

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in how the administrators and the rest of the organization understand this factual knowledge, this
influence is partially validated as a need.
Conceptual Knowledge
According to Rueda (2011), conceptual knowledge involves generalizations, models,
theories, principles, categories, and classifications to better understand a particular area.
Krathwohl (2002) described conceptual knowledge as the interrelationships among the basic
elements within a larger structure that enables them to function together into a pattern. Under the
conceptual construct, probe-style questions were asked to determine if the faculty were aware of
different types of plans that can be used to effectively recruit Latinx students to the MSPA
program. Garcia et al. (2019) listed elements for an HSI as a way to multidimensionally and
conceptually serve the community beyond just enrollment. One element is to seek the
transformation of all structures that affect the institution’s ability to serve students with respect to
governance, decision-making processes, and assessment and evaluations (Garcia et al., 2019).
Therefore, the patterns of different types of plans utilized for Latinx minority student recruitment
will help the participants build conceptual knowledge to develop a new recruitment plan to serve
students from the Latinx community. The conceptual knowledge influence discussed here was
that HU administrators need conceptual knowledge of the different types of plans utilized for
Latinx minority students.
Survey Results
In this survey, the ability of the participant to engage in various recruitment plans that
facilitates the increase of Latinx students was explored. According to the survey, 60% of the
administrators agreed that there are different types of recruitment plans to choose from to help
increase Latinx minority student recruitment (Table 26). The staff and faculty also shared a

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similar response rate of 67%, indicating this may be attributed to a shared schema (Table 27). A
student survey asked the question on the need to have different recruitment efforts to increase
Latinx students, with 65% in favor (Table 28). This result indicates that the administration is not
completely aware that there are different types of recruitment plans needed to develop a
recruitment plan for Latinx students.

Table 26
Administration Survey Results for Conceptual Knowledge
Survey # Survey item Count Percentage
Q11

I can choose different types of
recruitment plans to facilitate an
increase in Latinx students.
5 60%

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Table 27
Staff and Faculty Survey Results for Conceptual Knowledge
Survey # Survey item Count Percentage
Q11

I can choose different types of
recruitment plans to facilitate an
increase in Latinx students.
12 67%

Table 28
Student Survey Results for Conceptual Knowledge
Survey # Survey item Count Percentage
Q8

There should be different recruitment
efforts to facilitate the increase of
minority students.
23 65%

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Interview Results
The interview question follows Patton's (2015) approach to the interviewee’s experience
by what they have done or have aimed to do and is applied in this study to the participant’s
experience or observations with different forms of recruitment strategies as it relates to Latinx
students. The question is a probe-style question intended to determine if the participant has
knowledge of different types of recruitment plans directed at minority students. In contrast to the
survey, all senior administration respondents (R1–4, R9) could not directly relate to the different
forms of recruitment strategies in place for the MSPA program. One respondent (R2) did
express, “My expectation is to recruit not just Latinx students, but employees, including faculty,
to better represent the community that our institution is in.” Another respondent (R4) admitted
there are not a lot of recruiting activities related to Latinx students.
The faculty and staff were also aligned with the senior administrators in admitting there
were no specific recruitment strategies for Latinx students. R8 indicated that recruitment
strategies are “not specific to Latinx students” and mentioned that the admissions department is
not focused on recruitment because “they get so many applicants every year.” R8 did note that it
is not about the “number of applicants” but “the quality and also certain characteristics of
applicants.” R8 did feel there was a “bit of a disconnect” between admissions, marketing, and the
PA program. R10 mentioned they are still in the “infancy stages,” and any activities related to
recruitment should be “institution-wide” in every program. In addition, R11 described the
recruitment strategy as “generic.” R12 mentioned, “I don’t really know anything about
recruitment strategies.” R17 concluded, “as far as intentionally trying to reach a specific group, I
don't see that happening.” Table 29 shows other themes that emerged from the interviews
associated with conceptual knowledge.

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Table 29
Emerging Conceptual Knowledge Themes
Theme description Transcript evidence
The recruitment of faculty is equally
important.
Recruit faculty to better represent the community.

Recognize the importance Latinx faculty within the
PA program.

Students see who makes up the faculty.
Social media recruitment tools are ways
to project diversity.
Monthly virtual events are accessed online.

Facebook and Instagram are used to expose the
program to the public.
Compliance with discrimination laws. Legal counsel evaluates criteria in terms of developing
a program that can help augment diversity.

It is critical the program follows the PA guidelines.
GPA does not equal ability. GPA performance should not judge or stride to not
make false assumptions.

A poor GPA does not mean the student is not capable
of doing the work.

Document Analysis Results
There were efforts to obtain enrollment plans, marketing plans, brochures, and
pamphlets, but there were no documents in existence that could provide research support to
further assess the influence. The only document related to recruitment efforts was found in the
HU institutional plan for 2018 through 2023, planning the transformation of the institution. The
plan outlined support strategies directed toward a patient-centered and outcomes-focused model.
It also corroborated the application of key performance indicators (KPIs) for recruitment. One
focus observed in the plan was around student enrollment and retention as well as faculty

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recruitment and retention. There was no direct initiative under the context of diversity described
in this section of the plan.
Another section of the institutional plan discussed the identity of the institution. It
centered this action through investments into marketing and recruitment efforts to shape the
profile of entering cohorts. It also aimed to increase the institutional reputation and brand.
However, no direct strategy was found describing how these efforts would be implemented. In
addition, documentation on the website did provide evidence for a director of people and culture
who oversees the recruitment strategy. The position is intended to forecast the organizational
staff needs, but there were no formal recruitment strategies presented in the plan for analysis.
Summary
The results indicate the conceptual knowledge influence is validated as a need. The
surveys show a low response rate in the ability of the administrators to facilitate recruitment
plans to help increase Latinx minority representation in the MSPA program. The interviews
showed a shared perspective in the administrators in that no recruitment plans were necessary
due to high application rates. It is important to note that the high application rate does not
necessarily translate to a higher opportunity for Latinx students in the application pool. The
document analysis provided evidence of KPIs supporting recruitment efforts, but there was a
lack of information on how these strategies address increasing Latinx representation. Responses
from faculty, staff, and students were similar, with a response rate below 70%, indicating this
influence is validated as a need for the administration.
Procedural Knowledge
According to Rueda (2011), knowing how to do something, methodologies, processes,
and procedures to accomplish a particular activity refer to procedural knowledge. These include

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methods of inquiry and criteria for using skills, algorithms, techniques, and methods (Krathwohl,
2002). The know-how steps of the recruitment process are critical to understand to draw out
changes that would be effective for expected outcomes. Kreiter et al. (2013) provided elements
of organizational barriers that challenge recruitment efforts. Scott et al. (2015) and Capers et al.
(2018) looked at a holistic review process as a diversity-directed approach. Healey (2013)
provides improvement strategies for Hispanic students’ retention. The administrator’s level of
procedural knowledge is critical to proposing a recruitment strategy for minorities to bring an
effective change in the recruitment process. The procedural knowledge influence discussed here
was that HU administrators need procedural knowledge of the steps to recruit Latinx minority
students.
Survey Results
The survey item in this section aimed to understand the level of procedural knowledge by
evaluating the consistency the administration has in identifying the steps to recruit Latinx
students. The survey items examined were based on high-level summarized tasks from the
AAMC (2021c) strategic planning process toolkit for diversity and inclusion. Table 30 shows
how the survey items were described and aligned to the AAMC DEI Tool Kit Sequence in
increasing diversity.

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Table 30
Tool Kit Sequence and Survey Item Step Description
Tool kit sequence Survey step description
Getting started Establish roles and responsibilities for faculty
members, administrators, staff, and trustees.
Environmental scan Understand the needs of the regional economy with
respect to contributing to the development of
sustainable communities.
SWOT analysis Perform assessment of institutional performance and
effectiveness on student outcomes.
Vision, mission, and strategic goals Use the mission and values to guide academic
decision-making and resource allocation.
Objectives, tasks, and metrics Establish criteria for appointing and evaluating the
performance of the organization.
Implementation and alignment Understand knowledge and competencies that are
expected of academic leaders, faculty, staff, and
trustees.

The responses varied within the administration, but there were some consistencies in how
each survey item ranked in sequence. Table 31 shows the responses by percentage per rank as
how the survey item is perceived in the sequence of events for procedural recruitment by the
senior administrators.

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Table 31
Administration Survey Results for Procedural Knowledge
Survey # Item Rank percentage (%)
Q12

Place the following steps in order
of sequence:
1 2 3 4 5 6
1
Establish criteria for appointing
and evaluating the performance
of the organization.
0
(0)
0
(0)
40
(2)
20
(1)
20
(1)
20
(1)
2
Use the mission and values to
guide academic decision-
making and resource allocation.
40
(2)
40
(2)
20
(1)
0
(0)
0
(0)
0
(0)
3
Understand the needs of the
regional economy with respect
to contributing to the
development of sustainable
communities.
60
(3)
0
(0)
0
(0)
0
(0)
40
(2)
0
(0)
4
Establish roles and
responsibilities for faculty
members, administrators, staff,
and trustees.
0
(0)
20
(1)
20
(1)
0
(0)
40
(2)
20
(1)
5
Perform assessment of
institutional performance and
effectiveness on student
outcomes.
0
(0)
20
(1)
20
(1)
20
(1)
0
(0)
40
(2)
6
Understand knowledge and
competencies that are expected
of academic leaders, faculty,
staff, and trustees.
0
(0)
20
(1)
0
(0)
60
(3)
0
(0)
20
(1)

Note. Counts are presented in parentheses.

The average mean rank score was calculated per sequence as the sum product of
respondents to each rank divided by the total number of respondents yielding an average rank
(Table 32). Steps 4 and 5 yielded the same average rank score, and responses yielding the same
ranking were mitigated, denoting the appropriate rank to the number of observations. Step 4

112
scored for two respondents selecting it as a fifth rank and Step 5 scored for one respondent
selecting it as the sixth rank. This placed Step 4 above Step 5 in the ranking order of average
mean.

Table 32
Administration Survey Results in Ranking Order for Procedural Knowledge
Description Mean Average rank
Establish criteria for appointing and evaluating the
performance of the organization.
4.2 4
Use the mission and values to guide academic decision-
making and resource allocation.
1.8 1
Understand the needs of the regional economy with respect
to contributing to the development of sustainable
communities.
2.6 2
Establish roles and responsibilities for faculty members,
administrators, staff, and trustees.
4.2 5
a
Perform assessment of institutional performance and
effectiveness on student outcomes.
4.2 6
b
Understand knowledge and competencies that are expected
of academic leaders, faculty, staff, and trustees
4 3

a
Step 4 scored two respondents for Ranking 5 versus one respondent for Ranking 6.
b
Step 5 scored one respondent for Ranking 5 and two respondents for Ranking 6.

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The same survey questions were also provided to staff and faculty. There were
consistencies observed in the sequential order to that of the administration. Table 33 shows the
responses by rank percentage characterizing how the staff and faculty perceive the sequence of
events for procedural recruitment.

Table 33
Staff and Faculty Survey Results for Procedural Knowledge
Survey # Item Rank percentage
Q12

Place the following steps in order
of sequence:
1 2 3 4 5 6
1
Establish criteria for appointing
and evaluating the performance
of the organization.
8.33
(1)
25
(3)
8.33
(1)
25
(3)
20
(4)
0
(0)
2
Use the mission and values to
guide academic decision-making
and resource allocation.
41.67
(5)
25
(3)
8.33
(1)
16.67
(2)
8.33
(1)
0
(0)
3
Understand the needs of the
regional economy with respect
to contributing to the
development of sustainable
communities.
41.67
(5)
16.67
(2)
25
(3)
0
(0)
8.33
(1)
8.33
(1)
4
Establish roles and responsibilities
for faculty members,
administrators, staff, and
trustees.
0
(0)
0
(0)
25
(3)
33.33
(4)
33.33
(4)
8.33
(1)
5
Perform assessment of
institutional performance and
effectiveness on student
outcomes.
8.33
(1)
8.33
(1)
8.33
(1)
8.3%
(1)
16.67
(2)
50
(6)
6
Understand knowledge and
competencies that are expected
of academic leaders, faculty,
staff, and trustees.
0
(0)
25
(3)
25
(3)
16.7
(2)
0
(0)
33.3
(4)

Note. Counts are presented in parentheses.

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The average mean rank score was calculated for the staff and faculty (Table 34) as it was
done for the administration survey (Table 32). The average mean of the rank score was more
discrete in the staff and faculty survey, mainly due to the sample size. The results of the two
average ranks by the administration and the staff and faculty were also compared.

Table 34
Staff and Faculty Survey Results for Procedural Knowledge
Item # Description Mean Average rank
1
Establish criteria for appointing and evaluating the
performance of the organization.
3.50 4
2
Use the mission and values to guide academic decision-
making and resource allocation.
2.25 2
3
Understand the needs of the regional economy with
respect to contributing to the development of
sustainable communities.
2.42 3
4
Establish roles and responsibilities for faculty members,
administrators, staff, and trustees.
4.25 5
5
Perform assessment of institutional performance and
effectiveness on student outcomes.
4.67 6
6
Understand knowledge and competencies that are
expected of academic leaders, faculty, staff, and
trustees
1.75 1

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These survey results were placed in a side-by-side comparison to help validate the
influence of procedural knowledge in Table 35. A pass/fail criterion was applied by indicating a
pass if the step deviated by only one step from the tool kit. If the administration’s average rank
deviated two steps or more from the toolkit, the result was indicated as a fail. There were three
sequential steps that agreed with the tool kit sequences 2 and 5. There were two distinct tool kit
sequences that were completely misaligned by the survey items #2 and #4 by two steps or more.
Survey Item 2 describes the use of the mission and vision as a guide to make decisions, and it
ranked 1 by respondents, but Item 4as recommended in the toolkit. Additionally, Survey Item 4
is on establishing roles for all members, which is the primary step in getting started per the
toolkit, but the administration selected this as a fifth rank in the process.

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Table 35
Comparison of Administration vs Staff and Faculty Survey Results for Procedural Knowledge
Description
Administration
average rank
Staff/Faculty
average rank
Toolkit
sequence
Pass/Fail
Establish criteria for appointing and
evaluating the performance of the
organization.
4 4 5 Pass
Use the mission and values to guide
academic decision-making and
resource allocation.
1 2 4 Fail
Understand the needs of the regional
economy with respect to
contributing to the development of
sustainable communities.
2 3 2 Pass
Establish roles and responsibilities
for faculty members,
administrators, staff, and trustees.
5 5 1 Fail
Perform assessment of institutional
performance and effectiveness on
student outcomes.
6 6 3 Fail
Understand knowledge and
competencies that are expected of
academic leaders, faculty, staff,
and trustees
3 1 6 Fail

The total number of failed responses shows a detection of four out of six steps out of
sequence resulting in a 30% response rate in agreement with the toolkit. This exercise shows
there is a potential gap in the administration’s knowledge of procedures associated with
recruitment strategies needed for Latinx students.
Interview Results
The interview examined procedural knowledge based on Patton’s (2015) function on
sequencing questions aimed at understanding the cognitive and interpretive process. Patton’s

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approach was applied to see how the senior administrators think about the recruitment process
for minority students. The first question places an emphasis on values on what sequence of
events are most important by the participant, which can be based on their thoughts about the
experience in the recruitment process when asked about the steps on how Latinx students are
recruited for the MSPA program. The second question is based on Patton’s (2015) advocate-
adversary principle. This advocate-adversary approach was applied to study how the principles
established by the institution advocate for recruitment plans that promote diversity. Together,
these two sequential questions are open-ended and in series to see if the participant knows the
procedures in the recruitment process and if they are aligned with the organization’s mission and
values.
When the senior administrators were asked about steps in recruiting Latinx students, R1-
R3, and R9 could not directly respond to providing examples of how the recruitment process
works. R1 shared, “I'm not sure if I’m current on the current practices with the university.” R2
said, “I don't have a specific knowledge on and I don't I don't think that there is a specific
recruitment plan for that.” R3 stated, “Nothing comes to mind in terms of specific recruiting of
Latinx minorities into our programs.” R4 indicated that “it doesn't work any differently than it
works for every other student population. It's a highly competitive program, with thousands of
applicants. All applicants are treated the same for that application process.” R9 stated, “I haven't
heard anything that would indicate that there's anything designed, that would be different,
depending on the person's ethnic background.”
The faculty and staff were more detailed with their responses in providing actual steps to
the process. For example, R6 who described the process starting with sessions where they meet
faculty and ask questions, but not specifically targeting Latinx students. R5 said, “I don't know if

118
I can pinpoint something specific that we. do for the Latin community right now.” Participants
R7 and R8 did not have any knowledge in how Latinx students are recruited to the MSPA
program as the process is generic and there are no targeted initiatives in place. Participant R10
had a different view not specific to the process in that it is the challenge of “educating the masses
in terms of what physician assistants can do.” R10 stated that the key is ensuring that if our goal
is to increase diversity, students need to understand that it's a “viable career option.” R10 also
described the process as “multifaceted” and that there is just not “one approach that's most
effective.” The respondent closed out the interview by saying, “The key is to first identify that
it's something that you want to seriously attain, which is a diverse student body but, more
importantly, you have to know that you have institutional support.”
In contrast, although participant R11 could not describe the recruitment process as not
having “any specific recruitment for all nationalities,” she did feel a need for a plan: “We do
need recruitment, because we do need recruitment of African Americans, Latinx, Pacific
Islander. That's where we fall short. I think there's an illusion that we don't need it, but we do.”
R12 described the process as new and not completing a cycle, “for the class that is seated now
the first year, we did.” Participant R12 described a numeric system but not preferentially
targeting parties.” Participant R13 also, was not familiar with the process, but did mention
having “university learning outcomes of working in a diverse and integrative environment.”
Finally, participant R17 mentioned that most of the recruitment is based on “word of mouth”
from students that are in the PA program now or from other programs within the same institution
in regard to “intentional recruitment.” Table 36 lists emerging themes based on the interview
questions on procedural knowledge.

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Table 36
Emerging Procedural Knowledge Themes
Theme description Transcript evidence
The appointment of a new DEI officer
position.
A new position was created specifically for the MSPA
to help with diversity.
Director of DEI is in process of developing diversity
initiatives.
Recruitment is not necessary The program does not have to spend a lot of money or
do a lot of outreach.
One of the benefits of our profession is that we really
don’t have to recruit.
There is minimal resources in the PA program due to
the high volume of applications.
Examine the process to understand why
students did not choose the HU MSPA
program.
The process must be evaluated to see why students did
not matriculate.
The recruitment is going to take place after students
apply through CASPA.
The HU MSPA program needs to be
committed to supporting students.
Recruit students includes a commitment to support
them.
Students who come from underrepresented
communities need to supplement tuition.
Our competition has bigger budgets and they're able to
attract more diverse students giving them a full ride
so they're not having to pay for their education.
Establishing college pipelines. The educational pipeline is very long starting with K-
12 where the exposure happens.
Starting a pipeline, begins with high schools and
junior high schools in underrepresented
communities.

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The second question in this part of the interview section asked about the program
principles that advocate for a recruitment plan that promotes diversity to understand how aligned
the recruitment process is to the organization's values. The senior administrators did show
interest in pursuing a diverse culture within its student population but did not provide direct
relation of program principles to diversity outcomes. R1 mentioned a strong desire to have a
“multicultural population;” however, the participant said, “I'm pretty confident we have not set
any percentages in the program”. R2 also supports the integration of diversity “on an institutional
level” and that the institution has “some values that specifically deal with diversity of thought
and integration,” but not specific to a diversity plan.” R3 and R9 could not respond, while R4
mentioned, “I don't know every program's objectives off the top of my head.”
The faculty and staff respondents provided a different perspective from that of the
administration. R5 appeared to have direct knowledge of the principles of the program:
It's part of our program learning outcomes. It's part of our mission as part of our goal to
enroll students who possess a variety of clinical experiences, ages, gender and ethnicities.
Our goal is to enroll students from various ethnicities, with the intention, hopefully, that
they can go back and provide care, not only to their own communities, but also to diverse
communities.
R6 mentioned the challenge of unconscious bias and said, “You have to be holistic. It's important
for us as a faculty to understand what we do consciously or unconsciously.”
R7 stated in support to the diversity initiatives in the recruitment process to the
community: “We want our class to mirror the population that our students are going back to take
care of. By having a diverse class we're going to be better healthcare providers, so that's
definitely one of our goals.” R8 recollected that, recently, the department

121
identified that diversity is a program goal. So, as it relates to Latinx applicants, we do
have a plan to reach out to colleges and universities that are designated as Hispanic-
serving institutions, to recruit more individuals from this ethnicity, but that is not
something that has been implemented yet.
R10 described the recruitment efforts as “still in its infancy stages,” and the program is
“evolving.” R10 did mention that embedded within the “accreditation standards is most certainly
a focus on diversity.” R11 did mention that “our recruitment plan, we stand by diversity. We
want to make sure that we are putting out PAs that look like the community.” R11 also stated,
“We want to make sure that our numbers reflect the population that we live in and in our area.
The Latino population is large right now.” R12 was not able to respond to program principles as
they relate to diversity efforts, and R13 stated that the “university ones” in respect to principles
“are really broad, and it's just a matter of how you line up with the programmatic ones.” R17
positively spoke about the faculty and staff as very diverse, so the participant thinks that in itself
helps promote students to apply.” Respondent R17 also indicated that with respect to “principles
and goals, they do want to have a diverse class as one of their program goals and they are
actively looking at ways that we can do that; however, they're limited with their budget.”
Document Analysis Results
The faculty and employee handbook were thoroughly researched and investigated with
no evidence of recruitment plans or strategies in place to support the increase of Latinx students.
Priorities that can help define types of recruitment were found in action plans that may help
initiate these steps, such as “build and implement partnerships,” “define key performance
benchmarks, align with national standards, and set HU benchmark rates,” and “refine enrolment
management strategies that deep-end engagement among departments to maximize enrollment.”

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The plans set in the context of increasing diversity are not clearly stated, and it is not clear if the
action plans to achieve institutional goals are designed to help assist in Latinx recruitment
strategies.
Summary
The results indicate the Procedural Knowledge influence is validated as a need. The
survey shows inconsistencies in responses as it relates to a standard of recruitment per AAMC
guidelines to increase diversity. There was also an inconsistency with how faculty and staff also
responded to their rankings in comparison to the administration, indicating a lack of alignment in
procedural understanding in recruiting minority students. During the interviews, the
administration also did not have knowledge regarding procedures related to the recruitment of
Latinx students. The responses by the faculty and staff make it clear that there is a lack of
process as it relates to the recruitment of minority students and agree to initiate efforts to
improve the process. The interview did show the administration, faculty, and staff are in support
of establishing a process related to the recruitment of Latinx minorities. Finally, the
documentation analysis does not clarify if the goals set toward increasing diversity are poised to
help also improve Latinx minority representation by metrics. The findings in this data collection
validate the Procedural Knowledge as a need for the administration to know the recruitment
process of Latinx students to initiate improvement metrics.
Metacognitive Knowledge
The awareness of one’s own cognition is known as Metacognitive Knowledge and deals
with strategic behavior in solving problems, according to Rueda (2011). According to Proust
(2013), “Metacognition is the set of capacities through which an operating cognitive subsystem
is evaluated or represented by another subsystem in a context-sensitive way” (p. 4). In this

123
section, we are trying to understand if the participants have the ability to assess their own needs
regarding the problem of shaping a recruitment plan and if they can determine if this is a difficult
problem for them to solve or if it is beyond their capabilities. Understanding the gap associated
with metacognitive knowledge as it pertains to the needs for self-awareness in their own
effectiveness is critical to understanding if intervention is needed to exercise metacognition
through collaborative learning efforts. Thus, understanding the metacognitive skills, such as
problem recognition, problem definition, problem representation, strategy formulation, resource
allocation, monitoring of problem solving, and evaluation of problem solving, is critical to the
need for change (Elliot et al., 2017; Sternberg, 1998). The metacognitive knowledge influence
discussed here was that HU Administrators Need Self-Awareness in Their Effectiveness to
Collaborate With Others in Shaping a Recruitment Plan That Promotes Student Diversity
Survey Results
In this survey question, the participants were asked on the time they take to reflect on
actions with others through collaborative work as it relates to recruitment planning. According to
the survey, 60% of the administrators responded favorably, agreeing that they often reflect on
their actions with collaboration on recruitment planning (Table 37). Faculty and staff also shared
a similar response rate of 64% in agreement (Table 38). The students were also asked if they had
collaborated with the department on recruitment efforts and responded with a 14% in agreement
(Table 39). This result indicates that the administration is not taking too much time reflecting on
potential ways to collaborate to help solve recruitment planning-related problems, and
improvements can be found with the integration of students in recruitment efforts.

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Table 37
Administration Survey Results for Metacognitive Knowledge
Survey item Count Percentage
I take time to reflect on my actions with
others after collaboratively working on
recruitment plans
5 60%

Table 38
Staff and Faculty Survey Results for Metacognitive Knowledge
Survey item Count Percentage
I take time to reflect on my actions with
others after collaboratively working on
recruitment plans
11
a
64%

a
One respondent did not complete the survey.

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Table 39
Student Survey Results for Metacognitive Knowledge
Survey item Count Percentage
I have been able to collaborate with the
department to help with recruitment
efforts.
22 14%

Interview Results
The question related to the interview asks the participant if they can share experiences in
collaborating with others in developing recruitment strategies for minorities. The question is
based on Patton’s (2015) approach to experience and is an open-ended question. The question is
intended to understand if the participant is aware of their effectiveness in collaborating with
others in shaping a new recruitment plan to increase student diversity.
The senior administrators did not provide concrete examples of collaborating with others
in shaping a new recruitment strategy to increase student diversity but did respond favorably to
the idea of engaging in these efforts. This is exemplified by R1 responding, “Everyone’s really
open to that and willing to discuss it. Everyone’s got their recruitment package. Everyone’s got
their marketing packages.” The other issue expressed by R1 is how to overcome cultural
differences and biases and turn them into “action” in the recruitment and admissions process.
Participant R2 brought up the concept of 360 degrees assessment, where they take a baseline
study and how the organization can better serve their students for success, “I think looking at the
diversity issue, we can use the same process.” R3 was not able to address the question directly
but did mention “there may be policy documents and maybe postings on our website we will
want to have reviewed to make sure that they are compliant with discrimination law.” Senior

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administrator R4 stated, “I don't really do the collaboration, the folks that do marketing
recruitment report to me. We have a lot of conversations about the strategies that they develop,
but I'm not doing the development of the strategies.” R4 did provide some metacognitive
knowledge by engaging in conversation,
So, I will engage in that conversation with them. Why did I want to do that? Because I
wanted to better understand who our students were, and I wanted to better understand if
there were opportunities for us to target or have success in recruiting different student
populations, and we currently do, but I don't do the work.
Participant R9 mentioned hearing about “updates on plans to have certain scholarships that are
designated for minority students” and “being designated as the next Hispanic-serving
institution,” but not much experience collaborating with others directly with recruitment
planning.
The faculty and staff had similar sentiments where there is a desire to collaborate, but no
direct descriptions of experience related to reflecting on recruitment planning in collaborative
ways. Participant R5 mentioned collaborative efforts through “faculty retreats” that can be used
to discuss admissions and recruiting efforts. He also disclosed, “We have ongoing faculty
meetings and weekly faculty meetings where we talk about recruitment efforts that will focus on
various diverse groups.” He also mentioned having an “advisory board annually that could
address recruiting efforts.” Participant R6 noted that having a diverse faculty, “I think, as we go
on this journey, our job is to call in our White counterparts on some of their perceptions for their
thoughts in a collegial way.” Participant R6 also mentioned the use of a “GRIT score” to see
their ability to complete the program and allows “White colleagues” to really see the applicant in
respect to resilience.

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Participant R7 shared this last year was the initial stage in which the program really had
internal discussions about admissions criteria, “I would say in this last year our program has had
a ton of internal conversations looking at what type of criteria we should be selecting,” but no
reflection on the outcome of this activity. R8 has engaged in collaboration with the marketing
department around “initiatives or possible initiatives that we could have to increase enrollment or
increase applicants and the PA program specifically as it relates to diversity.” However, one of
the challenges noted by R8 is that “I was kind of told that the PA was not a priority because they
are focusing on other programs where maybe they don't reach their enrollment goals, and PA
always reaches their enrollment goal.” R10 shared her experience as a retention coordinator on
the challenges to collaborate with the administration, “If they don't have recruitment efforts in
place or they don't see the value of having students of color interested in the institution in the
end, wanting to enroll, then the buck stops there right.” R10 expressed the importance of
institutional support by providing information. R11 stated that in order to “mirror the population,
we're looking at holistic recruitment tools so that we can find out how do we get the best and
brightest in every nationality field.” Participant R12 confirmed R5's response that “we have our
meetings every week, but “in some meetings, we don't talk about recruitment strategy;” however,
establishing the director position of DEI was the impetus for “how are we going to get more
minorities exposed to the profession.”
R12 confirmed that the faculty is “fairly diverse” and they “all get along. To me, it's not
an issue and, from what I gather from looking at everybody else you know, let's just get the job
done.” and alludes that faculty diversity is not a barrier to achieve collaborative efforts. R13 one
of the biggest challenges in gathering data collaboratively was asking to integrate more questions
from the applicant and felt the admissions “don't want to ask questions to keep people from

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applying”. R13 stated, “I think it needs to be a conversation at a very high level, perhaps even
the board. What are we doing here at the academic institution?” R17 confirmed that the “PA is
actively looking at ways to increase the recruitment to increase diversity,” and mentioned the
new DEI officer position that helps collaboratively with these efforts. She mentioned that “our
requirements are the same as everybody else's, so it is just a challenging program to get into
that's why the acceptance rate is so low.” R17 felt the need to “identify what barriers are keeping
different groups of people out, like a GPA, science GPA, clinical hours. Identifying barriers is
first, and then the second thing would be a holistic admissions review.”
The metacognition assessment in the student’s perception of the administrator’s
opportunities for student engagement was examined by their experience to collaborate with the
administration with recruitment planning. In this context, R14 stated he will be a part of a
“mentoring program” and confirms “that's probably the first and only encounter I've ever had
with any administrator.” R15 focused on sharing about her experience during the PA Expo at
Channel Islands. She worked closely with staff and learned more about “the admission process.”
She mentioned, the administrator “was there when I spoke about my experiences, and she was
very supportive.” She felt she had a very positive experience working with the administration
and to explore more opportunities: “I’ve never really had anything like meeting with them to
discuss how we can better our recruitment process. If I was given that opportunity, I would
definitely participate and share with them.” Student participant R16 mentioned that she was
appointed a new position as part of the diversity equity and inclusion initiative: “I am the REP
for my class, but we haven't had the first meeting yet because it's a new position.” It appears as if
the organization is setting a collaborative experience with students to help understand

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recruitment strategies for DEI in the MSPA program. Other emerging metacognitive knowledge
themes were documented in Table 40.

Table 40
Emerging Metacognitive Knowledge Themes
Theme description Transcript evidence
The office of institutional effectiveness
can help in the analysis of
achievement gaps.
Student achievement gaps can be analyzed by
desegregating the data around students.

Analysis can be achieved through allocation of
resources and working with people producing the
data.
Applying GRIT scores to evaluate
resiliency.
There is a need to evaluate student resiliency.

We pride ourselves in being a place where people who
have struggled can come here and work hard and
diligently to succeed.
Reluctance to change policy or
procedures.
The work is going to be in the political will to do it.

Framing questions to gather data depends on the
support to change procedures or policies.

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Document Analysis Results
There were no formal documents available to further provide research support for the
metacognitive dimension and gaps associated with the need for self-awareness to collaborate
with others in shaping recruitment plans. However, the interviews were analyzed, and a few
respondents referred to experiencing 360-degree assessments where they bring people from
across the campus. The initial need was to establish a baseline and how they can better serve the
students with support for success as it aligns with the institutional plans.
The interviews exposed the 360 feedbacks as a way to increase reflective mechanisms to
benchmark individual performance. A proposal by one of the interviewees mentioned the use of
the 360 feedbacks as a means to address diversity issues that can identify parameters, such as
ethnicity, gender, or other factors that can be considered under an evaluation. The institutional
plan supported the activities related to benchmarking, and from the interview, it appears the 360
approaches has presented collaborative efforts across the campus, and there is an interest in using
it for increasing diversity in the MSPA program. Under a DEI training seminar, factors to
consider that fall under the metacognitive construct that was presented to faculty were the
following:
1. research shows the engagement is the key factor that promotes higher performance,
2. Engagement predicts performance (individual and organizational),
3. Companies are not clear as to what they are measuring in terms of engagement,
(engagement is often confused with organizational satisfaction, commitment, and
pride).
Ultimately, the direction that HU has taken in its efforts to effectively apply intervention
plans to assist in collaborative efforts within the department seems to be positive. In summary,

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most of the materials related to the metacognitive dimension were not observed in practical use
for the development of a recruitment plan, and evidence from the interviews showed that the
process is “evolving” and in its “early stages.”
A department seminar provided by the Center of Excellence for online course learning
went over Bloom’s Taxonomy around the four knowledge dimensions, including metacognitive
knowledge and its analysis. A study was presented on interpersonal interactions impacting GPA
and provided an opportunity for self-reflection in that GPA impacting students may be
influenced by the level of engagement the instructor had with that particular cohort. Although the
seminars and training were well versed in understanding the knowledge dimension in learning,
there was no application of this construct in recruitment efforts for minority students.
Summary
The results indicate the Metacognitive Knowledge influence is validated as a need. The
administrator’s survey response shows a low response in reflecting on how to collaborate with
others to improve the recruitment of minorities. The interviews also show a lack of self-
awareness in their need to collaborate with others, such as administrators indicating they do not
collaborate or are willing to discuss collaborative efforts without concrete metrics toward
improving diversity for Latinx minorities. The interviews from the faculty and staff address the
need for alignment as they felt the MSPA program was not a priority for recruitment, which the
interview data shows may be attributed to a high application rate. The student interviews did
indicate a level of collaboration with the MSPA department, but not necessarily with
administrators. The documentation analysis points to 360-degree feedback but does not
incorporate time to reflect on how improvements can be made collaboratively. The results
indicate that evidence for the metacognitive dimension was not observed in practice toward

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improving or creating a recruitment plan for Latinx students, thereby validating the
Metacognitive Knowledge as a need for the administration.
Results and Findings for Motivation Needs
This section presents the survey and interview results to address the research questions
related to the motivation of the senior administrators. According to Clark and Estes (2008),
motivation is the product of an interaction between people and their work environment. There
are multiple constructs under the motivational dimension, and in this study, self-efficacy, utility
value, attainment value, goals, and goal orientation were assessed. The results from the survey
provide a quantitative measure to define the gaps found in the administration’s motivational
influences in the organization.
Self-Efficacy
According to Bandura (1986), self-efficacy is defined as, “people’s judgements on their
capabilities to organize and execute the course of action required to attain designated levels of
performances” (p. 391). There are multiple ways self-efficacy can be measured per Elliot et al.,
(2017),
• The assessment of cognitive judgments of personal capability to perform specific tasks or
activities.
• The self-evaluative standard based on goal-mastery standards and can be drawn in
comparison to other competencies.
• Measures that involve predicting future generative performance related to confidence.
• A self-measure to task performance outcomes designed to be adaptive to specific task
features and environmental context.
• One’s reaction to experience. . (p. 317-318)

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According to Mayer (2011), individuals whose motivation is based on high self-efficacy believe
that they can do well on a particular learning task. High self-efficacy beliefs can help exert more
effort on the individual to perform better in a particular task (Mayer, 2011). Therefore, the
administration’s self-efficacy beliefs are explored to understand the motivational gaps that are
needed for the development of recruitment plans to increase student diversity in the MSPA
program. The self-efficacy influence discussed here was that HU administrators need to increase
self-efficacy measures to develop recruitment plans for Latinx minorities
Survey Results
The evaluation of the participants' self-efficacy beliefs was captured for the
administration, staff and faculty, and the students. The question looked into the confidence the
participants have toward their ability to develop a recruitment plan for Latinx students. The
results gathered from the administration saw only 20% of the respondents agreed that there was a
level of confidence in their ability to develop a recruitment plan (Table 41). The confidence of
the staff and faculty was much higher, with 64% in agreement but not high enough to indicate a
different level of self-efficacy (Table 42). The students were also asked about their confidence in
their administration's ability to develop a recruitment plan, and their response was 60% in
agreement (Table 43). These results indicate that the administration may be experiencing barriers
to motivation that are affecting their confidence in building a recruitment plan for Latinx
students. The students appear to have more confidence in their administration than how the
administration feels about their own self-confidence in succeeding in these efforts.

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Table 41
Administration Survey Results for Motivation, Self-Efficacy
Survey # Item Count Percentage
Q14

I feel confident about my ability to
develop a recruitment plan for Latinx
students.
5 20%

Note. One respondent did not complete the survey.

Table 42
Staff and Faculty Survey Results for Motivation, Self-Efficacy
Survey # Survey item Count Percentage
Q14

I feel confident about my ability to
develop a recruitment plan for Latinx
students.
11 64%

Note. One respondent did not complete the survey.

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Table 43
Student Survey Results for Motivation, Self-Efficacy
Survey # Survey item Count Percentage
Q10

I feel confident about the
administration’s ability to develop a
recruitment plan for Latinx students.
22 60%

Interview Results
The question in this section of the interview asks the participant if they can describe how
they feel about their ability to increase the intake of Latinx students. The question is based on
Patton’s (2015) approach to experience and was an open-ended question. The approach is
intended to understand if the participant has self-efficacy beliefs in their ability to develop
recruitment plans for minority students based on their experience.
Overall, the senior administrators had mixed responses regarding their ability to develop
a recruitment plan. Participant R1 did not respond directly to their ability to increase the intake
of Latinx students but did mention, “We were looking at opportunities for the populations,
always being Latinx, among others in that we were able to speak to those communities.”
Participant R2 was very clear and concrete in stating, “I think my ability has a lot of weight. And
far as putting out specific initiatives and expectations, I can put in a commission task force, then
start looking at things specifically.” R3 was not confident in developing a recruitment plan: “I'm
not involved with recruiting. I probably don't have a lot of ability. The impact I would have
would be to give people the information they need, so they can develop and still be legally
compliant.” Participant R4 made it clear that “faculty selects the students, not the

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administration.” She also mentioned that she can ensure that “there are resources for initiatives
that are important to see HU mission and values are going back to inclusivity and health equity.”
Finally, R9 felt more likely to recruit more Latinx students once the university applied as an HSI.
The sentiment around the faculty and staff was more positive in regard to confidence.
Participant R5 indicated that he is personally “a mentor right now to high school students and the
majority of them are of the Latinx community, and these are all students who want to go into
healthcare professions.” He mentioned that working as “a mentor to these students myself being
a minority, they see another minority in a leadership role has been a provider and that they can
do it.” Based on this answer, R5 felt he could be a role model for many in the community. R6
attributed her confidence to several different levels: “Number 1 my beliefs. As a Christian, I
know that neighbor as thyself that is the greatest commandment. I think one of the gifts that God
has given me is an ability to connect.” R6 also mentioned, “because I understand the things that
are important to them, I don't think I have any problem recruiting, so I'm very confident in being
able to do it.” Respondent R7 was not able to contribute to the level of her confidence since she
had been in her role for only 3 months at the start of the interview.
Respondent R8 said, “I don't feel super well prepared. I'm mostly because I feel like this
is something that should be coming from the top down, and I don't feel like that's the case.” She
continued, “I feel a little bit ill-equipped to do that because I feel like that takes both time and
monetary resources that the program itself does not have now.” This statement is the first
connection in how resources around the organization can have an impact in self-efficacy beliefs
in becoming a barrier to motivation. Participant R10 felt “extremely confident about being able
to do so, primarily because I feel a level of understanding and empathy and desire to increase the
number of physician assistants who look like their patient population.” Participant R10 felt, “we

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need to have students in our program who represent our greater community, the population of
California.” She stated, “I believe that with my leadership style and my experience, I'm
extremely committed to ensuring that students represent the communities in which we serve.”
Similarly, R11 felt “great as a faculty member being here” but did not directly address the ability
to increase the intake of Latinx students. Participant R12 felt more confident about his ability to
develop a plan, attributing it to “growing up going down to Mexico, I speak the language and I
know a lot of the idioms. I can communicate with a lot of Hispanic Americans.”
Respondent R13 admitted to not having “any direct role” but feeling that he may have
“an indirect role by demonstrating that they're just as competent, as everybody else.” He felt he
could do this by “disaggregating the data and then inform the leadership of any disparities.” The
data he explained goes directly to the provost council and the program, and he may get “involved
in a follow-up.” He felt that the “more information they have, the better decisions they can
make,” and most importantly, proposed a reward system structure that can help admissions,
“credit for each student they bring in. They probably don't get dinged for the ones that don't
make it,” alluding to students that may have started but did not graduate the MSPA program. He
felt that passing the first term would be a good indicator of being “more careful about who they
let in.” Finally, R17 did not feel confident because “my decision or even suggestions are taken
very limited.” She felt she could give suggestions, but “I don't know if my experience or what
I'm sharing is valued.”
The student interviewees shared their perceptions of the HU administration’s ability to
develop a recruitment plan. R14 felt, “I didn't get the impression that they cater a little bit more
to a specific community. They could have like a section on their website that talks about that, or
maybe they can bring up specific issues.” He felt that maybe the administration could highlight

138
the reasons why the Latino community needs a little bit more focus and energy: I didn't really see
anything like that, so it just seems like they're trying to equally get all people.” Respondent R15
shared that she is a “DACA student.” She felt it “was really important to me that they wouldn't
discriminate against my citizenship status, and HU was one of the schools that accepts DACA
students regardless of the citizenship status.” She felt that it was a “huge factor for me because
other schools, I couldn't even apply because they needed you to be either a green card holder or a
U.S. citizen.” She shared that HU is a “school that is very receptive to any kind of student and
regardless of status, I think that it will give many opportunities, especially to Latinx students that
may be in the same situation.”
Finally, R16 felt she had not been a part of California before and was new to the
community to comment on the administration’s ability, but she felt that, “I think they probably
do kind of try. We do have the community center that I'm pretty sure is free to the public. I do
imagine HU to have a greater number of people in the community who are Latinx who can come
to this and receive services. Table 44 shows emerging motivation themes related to self-efficacy
beliefs.

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Table 44
Emerging Self-Efficacy Themes
Theme description Transcript evidence
There is a distrust in the community
around clinical programs.
There was a distrust of Western medicine in the
Hispanic culture.

Other clinical programs are far more accepted in the
Latin Community than just the Western medicine.
Aggregating the data is needed to make
an effective change.
We look at our total student population to identify a
particular group on an institutional level that is at a
disadvantage.
Use resources related to using ethnicity
and race in terms of making decisions.
Anything that is in writing, whether it be a policy
document or posting on the website, we certainly
want to have that reviewed by legal counsel, to
make sure that it's compliant with discrimination
laws.

College board put together a document that helps to
guide educational institutions with respect to
awarding scholarship in a way that is compliant
with discrimination laws

We are in the process of applying to become a
Hispanic-serving institution.
A focus group is an effective way to
improve recruitment planning
strategies.
Focus groups work really well to gather feedback.

Focus groups led to the discovery that a lot of the
challenges are in academic preparation for the
student.

Document Analysis Results
The document analysis included an examination of the Center for Faculty Development
and Excellence (CFDE) website, which is shared with all faculty for resources and services to
provide an optimum learning experience. A series of faculty development training and seminars
were investigated and researched for evidence supporting self-efficacy measures. There was a

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good discussion on self-awareness and self-efficacy in the seminar related to student services and
student success. Although self-efficacy was discussed in the context of students' success through
collaborative efforts with student services and faculty, it did look at the student as the whole self
and in the context of having student engagement and community building. The seminar did not
go into recruitment strategies or reflection on improvements to the recruitment process.
Summary
The results indicate the motivational influence on self-efficacy is validated as a need. The
administrator’s response was very low at 20% in their confidence to develop a recruitment plan.
The staff and administrator had a better perception in their beliefs that a recruitment plan could
be developed geared toward Latinx students. The interview questions also supported this finding
in the administration feeling they are not confident in their ability to develop a recruitment plan.
The faculty and staff felt more confident in developing a plan indicating a misalignment in
sharing a belief that a recruitment plan can be developed to help in Latinx recruitment planning.
The documentation analysis supports evidence that self-efficacy was described in a seminar and
training modules, but these were geared toward student success rather than DEI. There was no
further evidence of confidence in administrators’ ability to help increase Latinx minority
representation through the development of a plan, indicating that the self-efficacy motivational
influence is validated as a need.
Utility Value
Utility value is a part of the expectancy-value motivational theory described by Wigfield
et al., (2000) and Eccles et al. (2002) as task value that refers to how useful one believes a task to
be to achieve a goal. The evaluation of expectancy value has been utilized to determine
characteristics in guiding a framework, as noted by Wang et al. (2013) in identifying barriers and

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factors to help motivate women to pursue STEM-related fields. Clark and Estes (2008) suggested
that values are ways that people express their views about what they expect will make them
effective in their performance goals. Thus, it is worth exploring the benefits that participants see
in finishing a task related to the development of a recruitment plan as a means to an end. Thus,
evaluating the perspectives of the HU administration on the increase of Latinx students, so it is
not avoided but rather supported, follows the practical evaluation of extrinsic motivation as
described, per Ryan et al. (2009) and Elliot et al. (2017). Utility value also connects to personal
goals and connects to the attainment value the individual holds, which will be presented in the
next influence. Here, the evaluation of the survey and interview transcripts regarding utility
value is presented to see if there is a motivational gap in the administration’s usefulness of a
recruitment plan to increase student diversity. The utility value influence discussed here was that
HU administrators need to see the usefulness of a recruitment plan to increase student diversity.
Survey Results
The evaluation of the utility value held by the participants in finding a need to see the
usefulness of a recruitment plan to increase study diversity is presented. The results gathered
from the administration showed a very high response in finding tasks related to the development
of a recruitment plan for increasing student diversity as useful, showing 80% in agreement
(Table 45). The staff and faculty scored higher with a 90% response rate in agreement on a
Latinx recruitment plan providing a way to help increase student diversity (Table 46). The
students were also asked if they agreed that a Latinx-focused recruitment plan will help provide
options to increase student diversity, but their response rate in agreement was much lower, 64%
(Table 47). These results indicate that the administration finds tasks related to building a
recruitment plan for Latinx students as useful in helping increase student diversity. In contrast,

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the students do not feel strongly that this would be an option to help increase student diversity,
which does not fully validate the influence as an asset.

Table 45
Administration Survey Results for Motivation - Utility
Survey # Item Count Percentage
Q15

A Latinx focused recruitment plan will
provide me with more options to help
increase student diversity.
5 80%

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Table 46
Staff and Faculty Survey Results for Motivation, Utility
Survey # Survey item Count Percentage
Q15

A Latinx focused recruitment plan will
provide me with more options to help
increase student diversity.
11
a
90%
a
One respondent did not complete the survey.

Table 47
Student Survey Results for Motivation, Utility
Survey # Item Count Percentage
Q11

A Latinx focused recruitment plan will
help increase student diversity
22 64%

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Interview Results
The question in this section of the interview asked the participant if they find a Latinx
recruitment plan useful in helping increase student diversity. The question is based on Strauss et
al. (1964) using the posing the ideal construct, where the participant is asked to describe an ideal
situation or condition. In this case, the question is framed in understanding an ideal recruitment
plan to increase student diversity. The question is open-ended, and it is intended to determine if
the individual values the need for a recruitment plan geared toward the intake of Latinx
minorities.
The senior administrators showed favorable responses regarding the need to utilize a
Latinx recruitment plan to increase student diversity. R1 shared, “I think it's critical to our
mission. I think the community of ours is looking for outcomes with individuals who are
sensitive to the cultural identity of the area and the population.” R2 confirmed that “we need to
do it and not just on the Latinx, but also on all potential students of color.” R3 was “very much in
favor of it. Given that we are located in southern California, our population here in California,
the population of our program would coincide with that.” R4 clarified that “specific to
underrepresented populations, there's been a lot of conversation about that because we re-
evaluated our values and emphasized inclusivity and health equity.” Finally, senior administrator
R9 indicated that research shows “that people are more comfortable when they are seeing a
healthcare professional that maybe looks and sounds more like them, and even understands their
culture more.”
Similarly, the faculty and staff shared the same sentiment, R5 felt, “it's critical to develop
a targeted action plan for Latinx community so that we can demonstrate a depth and breadth of
diversity within our program among our students that make up a cohort for the PA class.” He

145
added that targeting Latinx students would allow them “to go back into their own communities to
deliver care in medically underserved communities.” R6 went beyond finding the usefulness of a
recruitment plan, but the integration of “retention” of students and creating a “support” system to
stay in the program. R7 confidently stated, “we're in full support of trying to diversify our MSPA
class for sure, and that is definitely something we're working on because we've been struggling
with having a diverse class every year.” She was very excited to indicate that “we've just updated
our program goal for diversity so we're really taking an introspective look of how we can
diversify our class and improve that.” R8 was also in agreement, but wanted to clarify, “I would
not recommend that it just focuses on Latinx students, we have needs to increase diversity among
African American, Pacific islander, Native American as well, but Hispanic is one component of
our diversity initiative.” R10 stated, “I fully support those efforts.” She also confirmed research
presented here on patient-provider relationship: “literature supports those patients tend to feel
more comfortable with providers that look like them that potentially speak their language they
potentially understand their culture.” She went on to reason,
I would support efforts to increase the number of Latinx students within our PA program
because it would be a representation of our communities as a whole and you are
furthering the ability of your providers to be more effective for patients to receive better
care if their providers again look like them, understand their experiences, not just from a
contextual framework, but from actual experiences.
R12 also agreed, “every school needs to find something to focus on. It's quite clearly an
underrepresented population, especially in inner cities or in communities where there's not a lot
of access to healthcare and especially with migrant workers.” He agreed that “practitioners that
speak the language fluently come from that culture and the people in that culture are essential.”

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R13 mentions a recruitment plan is “probably be a good idea.” However, he suggested, “Perhaps
collecting more data on the way in, which allows us to do better research.” He provided insight
to some challenges as it relates to a different program on campus:
One of these issues we have is a disparity in Latinx students that aren't performing as
well as some other students. Latinx and African American or Black students aren't
performing as well, but we can't tell whether it's just because they don't have the
educational background that the Asian and White students have or if there's something
else at play. Because we don't ask enough questions on the way in or even if we ask
them. we don't keep track of the answers in a systematic way.
R17 felt that “outreach is difficult, and you can't always rely on social media because if it's only
in English, that's a barrier.” She believes they need to do more “outreach to community colleges
and even the high schools to let them know so we actually have had some PA pro PA students
apply that came here as a high school student.” In contrast, R11 felt from data analytics that “our
Latinx is one of the only numbers that has been met. Since the time that we've been here African
Americans are falling short so we're trying to do that better.”
Finally, the students felt positive about the use of a recruitment plan to drive student
diversity. R14 said,
I think for where the school is, it makes sense we're going to Southern California. I
assume there's probably a lot in Washington state. there was also a lot of Latinx people,
but I think there's probably much more in Washington, so it just makes sense, logically, I
think, why there would be programs trying to help a specific community because you're
going to help the people that are around there.

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R15 confirmed that HU has, “always been inclusive, I feel, the fact that my program is
already diverse enough, I feel we represent different cultures fairly well. I'm actually proud to be
in this program.” She mentioned participating in “preview days” and how it helps show the types
of faces she is going to see: “I actually spoke with one of my classmates. Last year, when I used
to live with her, she told me that really attracted me to this program because I saw different types
of people.” R16 acknowledged the creation of a new DEI position at the university. She
mentioned, “I do think this is actually one of the most diverse programs I've ever been in. The
program already does a pretty good job of diversity.” The emerging themes associated with the
motivation dimension on utility values was noted in Table 48.

Table 48
Emerging Motivation Themes on Utility Values
Theme description Transcript evidence
Recruitment is a longitudinal process. Recruitment includes retaining the student and
graduating them.
How can we solicit students and retain them
throughout the process.
Reputation for good retention helps with recruitment.
Secondary languages are important in
patient care.
Surgical rooms require a phone with an interpreter to
be in place.
Anytime patient care was needed, the phone call was
there and documented.
Students need to be aware of the PA
school at HU.
It is important is that prospective students should be
aware of what the role of a PA.
The Latino community may not know about the HU
MSPA.

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Document Analysis Results
A seminar was provided for all faculty to improve their instruction for creating an
optimal learning environment for students. This seminar was focused on DEI. This is one of the
very first training promoted by HU to their faculty in understanding initiatives to increase
diversity on campus. The presentation was promoted by the DEI initiatives for the MSPA
program to institute justice, equity, diversity, and inclusion. The initiative was a response to
fostering excellence in PA programs to assure the general public that the program complies with
accredited programs to meet educational standards and establish educational effectiveness in
diversity. The seminar presented the ARC-PA standard for compliance under A1.11,
The sponsoring institution must demonstrate its commitment to student, faculty, and staff
diversity and inclusion by
● supporting the program in defining its goal(s) for diversity and inclusion,
● Supporting the program in implementing recruitment strategies,
● supporting the program in implementing retention strategies, and
● making available resources that promote diversity and inclusion.
The initial steps in organizing an event to help faculty and staff to understand the
importance of diversity and inclusion efforts is a positive sign that HU MSPA program is making
strides in preparing for implementing diversity initiatives. The documentation analysis here
supports the administration views diversity efforts as valuable.
Summary
The results indicate the motivational influence on Utility Value is validated as an asset.
There was a favorable response by the administration in support of a Latinx student recruitment
plan as being useful to increase student diversity. There was a stronger response by the staff and

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faculty. The student survey response did not share the same sentiment. However, the interviews
indicated the student’s perception of the HU MSPA program was very well diverse, and they felt
represented fairly well. A documentation analysis around the utility value of a recruitment plan
pointed in a good direction in HU’s initiative to hold training sessions for their faculty and staff
on DEI. The effort was led by the MSPA leadership staff with good attendance, and it shows a
strong direction toward seeing recruitment plans as useful in increasing diversity. The
motivational influence around utility value was validated as an asset.
Attainment Value
Attainment value is a type of task value related to how important the task is to the
individual (Wigfield et al., 2000; Eccles et al., 2002). Particular activities can also connect to
personal goals and sense of self as tasks that are important when individuals view them as central
to their own sense of themselves as a motivational factor (Elliot et al., 2017). Therefore, an
evaluation of the administration’s attainment value in tasks associated with promoting innovative
behavior for the development of a recruitment plan to increase student diversity will help
understand the gaps associated with motivational factors. The attainment value influence
discussed here was that HU administrators need to increase attainment value to promote
innovative behavior for the development of a recruitment plan.
Survey Results
The participants' evaluation of the attainment value in promoting innovative behavior for
the development of a recruitment plan was assessed. The results gathered from the administration
showed an 80% response in agreement that it is important for them to apply new ideas in
recruitment planning (Table 49). It was much higher for staff and faculty resulting in 90% in
agreement (Table 50). The question did not extend to the students as the question was framed to

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fit under the expectancy-value theory construct. However, the students were asked task-value
related questions in the interview. These results indicate that the administration finds it important
to apply new ideas in recruitment planning, which supports the motivational influence to
promote innovative behavior for the development of a recruitment plan.

Table 49
Administration Survey Results for Motivation, Attainment
Survey # Item Count Percentage
Q16

It is important for me to apply new ideas
in recruitment planning that increases
diversity in the MSPA program.
5 80%

Note. One respondent did not complete the survey.

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Table 50
Staff and Faculty Survey Results for Motivation, Attainment
Survey # Item Count Percentage
Q16

It is important for me to apply new ideas
in recruitment planning that increases
diversity in the MSPA program.
11 90%

Note. One respondent did not complete the survey.

Interview Results
The question related to attainment value asked the participants to share any value they
would personally find around a strategic recruitment plan for Latinx students. The question
follows Patton’s (2015) approach on values. It was designed as an open-ended question to help
understand if the participant feels it is important to increase student diversity particularly in the
Latinx communities in the MSPA program. The importance factor can drive a motivational
influence in innovative behavior to attain tasks related to the development of a recruitment plan.
Respondent R1 indicated, “we are very close to being a predominant Latinx recruiting
admissions institution. That opens up other opportunities from grant opportunities to funding
opportunities from various donors.” He also mentioned that HU engages with “the underserved
communities with our students for preceptorships for clinical work. This approach is innovative
in looking at the clinicians to be trained so that a relationship is built with the communities.” He
pointed out that pursuing both improves the “admission side and then graduate students into the
medical community so it's great.” Senior administrator, R2, stated, “that would be very valuable
to us since we are specifically looking if we can qualify as a Hispanic-serving institution which
will allow for grants and infrastructure.” He also mentioned, “I think mostly within our particular

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location that has helped our diversity, without a specific plan to improve the Latinx student
applications.” R3 said in support stating, “I think the value of bringing different peoples and
cultures into your program brings a richness of diversity, for not only students but for our faculty
as well.”
R4 responded that the more diverse student graduates are the more likely they are to
impact health equity: “Part of our values, as an institution, is to promote health equity, and one of
the ways that we can promote health equity is to ensure that our graduates are able to work in all
kinds of populations.” She also pointed to innovative thinking by suggesting, “I think a strategic
enrollment plan directed at Latinx students could potentially identify access obstacles.” Finally,
senior administrator, R9, responded, “I think that the value would be that we're trying transform
healthcare and healthcare education. I think that it directly speaks to the university admission to
be able to become more diverse.”
The responses from the faculty and staff also had similar thoughts around the importance
of a recruitment plan. Participant R5 said, “the value is to demonstrate that we are a diverse
university, so there is value in reaching out to this community and targeting students from the
Latinx community.”
R6 stated it is important to recruit Latinx students and graduate them to serve their
communities, “in order, for that population to have great healthcare outcomes, it helps with them
to have people that look like them and understand the culture, so that's why the recruitment is so
important.” R7 saw the value as being able to “train healthcare providers who are ready to go
back into the community and take care of their patients. The more diverse our classes, the better
equipped we are to do that.” R8 felt the value would be in being able to increase student
diversity,

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We set a program goal of enrolling greater than or equal to 18% of students that identify
as Hispanic and historically using that benchmark we've only hit back or two out of the
five prior classes. I think a strategic enrollment initiative would allow us to hopefully
meet that benchmark continuously in the future.
R10 was also in favor of not only recruiting but graduating students: “I'm committed to
graduating a diverse well-educated well-equipped student who will go out and provide excellent
care to a diverse community.” R11 expressed the value in maintaining a high competency level:
“I think it is important that we seek out the best and the brightest of all nationalities. I want to go
get the best and the brightest Latin American PAs that can promote our profession.” R12 also
valued the idea of extending recruitment efforts to other ethnic groups: “this is something that
absolutely needs to take place, and we're talking about Latinx, but it can be any culture. it can be
African Americans and other Asians cultures.” R13 indicated Latinx regional being low: “that’s
the one group that were below regional ratios. being intentional about it would show we're trying
to do something about that Hispanics the only one that's below target.” R17 also agreed on the
value of tasks in regard to demographics: “Our PA program should mirror California. We've
done studies on what the demographic looks like regionally in California, in the United States. It
would be better if we had more diversity.”
The students’ responses had mixed feedback. R14 was in favor of finding value “because
I’m a minority and just the fact that the school seems interested enough and helping this minority
group to take the time to create a plan gives me hope.” R15 stated, “I feel like HU has the quality
of inclusivity, but they are probably not marketing it.” She also shared, “I honestly don't feel like
I’m just a number” and described the recruitment process as “not marketing, but like recruitment
value where you're not treated as just a number, you are a quality candidate.” Only one student,

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R16, did not find value in a Latinx recruitment plan: “No. I don't I can't see any recruitment for
any one specific.” Table 51 describes the emerging themes that were captured during the
interview for attainment values.

Table 51
Emerging Attainment Value Themes
Theme description Transcript evidence
Campus organizations can help diversify
the student population.
There are clubs focused on teaching Spanish medical
terminology and Spanish.
Racism in healthcare. Recruitment is so important because those
communities need it and we're not going to be able
to take care of them and improve their health, health
outcomes, because they don't necessarily trust
others, for good reason.
There are two tiers of education in the United States,
one for the haves and one for the have nots and so at
some point, there may have been an educational
deficit.
The language and communication barrier may create
mistrust between the patient and healthcare
professional.
Increasing diversity helps with
accreditation.
Deeper dives at every aspect of recruiting and its
process go into accreditation.
Program information is gathered as it relates to
diversity for the accreditation process.

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Document Analysis Results
The HU institutional plan was examined extensively for evidence related to the
attainment value in promoting innovative behavior in the development of a recruitment plan. Out
of all the goals stated, one emerged from a plan calling for a need to create an innovative
infrastructure that “leverages systems and increases new and continuing enrollment.” This is a
key goal that is intended to create the right environment for increasing enrollment efforts but
does not go into detail in the recruitment process of plans for Latinx students or other
disadvantaged or underrepresented student communities. The institutional plan clearly states the
framework and desire to improve this metric, and the interviews corroborate this metric through
the revision of program goals in the MSPA program presented by R7 in the interview, where the
goals are benchmarked to the national averages. This document analysis provides evidence that
HU is working towards goals aligned with the institutional plan and recruitment efforts to
increase diversity.
Summary
The results indicate the motivational influence on Attainment Value is validated as an
asset. The administrator was favorable in thinking of new ways to improve recruitment strategies
alluding to the intent to innovate the process. The staff and faculty had a stronger response in
favor of applying new ideas, showing motivation that this effort needs to be addressed. A
documentation analysis on the attainment value was observed by reviewing the institutional plan,
which indicated the need to innovate had a better perception in their beliefs that a recruitment
plan can be developed geared toward Latinx students. This was confirmed in the staff and faculty
interview, showing benchmarked data in using data analysis to navigate decision-making
strategies to address deficiencies in diversity performance in the program. The administrator

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interviews showed signs of motivation under the attainment value construct in their views that
pursuing tasks related to Latinx recruitment plans may help define HU as an HSI. Therefore, the
result in this study shows the Attainment Value shared by the administrators was validated as an
asset.
Goals
Goals relate to what someone is looking to achieve (Lock et al., 1990; Rueda, 2011).
Under goal content, following Lock et al. (2002), the role of goals in motivation can focus on
characteristics of whether they are current, concrete, and challenging. Goals that are too vague or
too challenging, per Rueda (2011), can become a demotivating factor for the administration to
increase diversity in the MSPA program. Perrow (1961) argued that one reason goals may
remain static is that they have not received adequate conceptualization where individuals are
forced to see many more problematic things. In addition, Perrow (1961) cautions against
unofficial goals in the organization and those that must remain operative goals per March et al.
(1958), which are designed around actual operating policies in the organization. Wentzel (2000)
discussed the relations between social and academic goals as well as social and task-related goals
as a developmental process. She argued that any changes to maladaptive motivational
orientations are linked to social and emotional needs. The intent in this section is to gain more
insight in the adaptive behavior and outcomes in the conceptualization of goals and goal
orientation that may lead to administrators increasing diversity in the MSPA program. The goals-
related influence discussed here was that HU Administrators must have clear goals in increasing
diversity in the MSPA program.

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Survey Results
In this survey item, the perception of clear goals by the administrators, faculty, and staff
was evaluated for increasing diversity within the MSPA program. The results indicate a
favorable 80% of the administrators agreed (Table 52). The staff and faculty also indicated a
favorable response for goals being clear, registering an 82% (Table 53). The survey results
indicate that the administration finds that the goals are clear in regard to the recruitment of
Latinx students to increase student diversity. The students were also asked if the goal in the
institutional plan to increase diversity was clear to students. Their response rate showed a 71% in
agreement that there is some goal by the administration to help increase student diversity (Table
54).

Table 52
Administration Survey Results for Motivation - Goals
Survey # Survey item Count Percentage
Q17

The goal of recruiting Latinx students to
increase diversity is clear to me.
5 80%

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Table 53
Staff and Faculty Survey Results for Motivation, Goals
Survey # Survey item Count Percentage
Q17

The goal of recruiting Latinx students to
increase diversity is clear to me.
11 82%

Note. One respondent did not complete the survey.

Table 54
Student Survey Results for Motivation, Goals
Survey # Survey item Count Percentage
Q12

The goal of recruiting Latinx students to
increase diversity is clear to me.
21 71%

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Interview Results
The interview questions related to goals were asked to the administration and staff and
faculty in two parts. The first part was organized in a two-series question on how they perceive
goals to be toward increasing diversity in the MSPA program, followed by perceptions of goals
as clear or challenging. These questions were open-ended following Patton’s (2015) approach to
feelings, which are aimed at eliciting emotions as it relates to their experiences and thoughts.
These questions are designed to determine if the participant is clear on goals to increase student
diversity and how they feel about them rather than their opinion about the way the goals are
designated for increasing diversity.
In the second part of the interview, the goals were examined in two separate series of
questions. The first question was aimed toward their opinions to gauge their mastery-approach
orientation on the goals, as Patton (2015) indicated that opinions are aimed at understanding the
cognitive and interpretive process, which in this study is to better understand the motivation for a
new recruitment plan to increase diversity. The questions were based on a 4-series delivery,
asking first about their reasons for participating in recruitment planning efforts, then asking to
share out any failures associated with recruitment planning, followed by opportunities to add
more goals on recruitment planning efforts for Latinx minorities, and finally to see how they
would respond if something was wrong in the recruitment process and how they would address
the issue.
Goal Perception for Increasing Diversity. When asked about the perception of the
goals in respect to increasing diversity in the MSPA program, the responses varied. R1 addressed
the goals: “I think they were about as clear as it could be. The program should reflect the
demographic and we're probably a little bit weak on the Latinx presentation on the faculty and

160
staff.” R2 noted the direction of establishing goals: “If you're going to attract, a diverse student
population, they need to have mentors and faculty who understand, represent and look from
where they are, as well as a culture.” In contrast, Senior Administrator R3 acknowledged there
“is a goal of ours to increase our diversity, but I don't know whether specific goals have been set,
or any kind of targets.” R4 responded,
I feel like this is a question not for me and my position. The PA faculty are very
interested in outreach to underserved communities. How do you reach it? underserved
rural communities underserved urban communities? That is a goal that they have set for
themselves.
Senior administrator R9 felt the goals as “not clear to me because I don't know.”
The faculty and staff were also asked the same question. R5 felt opposite to the senior
administrators and stated the goals have been met and establishing new ones: “We've already
exceeded our goal. Maybe we can move our goal post a little bit. If we have 10% of the class
makes up Latinx, the next step is moving into 15%.” R6 also felt the goals were clear, and
indicated, “once we identify the goals, we sit down as a faculty looking at what our goals are and
what we want to do. Then, it becomes very clear.” R7, interestingly, felt the opposite: “I don't
think it was ever a clear goal of ours per se. We're in the process of revising all of our goals.
Diversity is one of the three goals.” She was familiar with the current benchmark, “to be greater
than or equal to 18% of a curriculum to identify as Hispanic, but this is our current goal.”
R8 had participated in “setting those goals, so I have like background knowledge on what
went into that. I think that they are clear.” R10 felt the question was “very thoughtful because of
the mere fact that I could not speak out the exact goal, tells me that there may be a lack of
clarity.” R10 described the goal setting as “an evolving process. We are working on developing

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this as a programmatic goal. My perception is that there is no resistance. Everybody's on board.
We all recognize that this is important, it's something that we value.” R11 was able to look at
data and fund the results falling short: “We set our goals a few years back and said we wanted to
mimic what we have in the population either nationally or locally, so we found out that we were
falling short.” She did feel “we're not falling short in terms of the Latinx area, but how do we get
better right and then also making sure that every group is represented.” R12 responded, “I'm not
aware of any specific goals.” R13 felt “it seemed like a reasonable goal, but I don't remember the
distributions for that program.” R17 clarified, “we're actually in process of redoing those goals
when the PA program started there was not enough time or thought, but they're going to fine tune
it a little bit.”
Clarity and Challenges Goals. When asked if the goals around increasing diversity were
clear or challenging, R1 responded, “I think they're clear, I know I will say they're clear. I don't
know if any goals were necessarily challenging.” He attributed the challenge in increasing
diversity to the accreditor. R2 mentioned, “I think they're challenging,” but “clear when you look
at the surrounding area, the counties, and their diversity. I think that becomes pretty clear of what
our goals are to try to match that.” However, he did mention what isn’t clear is “the radius from
the institution. Immediate radius, how far out? I think we need to make that our next step goal.”
Participant R3 was “not familiar enough with the goals” or “not familiar enough with the process
to really come in on a specific challenge that we are experiencing.” Respondent R4 could also
not comment on the clarity or challenge of the goals as the participant felt it was outside the
scope of her role. Respondent R9 could not comment, “I don't even know how many Latinx
applicants we get,” and attributed the lack of data because she felt, “I don't think, theoretically, it

162
shouldn't be challenging,” so she emphasized that having data would “address those barriers, that
are existing.”
The faculty and staff were also asked if the goals were clear or challenging. R5 felt, “I'm
sure it was challenging because we didn't understand the space as an institution. Now,
everybody's creating an office of diversity and inclusion. We really have to focus on these
various groups for recruitment efforts. It has been challenging.” Additionally, R5 stated 50% of
the goals were clear and “probably about 50% challenging.” R6 indicated the goals were
“probably 25% challenging because we want to make sure we were stating a goal that was
measurable.” He described “trying to define a goal that was measurable was the challenge. We
struggled with it. We just had to find the target. Once we found it the goal was clear.” R7 felt the
goals were “100% clear and definitely anticipated to be very challenging, probably 50%.” R8 felt
the goals were “100% clear,” but admitted, “I'm biased because I helped make that.” R8
continued to feel the goals were somewhat challenging because “we've met without really
actively trying to recruit Latinx applicants. We've met the target 2 out of 5 years, historically.
Maybe 60% difficulty because we have not met it, the other 3 out of 5 years.”
When speaking to challenges and clarity, R10 mentioned, “I will admit I think the fact
that I can't directly spew out that and tell you exactly what it is, does speak a tad bit to clarity of
the goal.” R11 felt “they're not challenging at all.” She also felt, “100% clear because data shows
that we are deficient or proficient in certain areas. R11 also justified feeling not challenging
“because we've met the numbers for Latinx” and described it as 10% challenging. R12 alluded to
the possibility of the diversity goal being unofficial: “We're all thinking about it and it's all on
our radar. I just don't know if it's an official university or program policy.” R13 felt, “I wasn't
aware of them so.” R17 felt, there is a challenge with diversity goals as it relates to accreditation

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standards: “We can't have unfair admission practices. We have to provide documentation. Even
if we really like someone and they fit the HU characteristics, we have to go and score in order.”
She described the challenges with minority recruitment goals: “There's not as many African
Americans that apply. If we have 1,200 applicants, we might only get 20 African American
applicants.” R17 ended the discussion:
It was clear for me because we discussed it at meetings, but it's still going to be difficult
[because] we only can work with the people that are applying if they're not applying then
it doesn't look like we're meeting our goals. That's a challenge!
Reason to Participate in Recruitment Planning. In this section, the administrators
discussed reasons to participate in recruitment planning. R1 stated, “To me, is that we achieved
the values that are presented in the goals of the university. The values and missions are all
delivered. That's where my piece comes into play.” R2 stated, “I want to help as much as I can,
in my position. My positional authority of this is our goals.” He gave an example with a potential
partnership for clinical rotations in underserved communities: “I think, as a result of providing
care in those communities and the internships of our institutions. It's going to be much easier for
us to recruit students in those areas.” R3 stated he was not involved in recruitment planning but
helped with the development of policies: “My involvement there is pretty much limited to
providing legal advice. I helped the university develop legally compliant policies.” R4
responded, “I oversee marketing and recruitment. I don't develop those plans, but I do oversee
the people who develop those plans.” R9 felt diversity is important for the representation of
diversity in healthcare: “We have to be strategic about enrollment planning that is going to help
the future of healthcare. We all agree that our system in the United States. There's a lot that's
broken about it, including lack of diversity.”

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When asking the faculty and staff about their reasons for participating in recruitment
planning efforts, R5 felt there was a good level of diversity representation: “We have a nice
distribution of students across the PA program, that we have equal representation of students
from these various backgrounds.” R6 reasoned that in order to have any input in the process, one
must be active: “If I’m not active, then I don't have a voice. If I don't have a voice as an African
American woman, the people that are in the boat with me will not get a voice.” R7, felt it was
extremely important to be directly involved in admissions to understand the make-up of the
cohort for accreditation purposes: “We're able to take all the admissions criteria and correlate it
with every part of our program, whether it's graduation rates, remediation rates. I feel that's so
crucial and important of how to seat your class.”
R8 stated her role as chair of the PA admissions committee requires her to participate in
recruitment efforts as well as be a healthcare provider to ensure the workforce is representative
of the patient population: “We chose the goal of 18% because that's the most recent percentage
that was identified as Hispanic in the general population in the U.S., and so we feel like our
class, should mimic the U.S. population of Hispanics.” R10 recognized how important it is for
patients to interact with individuals that are “highly competent, well trained, well skilled,” who
understand their culture or background: “45% of the population in California is Latinx we should
be producing the same percentage of Latinx students to provide care to all communities.” R11,
responded similarly: “I think representation is key. Students are looking for representation and its
key to have people that can represent you.”
R12 shared the same sentiment in that there is a lack of representation of minorities in
these underrepresented communities: “If we can get some more of those qualified motivated
applicants that are going to be successful in this program then that's a win for us.” He mentioned

165
that one of the goals is for HU to be representative as one of the top PA program in the country:
“It's the best academics, the best clinical experience, again best in terms of diversity and
inclusion and it's going to be the one students want to come to the most.” In a different context,
R14 stated, he participates in recruitment planning efforts by providing data for analysis: “that’s
my job and that's the way I can make an influence. By providing disaggregated data break the
numbers down by race, ethnicity, gender, what have you.” R17 was very content and enthusiastic
about participating with recruitment efforts indicating it was something that she enjoys in
helping others: “I think if you do something that you're passionate about it doesn't feel like work
if you make a difference in people's lives it doesn't feel like work, and I know my job is doing
that.”
Failures Associated With Recruitment Planning. When the administrators were asked
about how they respond to failures in recruitment planning efforts, R1 did not directly note a
failure, but he did bring up challenges in his role and goals: “My big push was to ensure that the
training development of our employees was sensitive to both the various populations [in] how to
deal with challenges that are preventing them from deciding to make an admissions decision.”
R2 mentioned working as a group to address failures: “We have to do a better job of creating a
more diverse student population by making all those decisions in the recruitment as a faculty.
Let's start that priority. Let's get that going.” R3 mentioned, “I'm not aware of any failures that
we've had along those lines.” R4 alluded to the presence of an unofficial goal and not one that is
operational, stating, “Failed? We haven't set goals by demographic group, so I don't know that I
can answer that question because there's a presumption that we've set a goal. We haven't set that
as a goal.” R9 stated, “I would want it to mirror the demographics of our area.”

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When asking the faculty and staff about how they respond to failures, R5 was not sure of
any failures. R6 responded, “You go back to the table. Going back to the woodshed, realizing
that some things you just are going to do over again until you get it right.” R7 was not able to
respond to the question. R8 stated, “We haven't really had any failures, because we haven't had
any specific goals. This will be the first year that we have a goal, so I might be able to comment
on that by next year.” R10 stated, “I haven't responded to any failures at this point again ever
evolving for our program in particular.”
R11 was in support of devising a holistic recruitment tool: “We have to do a better job
and making sure that we are visible, and our recruitment tool is in line with where we're trying to
go, and that narrative needs to be proliferated outside.” R12 also did not feel there were many
failures to discuss. In reference to minority groups. R13 stated, “We have to find out what's
wrong, and why it's wrong, then address that problem.” R17 was not sure what to consider a
failure, but she did say that she is always in contact with the student, and she holds information
that is not always asked: “My opinion is not asked.” She attributed categorized failures to
“decisions are made without faculty and staff input.” She felt strongly that the input of the
“people that are actually talking to the applicants and understand these applicants don't talk to
anybody in administration.” This provides insight to the relationship between faculty and staff
and the administration in defining recruitment strategies.
Opportunities to Add Goals Toward Recruitment Planning. In the next series of
questions, the participants were asked about what goals they would consider adding on the
recruitment planning for Latinx. R1 said, “More consistent contact and follow up and not direct
emails nor tech chats. This is a personal relationship with the Latinx community.” He also
mentioned, “potential outreach to bring those people on the campus more. I think there is more

167
value to actually gaining a student and the family on the campus for a tour.” He mentioned the
“roadblocks to visiting campus would be a big one. We may have to facilitate some funding and
some tools to help get them there because when you think about underrepresented underserved,
there's a financial component.” R2 stated that there must be an “integrated system,” a systematic
approach by looking at the student support systems in, what are the costs of those student support
systems. He also mentioned, “We can do that with collaborative opportunities with other
institution, whether it's a 4-year institution that has a high population of Latinx students that want
to get into health healthcare.” Most importantly, he mentioned “looking at grants, especially if
we qualify as a predominantly Hispanic teaching institution, if we can qualify for those types of
grants that will help with the infrastructure.” R3 said, “I'd want to work collaboratively to figure
out what our goal should be and make sure it's compliant with discrimination laws.” R9: stated,
“I'm not familiar with any. I've seen a lot of changes happen over the years, so I would say we
address problems by making changes.”
About what additional goals they would add to make an effective strategic recruitment
plan, R5 said, “recruitment efforts, I would say, investing more dollars in the team, so that they
can understand the space.” R6 mentioned, “I think for recruitment, creating a boot camp.” She
mentioned a boot camp would prepare the students with some of the requisite skills they need to
be successful in a PA program, such as “time management, medical terminology, maybe a
refresher course in anatomy and physiology.” She mentioned that would ensure the students can
become “familiar with the campus [and] the system,” so they can survive the program: “I would
like to see something like that, for our PA students or Latinx students.” R7 responded, “I feel like
at this point in time, they don't have much to add to the current goal.” R8 responded with setting
a good place to reflect the national population, indicating that “some schools have lower targets

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because maybe they have a more difficult time recruiting Latinx applicants. I think we are lucky
in southern California, because we have a large population of Hispanic individuals.” R10 shared,
“identifying those organizations that already serve Latinx communities, scholar students, current
undergraduate students, K through 12 that serve that particular population and collaborating
creating connections.” R11 mentioned that some effective goals she would consider is the view
of who is represented in the program: “If I’m trying to recruit you, I want to make sure that at
least you're represented in our pamphlet, somebody that looks like you, somebody that motivates
you.” She included “vantage point” and “packaging” such as “scholarships” for underrepresented
minorities. R13 emphasized, “make the community and the high school students seem more
aware and a be on the college campuses. It's the scholastic exposure we want to have and
community exposure.” R17 felt the need to have a position doing outreach at the schools and in
the community and focusing on those metrics, specifically “it would be great if that would be
someone's job where they're doing things virtually and giving a presentation and talking to them
about the PA program.”
Responding to Problems with the Recruitment Process. Finally, they were asked in
the first component of the interview how would they go about addressing if there was something
wrong in the recruitment process. Participant R1 mentioned, “I tend to be a very direct person.
When I see challenges that we are self-creating, I am the first one to call it out.” He went on to
be supporting and providing to help “make an informed decision” and to “give people the
authority and permission to do their job. I'm going to give you the support and the tools in the
work and tell me what I can do to get the bricks out of your way.” R2 shared, “Asking my
provost and the program director to see if there's any changes needed and looking at our current
internal systems. I can probably put a commission task force together to look at that

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independently.” R3 stated, “that's difficult to answer because I’m not really involved in
managing recruitment so I’m not sure I would be involved.” R4 stated, “We don't do a lot of
recruitment. We do a lot of admission. So, what would I do? I allocate resources, I set priorities,
I ask questions, I review.” R9 shared, “The first thing I would do is go to the director of
admissions and let her know what I felt was my concern and ensure that she would address it.”
When asked about how they would respond to failures, R5 stated, “I think the first step is
let's sit back and reflect on what were the downfalls or the issues, so they don't reoccur. Let's
brainstorm and look at some solutions in the next recruitment effort.” R6 responded, “Directly
identify what it is and address it. You’re dealing with people's lives. That's the ethical thing to
do. The moral thing to do is to fix it and make it right.” R7 responded, “I'd be able to directly
handle that, evaluate it, and look at the data, make a data-driven decision and a data-driven
change and how we can improve that for the next time so directly.” R8 stated, “Maybe our
admissions criteria were preventing more Hispanic applicants from applying or qualifying for
admission, then we would present that to the admissions committee and assess if we should make
changes to those admissions criteria.”
R10 stated, “We have amazing leadership within our program, and they would be open to
it. Receptive to hearing feedback and being able to dialogue about challenge.” R11 also felt very
comfortable with speaking out on issues: “Faculty is really good. Our school is really good. I can
walk into the president’s office and say, you know what, close the door, we need to talk. I feel
comfortable to do that.” She described, “Our faculty members are very open, and I think that
we've developed a camaraderie where we can talk about hard things and not take it personal, and
they're very receptive.” R12 felt “it's pretty free-flow meeting, and everybody's comfortable with
each other. We've got a good group.” R13 felt improvements are needed: “We could be doing a

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better job of selecting students who will succeed here.” R14 said, “I would look for bringing in a
diversity of students within that demographic.” R17 felt responding to issues would be to “bring
it up to the admissions chair, first, and then to the VP. He is very receptive and listens. He
usually addresses issues pretty quickly.” She also mentioned that some decisions affected other
departments like marketing, admissions, student services, or that registrar and pointed to “we
can't do that without getting all of them on board.” This indicates collaborative engagement is
important to motivate the need to solve issues related to the recruitment process and to set goals
within the program. Table 55 captures emerging themes that came out during the interview for
this motivational influence around goals.

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Table 55
Emerging Goal Themes
Theme description Transcript evidence
It is hard to find diverse faculty
for the MSPA program.
It is tough finding faculty on a full-time basis for recruitment or
curriculum development.
It is very competitive to find a faculty that is specific to PA.
Systemic racism in higher
education.
Schools need African Americans for faculty representation.
General awareness in systemic racism is increasing in higher
education so programs are starting to put money behind
recruitment.
Goals to increase diversity
should come with increased
financial resources.
They need to get some money behind Latinx students to come
or they're going to be recruited to other programs.
Latinx communities are
familial.
Latinx is heavily familial, and admissions recruiters must think
about this rather than focus on individual students.
Latinx must broaden out to the families.
In Latinx family it is important that they get their questions
answered as much as the students because there's a secondary
decision point there.
It is more critical for the Latinx given their familial
environment.
Latinx appreciate that intimate discussion.
Utilize alumni as a support
system.
Many alumni contributed specifically to the institution well.
Funding allowed the provision of financial support to students.
Use tutoring as a support
system.
Tutoring is intended to help the student graduate.
Tutoring helps students get through PA school since it is like
medical school on steroids.
Revising procedures requires
additional resources and
funds.
Some procedure revisions may take up to six months or even a
year because there is so much information contained.
The roll out of new software called. Accurate will help make
updates on a timelier basis.
The revision of policies and procedures can require approval to
a dollar amount and if the dollar amounts are over a limit it
gets escalated to the board of regents.

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Document Analysis Results
The program goals related to diversity were shared by R7 and were evaluated further to
document the clarity of the goal as it pertains to the organization. The statement indicated, “the
goal of the program will recruit highly qualified individuals from various ethnic backgrounds,
resulting in a diverse and inclusive cohort of students with differing abilities will be equipped to
provide equitable care to our patients.” The benchmark stated in the drafted proposal is, “I will
matriculate individuals who identify as American Indian or Alaska native Hawaiian or other
Pacific Islander, Hispanic, and Black or African American at a rate that meets or exceeds the
national representation.” The benchmark matriculations are provided in Table 56.

Table 56
2021 Demographic Description of Matriculants
Matriculants Demographic description
≥ 18% Identify as Hispanic
≥ 2% Identify as American Indian or Alaska Native
≥ 14% Identify as Black or African American
≥ 2% Identify as Native Hawaiian or Pacific Islander

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Furthermore, the document indicates that the program outcomes were based on race and
ethnicity data for all matriculated students from the Centralized Application Service for
Physician Assistants (CASPA) and compared to their benchmarks. It was noted in their
evaluation that the program was lower than the percentage of Hispanic, American Indian or
Alaska Native, and Black or African American Applicants in the general applicant pool and
identified it as an area to improve through recruitment efforts targeting diverse race and ethnic
matriculation goals.
Summary
The results indicate the motivational influence on Goals is validated as a need. Although
the administrator’s response was high, sharing the same sentiment with staff and faculty, the
interviews show half of the administrators are not clear on the goals set for the increasing
diversity initiatives. The staff and faculty interviews did show great control on data analysis in
benchmarking the MSPA program but set goals have not been clearly stated across the
organization, with the administration having mixed responses, with some feeling positive about
meeting metric goals in diversity whereas, others were not sure if metrics were established. The
documentation analysis supports evidence that efforts made by the MSPA program staff were
made to understand benchmark data by comparing their performance against CASPA rates.
However, no clear set goals were established from this exercise as most of the information
appeared to provide descriptive statistics with no direct input to a specific metric toward
increasing diversity. Based on this information, the Goals Motivational influence is validated as
a need for the HU administration.

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Goal Orientation
Under goal orientation, patterns of beliefs are explored that may represent ways of
approaching, engaging, or responding to achievement situations (Ames, 1992; Rueda, 2011). In
this study, the master goal orientation construct is explored to better understand if the approach
to a specific task follows an order to learn, gain new competence, or to accomplish a challenging
activity (Rueda, 2011). Mastery goal orientation is different from performance goal orientation,
which is looking to avoid poor performance in front of others (Mayer, 2011). Pintrich (2000)
separated mastery goal orientation as master-approach orientation, where the individual is
interested in mastering a task, whereas mastery-avoid orientation is interested in avoiding
misunderstanding the task. Meece et al., (2006) defines mastery goal orientation as mastering a
new skill and learning new materials that leads to self-improvement and satisfaction from task-
related interests and challenges. The series of questions in this motivational influence is intended
to capture the administration’s perception of goal structures and assess their personal mastery
goal orientation in relation to a new recruitment strategy for Latinx students. The goal orientation
influence discussed here is that HU administrators possess mastery orientation in relation to new
recruitment strategies for Latinx minority students
Survey Results
In this survey item, the evaluation is around the administration’s possession of mastery
orientation as it relates to new recruitment strategies for Latinx students. The administrators were
asked if they liked learning more about recruitment planning for Latinx students, and there was a
strong response among the participants, with 100% in agreement, despite how challenging it may
be (Table 57). The results from the staff and faculty were also very strong, yielding a 91%
response rate in favor of learning more about recruitment planning (Table 58). Students were

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omitted from the goal orientation evaluation as the mastery pertains to the administration. The
survey results indicate that the administration has a strong indication to possess the willingness
for mastery goal orientation in facilitating new recruitment strategies for Latinx students.

Table 57
Administration Survey Results for Motivation, Goal Orientation
Survey # Survey item Count Percentage
Q18

I like to learn more about recruitment
planning for Latinx students despite
how challenging it may be.
5 100%

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Table 58
Staff and Faculty Survey Results for Motivation, Goal Orientation
Survey # Survey item Count Percentage
Q18

I like to learn more about recruitment
planning for Latinx students despite how
challenging it may be.
11 91%

Note. One respondent did not complete the survey.

Interview Results
The question in the interview for the administration is what type of goals they would
consider effective for increasing the intake of Latinx students to the MSPA program. The
question was based on feeling questions, which center around emotions to understand their
experiences and thoughts (Patton, 2015). Here the mastery-approach orientation was explored by
asking them what goals they would consider effective in increasing Latinx students to the MSPA
program. This question was asked as an open-ended question to leadership administration and
faculty and staff to determine if leadership diversification positively impacts student
diversification in the context of goal structure and orientation. A positive response in this
construct will indicate the administration can set goals and have the motivational influence on
master tasks associated with new recruitment plans for student diversity. A negative response
would highlight gaps in their motivational influence that need to be addressed prior to setting
plans for a new recruitment plan for Latinx students.

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When the senior administrators were asked about what goals they perceived as being
effective generally, there was a positive response, with R1 stating the goals should be focused
around “the interview step. We are big on culture. The interview step is the tipping point of
identifying students who are culturally fit and who understand the integrative approach within
PA.” He felt this will help attract Latinx students by identifying students in the interview process
that share characteristics tied to the principles of the organization. R2 was focused on
exceedingly not only the national average but the regional average: “I’d look at other counties
for sure, especially when it comes to Latinx in our immediate radius, and exceed those.” R3
stated, “we should look at the community and help define goals with respect to diversity in
admission.” R4 was focused on increasing the “representation of Latinx faculty first.” R9 was
also aligned in identifying the demographic regionally, “look at various counties and student
population and draw a comparison because we are much more diverse here in Southern
California” when compared to the national average.
When the staff and faculty were asked about what goals they see as effective in
increasing the intake of Latinx students, R5 stated, “One of the goals is looking at pipelines to
the community colleges to entice more Latinx students really trying to tap into those local
community colleges. R6 also mentioned looking at “communities within the next 25-mile radius
and looking at the numbers in those communities. How many can we pull from those
communities.” R7 was not able to contribute as her position just recently changed and was
focused mainly on “objectives and outcomes and accreditation” and could not identify effective
goals for increasing the intake of Latinx student to the MSPA program. R8 mentioned turning
“unspoken goals” to “formal goals” on diversity because currently, “there was never a formal
process for” setting effective goals for the intake of Latinx students.

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R10 was much in favor for increasing diversity within the program, “programmatic
goals” need to be set as “part of our accreditation document in terms of increasing more diverse
students.” R11 was focused on the improvement of “recruitment tools;” “we need to make sure
that we have billboards that say you can be a PA,” alluding to the representation of African
American or Asian American as an example to project to the community as “outreach.” R12 was
pretty aligned with most of the staff in that “exceeding national averages are goals that would be
considered effective,” but “having been reflective” in respect to “Southern California
demographics.” R13 also was in support of regional demographics: “I’m not sure we should be
looking at national averages, but rather Southern California.” R17 was more focused: “we need
to move towards a more holistic admissions process” to overcome barriers that minority students
experience. Table 59 shows additional themes that emerged from the interview as it relates to
goals.

Table 59
Emerging Goal Orientation Themes
Theme description Transcript evidence
Integrate goals at the interview step. Latinx is attracted to alternative methods of medicine
that is non-Western approach.
Interviews will help identify students as part of a
holistic review and overcome barriers.
Focus on marketing goals to increase
outreach
More visibility of the program is needed and placing
marketing materials in outreach communities.
Attend Latinx event and share marketing packages on
the MSPA program.
Formalizing goals from unspoken goals. Formal goals can be discussed in agreement as a
faculty.
Utilize CASPA to access information on the student to
formally select minority students to the pool.

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Document Analysis Results
A historical review of provost reports and town halls was investigated between 2020 and
2021. A thorough review of these reports provided the status of programs in general at HU
through KPIs. A few metrics related to this study fall under retention and new enrollments.
Under the retention metric, in 2020, the KPI for retention was reported at 119%, dropping to
96% in 2021. Under the new enrollment metric, it also dropped from 119% to 112%. It is worthy
to note that the performance around these metrics may have strongly been influenced by the
COVID-19 pandemic. Nonetheless, it was discovered at this time that the MSPA program was
placed on probation by the accreditation board. Provided the documentation analysis on the DEI
seminar, there are efforts to improve initiatives in promoting an increase in diversity in the
MSPA program; however, the factors related to the probation installment is unclear. This
documentation analysis provided input in the effort that KPI applications may be serving the
organization more on the performance goal orientation construct and a lack of mastery goal
orientation, which may be needed within the program to develop recruitment plans to increase
student diversity.
Summary
The results indicate the motivational influence on Goal Orientation is validated as an
asset. The administrator’s response was very strong, with all administrators in agreement that
they are willing to learn more about recruitment planning for Latinx students. The staff and
faculty also shared the same views with strong support toward the efforts and in alignment with
the administration. The staff and faculty interviews also corroborated the responses by the
administrators. The documentation analysis showed KPIs for enrollment and retention; however,
a diversity metric was not observed, which misaligned with the metric established by the

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institutional plan. Additional review of town hall results indicated the MSPA program was
placed on accreditation-probation, confirming findings on the website. The results provided in
the document analysis indicated that although the administration is in favor of learning new
recruitment plans, there has been very little influence on the leadership part to drive favorable
metrics in the MSPA program of having diversity initiatives are critical to the accreditation of
the program. There is no clear link indicated by the documentation analysis that the probationary
period is due to a lack of diversity. Given the inconsistencies in the performance of the program
with respect to KPIs, there is a lot more work needed to establish a clear metric on diversity
initiatives. Therefore, the goal orientation was partially validated as an asset for the
administration.
Results and Findings for Organization Needs
In this section, the results of the research questions related to the potential organizational
barriers surrounding the senior administrators. According to Clark and Estes (2008),
organizational influence and effectiveness are dependent on work processes, material resources,
and value chains and value streams. Organizational support is needed to achieve important work
goals, and it is critical to identify the factors that make it challenging to align with the
organizational strategy. Rueda (2011) described an organization through its culture and cultural
processes, structure, and policies and practices. Schein et al., (2017) described organizational
culture through the way people interact, mental models, and shared meanings. Gallimore and
Goldenberg (2001) addressed organizational influence through cultural models and settings.
Cultural models are the shared mental schema or normative understanding of how the world
works or ought to work (Rueda, 2015). Gallimore and Goldenberg (2001) indicated that
environmental work settings are characterized by influential factors of the specific context in

181
which behavior is enacted. The results from the survey provide a quantitative measure to define
the gaps found in the administration’s organizational influences through the cultural model and
cultural settings construct.
Cultural Model
According to Rueda (2015), cultural models are dynamic and expressed as cultural
practices. Schein (2017) indicated organizational cultures are multi-dimensional and complex,
going beyond the norms of national and ethnocultural, and exploring dimensions of shared
beliefs, values, and norms. Clark and Estes (2008) indicated that an organization’s core beliefs
can guide decisions about goal selections and ways to achieve those goals. Cohen (2005)
identified organizational culture under established norms of behavior, attitudes, and values. The
cultural model is explored in this study to consider the areas of culture and structure as they
relate to the values in the organization to support the cultural representation of Latinx students.
The cultural model influence discussed here is that the administrators need the organization to
value cultural representation to support the recruitment plan for Latinx students.
Survey Results
The evaluation of the cultural model of the organization as it pertains to the value of
cultural representation was gathered from the administrators to understand the support of a
recruitment plan for Latinx students. The survey question asked if the administrators agree with
cultural representation integrated in the recruitment plan for Latinx students. The administration
had a very strong response, with all administrators in agreement (Table 60). The staff and faculty
response rate were significantly less, with a response rate of 64% response in agreement (Table
61). The students were also asked if they feel the cultural representation is integrated into the
recruitment plan for Latinx students, and 77% agreed (Table 62). These results indicate that the

182
set of beliefs surrounding the administration in the context of cultural representation for the
Latinx students may need improvement. This is key to generating a support system for the
organization that can advocate the need for cultural representation in the recruitment plan for
Latinx students.

Table 60
Administration Survey Results for Cultural Model Influence 1
Survey # Item Count Percentage
Q22

There is cultural representation
integrated with the recruitment plan
for Latinx students.
5 100%

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Table 61
Staff and Faculty Survey Results for Cultural Model Influence 1
Survey # Item Count Percentage
Q22

There is cultural representation
integrated with the recruitment plan
for Latinx students.
11 64%

Note. One respondent did not complete the survey.

Table 62
Student Survey Results for Cultural Model - Influence 1
Survey # Survey item Count Percentage
Q13

There should be cultural representation
integrated in the recruitment efforts of
Latinx students
21 77%

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Interview Results
Cultural models were examined with the administration as well as the faculty and staff
around their thoughts on cultural representation of their peers when it comes to recruitment
planning. The question was framed as an open-ended question designed using the posing the
ideal construct per Strauss et al. (1964), where the participant’s response is analyzed in the ideal
situation or condition described by them in the context of an ideal cultural representation. This
question is aimed to determine if the participant is able to describe the representation of culture
within the organization. Cultural model influence is integrated in this study to understand the
needs of the organization to support a new recruitment plan for Latinx students.
The senior administrators responded with a need to improve on cultural representation
around their peers. As indicated by R1, “The cabinet is a little weak. I would say we're still
probably a little weak on a reasonably diverse faculty and staff specially on Latinx. Our student
recruitment may be in a better place.” R2 stated in favor of the environment being well
represented, “so the culture, I think, is pretty consistent. I think for any of these, diversity
initiatives, it is not just for students but also looking at our employee make-up.” R3 also felt
pretty good about it, particularly with respect to Latino population “because I believe that our
director of admissions is a Latino himself. I feel diversity is good and that respect.” R4
mentioned it was important to note historically,
I've always been a part of institutions that talk frequently and often about issues of
access, diversity central to its values, central to its mission. My impression of HU when I
first got here was that we didn't talk about those issues as much as I had been accustomed
to, and other higher education environments. I think that there has been a kind of
renaissance of those conversations.

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She also emphasized the financial component to the organization as a supporting
mechanism to cultural representation, indicating that “when you're not doing well financially,
you're in survival mode. We're not in survival mode. We're in build mode and that gives license
for people to think more creatively, to examine what other institutions are doing. R9 responded,
“The people who are directly involved with the recruitment plans are a diverse group of
individuals. When I look at the senior leadership team of that cabinet, that one is less diverse.”
She agreed and felt the cultural representation of her peers are representative of a recruitment
plan.
The responses of the faculty and staff included the following. R5’s thoughts on the
cultural representation were that “I think everybody's 100% invested in the fact that we have a
very diverse faculty. That alone, I think, says what our primary purposes are we have a diverse
faculty. We also want a diverse class.” R6 said, “We have diversity, not only in ethnicity, but we
have men. A lot of PA programs don't have male faculty, so I think it's important for the Latinx
students to see a doctor that's a Hispanic male.” R7 stated, “From a cultural standpoint, I think
we are okay in that regard. I mean we could obviously be more diverse, but I think we are
actually pretty diverse as far as having cultural representation.” Respondent R8 also felt that “In
order to have a strategic plan for diversity, you need a diverse faculty and staff. If we have very
few Hispanic faculty or staff, then I feel that presents a problem for recruiting students of that
ethnicity.” Participant R10 shared, “We have one of the most diverse faculty from any program
that I've ever worked with. We're represented on many different levels. Our students benefit from
the level of diversity in terms of our faculty and staff.” Respondent R11 stated, “We have a
robust team. We probably have great numbers in terms of representation on our faculty.” R12
also shared the same sentiment, “We are a pretty diverse group. I think we're all pretty well

186
represented.” R13 felt, “Well, it's pretty broad. We've got people from lots of different
backgrounds in the administration.” R17 also confirmed, “Our staff is pretty diverse. We only
have two men on staff so probably could increase that but I'm not really sure how the recruitment
goes for faculty and staff.”
The students were also included in this discussion and shared. R14 stated, “We all have
the same culture. We all have this sort of online PA student culture, so we have such a big
diverse group of people as far as culture is concerned.” R15 also stated, “I think we're very
diverse and also very respectful of each other's cultures. We enjoy each other's company. We still
coexist with professionalism, and we truly appreciate each other's cultural differences.” Student
participant R16 also felt very similarly: “I think it's very diverse. We have Indians. We have
Latinos. We have Black students. We have White students. We have a lot of Asian students, so I
think it is very, very diverse.” In addition to this interview, emerging themes captured were
gathered and listed in Table 63.

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Table 63
Emerging Cultural Model Themes
Theme description Transcript evidence
Establishing committees to promote
cultural awareness.
A campus organization called the culture crew
recommended the program evaluate the mission and
values.
Growth brings in new people to the
institution that bring their expectations
and experiences.
New people bring expectations and experiences from
higher education environments, and it helps make
the institution more inclusive.
Implementing Program 360 A 360 program was used by a cross representational
group from across the entire campus to talk about
the programs to better support the students.

The 360-program revealed faculty expressed a desire
to do more to diversify the faculty and student
population.
Accreditation renewals are very time
consuming.
Continued accreditation takes focus, time and
attention which means less time for recruitment
planning.

Document Analysis Results
The HU institutional plan was examined and revealed a particular goal to leverage a
distinctive approach to education and healthcare. The plan demonstrates its critical relevance in
integrative healthcare education through institutional branding. One of the initial objectives of
this goal is to build communications and brand infrastructure and define and articulate HU’s
unique identity and create the HU brand in the marketplace. This has allowed HU to create and
begin implementing a comprehensive marketing plan and brand effort. However, there are no
formal documents in place on how marketing plans address recruitment planning for diversity in
the MSPA program.

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Furthermore, through the investigation of strategic documents, a social media report was
provided that shows HU’s presence in social media strategy and social media metric definitions.
In 2020, they were able to establish a presence in their branding on Instagram, Facebook, and
LinkedIn. These are platforms that allow HU to use social channels to communicate virtually
their attraction to prospective students by sharing the HU values across all programs, including
MSPA. It allows HU to highlight their faculty and staff as well as student success to make their
mission and values known. This shows a very strong innovative approach to fostering a cultural
model across the institution. Although there was no formal metric for increasing diversity for
Latinx students, or a formal plan for a recruitment strategy, the posted feeds of images from the
community show a strong representation of ethnic diversity, including the representation of
Latinx students actively participating in the social media channels. This documentation analysis
supports the efforts that HU administrators are making in setting partnerships with its community
through social media channels. However, there are additional steps needed to formalize a
recruitment strategy as part of a cultural model for the institution.
Summary
The results indicate the cultural model within the organization in cultural representation
is validated as a need for the administration. Although the administrator’s response was perfectly
in agreement, the interviews did indicate that the cabinet lacked diversity. However, the
administrators, in general, felt the organization is well diverse besides the need to improve this
effort among the senior administrators. The staff did not share the same views as the
administrators, indicating a need to diversify the organization. The student surveys also provided
favorable results as well as their interviews in sharing a diverse campus. The documentation
analysis supports evidence of a strong representation of ethnic diversity across social media and

189
connecting with the community. However, there is still no clear indication as to how cultural
representation feeds into the efforts to recruit Latinx students. Thus, the lack of diverse
representation in the senior administration cabinet partially validates the cultural model
organizational influence as a need.
Cultural Setting
The cultural setting involves the organizational structure, policies, and procedures that
can impact behavior and are shaped by individuals and groups depending on interactional
processes (Rueda, 2011). According to Clark and Estes (2008), when organizational goals,
policies, or procedures conflict with the organizational culture, problems with organizational
performance arise. Thus, the cultural setting is explored further in this study to identify
procedures and policies that may act as barriers to organizational performance. In the next
section, several cultural settings are explored to identify the gaps in the organizational
framework for the development of a recruitment plan for Latinx minorities. The cultural settings
include the need for partnerships, the need for alternative criteria in the selection of candidates,
the need for periodic audits, and the need for sociocultural interactions to overcome
socioeconomic factors experienced by Latinx students.
Influence 2: The Administration Needs Partnerships in Developing a Recruitment Plan for
Minorities.
Survey Results. The cultural setting of the organization was assessed in the context of
the organization’s surroundings through partnerships. The survey question asked if the
administrators agree to collaborate with others on new projects involving recruitment planning.
The administration scored 80% in favor of the need to establish partnerships for recruitment
planning for minorities (Table 64). The staff and faculty also provided a strong response of 82%

190
in agreement (Table 65). There was no student survey component to supplement this question, as
the question is related more to the recruitment plans and collaboration within the administration,
which is outside the practice scope of the student. These results indicate that the need to
collaborate within the administration has a positive response.

Table 64
Administration Survey Results for Cultural Setting Influence 2
Survey # Survey item Count Percentage
Q19

I collaborate with others on new projects
involving the development of
recruitment plans and strategies for
minority students.
5 80%

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Table 65
Staff and Faculty Survey Results for Cultural Setting Influence 2
Survey # Item Count Percentage
Q19

I collaborate with others in new projects
involving the development of
recruitment plans and strategies for
minority students.
11 82%

Note. One respondent did not complete the survey.

Interview Results. In this part of the interview, the question to the administration is to
describe the organizational partnerships or collaborations in the community needed in the
outreach and recruitment of prospective Latinx students. This question is an open-ended question
framed around the hypothetical construct per Strauss et al. (1965), which is a technique for
rounding out the respondents thought structure, but without accompanying rhetorical
questioning. The question was designed to understand if the administrators established a
recruitment plan in a partnership with the community and what collaborations were in place with
the department to help with recruitment efforts. The question was also asked of faculty, staff, and
students. In addition, the students are evaluated to understand if the organization provides an
environment suitable for them to collaborate with the administration on outreach recruitment
efforts in their community.
When the senior administrators were asked about their partnerships in developing a
recruitment plan, R1 responded, “There's at least two or three key ones, high schools, financial
considerations, and the social considerations to facilitate.” R2 could not point to specific
collaboration: “we don't have any that are specifically targeting. We have a lot of service that
goes out to underserved communities. Our outreach is starting to look at institutions of color.”

192
He also mentioned, “We have a program that exposes our students to high school and a lot of
those institutions are in the surrounding area where the high schools are predominantly Latinx.”
R4 could not answer directly to any collaborative partnerships but mentioned, “It easier for
programs that don't have 1,000 students trying to get in.” R9 felt it was outside her area of
expertise, but mentioned, “the articulation agreements that we may have with undergraduate
universities that are Latinx-serving may be ways that we can create pathways and show students
what their possibilities are for their career.”
The staff and faculty were also asked a similar question. R5 also was not aware of any
partnership or collaborative work: “I don't know what we're currently doing in the community.
This is an area that we haven't done so well as a university, and we need to strengthen this
community outreach and develop some pathways for our students.” R6 responded, “Create
pipelines starting out with community college and high school and into the elementary schools.”
R7 was not able to comment, stating, “I think that's exactly where we're at right now, so we're
actually having those discussions right now.” R8 mentioned, “I think the idea that the DEI
committee had to reach out to Hispanic-serving institutions is probably a good start.” R10 said,
“I would say your educational entities K through 12 and any colleges within the facility right, so
any college, it has a high percentage of the student population in which you're desiring to
increase your numbers.” R11 thought they needed to do a “better outreach” and felt, “all the
information that we find when we're doing these studies is to take a deeper dive in the
community, making sure that we do a better job.” R12, in contrast, said, “I don't think any that's
established, yet I think that's part of our long-term, mid-range goal. You have to actually
physically go out to these communities and start making and developing relationships.” R12
responded, “This is who we are, what we're about are you interested in healthcare and coming

193
back and working in your community.” R13 felt “probably the high school counselors are in the
community college counselors would be the place to plug in there. And then hire some Latinx
people for admissions.” R17 stated, “The organization PAEA had a virtual pep rally, and the
whole goal of it was to get PA programs to intentionally recruit. And so, they gave us a lot of tips
and guidelines and resources.”
The students were also interviewed on their thoughts about partnerships and collaboration
efforts in recruitment planning, and R14 said, “I haven't been involved with any kind of drive or
any kind of school thing to recruit anything like that.” R14 continued, “I think it's good,
especially for young people, for them to see someone they can see themselves as ‘if he did it, I
can do it because I got motivated.’” R15 stated, “I do try to reach out to the Community through
my social media. I spoke about my own experiences, and I gave them a motivational speech to
keep going.” She also mentioned, “Oh, yeah, there's opportunities, but our school has been really
good with trying to reach out to students via preview days.” R16 said, “I can't say that we've had
any. I do think that if a minority group reached out to them like a pre-PA group, they would have
their own session for them if they want it.” Emerging themes related to the cultural setting in
establishing new partnerships are listed in Table 66.

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Table 66
Emerging Cultural Setting Themes, Establishing Partnerships
Theme description Textual evidence
Highly selective programs can lead to an
organization to look at diversity.

The MSPA program is the most selective program at
HU.

Limited seats provide a good first step to look at
diversity within the program.
Vocational schools may help expose
students to the PA program.
Exposing students from vocational schools can
increase program exposure.

Other program such as certifications or specialized
training such as ROTC can help extend the
exposure of the PA program.

Document Analysis Results. There were a few documents that were found relevant to
the cultural setting in providing objective evidence of collaborative partnerships. One document
was a promotional flier for a webinar in the DEI series offered by the Interprofessional
Education Department. The event promoted how healthcare and health practitioners can create
an inclusive and safe environment for the LGBTQ community. Another collaborative partnership
within the department was through the DEI faculty training through the CFDE, providing a
sustainable academic culture where faculty have the time and tools for reflection and assessment.
Although the DEI training through CFDE was jump-started for the MSPA program, it was
shared across the campus to bring awareness to the HU community about initiatives in promoting
diversity within programs. There was no documentation providing evidence of HU’s engagement
externally with partnerships occurring around the community within the vicinity, such as
working with hospitals, medical centers, and underserved communities.

195
One of the students in the MSPA program shared a website providing ways universities
have helped increase minority admissions. One of her sorority sisters who created the
organization started the website, which is currently focused on supporting Black physician
assistants. The student mentioned this website allows her to connect with people who look like
her and are already working in this field. She mentioned it provides mental health check-ins for
PA students, providing good mentorship. One of the services offered on this website helped the
student with their essay to get into PA school and offered mock interviews for preparation. This
is one example of an opportunity HU can form a partnership to direct students who can benefit
from these services to foster interest in this career path in groups of individuals that are not well
represented in the MSPA program.
Summary. The results indicate the cultural setting within the organization of establishing
partnerships to help with recruitment planning for minorities is validated as a need for the
administration. Although the administrator’s response was positive, the interviewees did not
describe any concrete evidence that a partnership was in place to assist in this effort. The staff
and faculty also agreed, and generally there is strong support for exploring partnerships around
the community. A few staff and faculty members felt the need to engage in more outreach
programs; however, there was no evidence that this has occurred from the interviews at HU.
In contrast, the student response had an extremely low response in support of establishing
a partnership. One student seemed to recruit on her own by promoting the HU MSPA program
through her social media outlet and not through the administration or the faculty and staff of the
program. The documentation analysis shows evidence of promoting diversity seminars for
students as well as diversity seminars and training for faculty and staff. One student also
provided an external link from the HU MSPA program that helped with her application to PA

196
school. The results found from the survey, interview, and documentation analysis validated the
organizational influence in the cultural setting to establish partnerships that will help increase
minorities to the MSPA program as a need.
Influence 3: The Organization Needs Alternative Criteria for the Assessment of Minority
Applicants
Survey Results. In this evaluation, the cultural setting was explored for policies and
procedures as they relate to the application of alternative criteria in the assessment of minority
applicants. The survey item asked if the participant engaged in the practice of utilizing
alternative criteria in the assessment of a minority applicant. The survey indicated a low response
in agreement for the administrators of 40% (Table 67). The staff and faculty also shared a similar
response rate, with 45% in favor (Table 68). The students were not asked this question since they
do not participate in the assessment of new candidates. These results indicate that there are
limitations in the application of the use of alternative methods to evaluate an applicant to the
MSPA program.

Table 67
Administration Survey Results for Cultural Setting Influence 3
Survey # Survey item Count Percentage
Q20

There are alternative criteria that we can
use to assess a minority applicant in
the recruitment process.
5 40%

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Table 68
Staff and Faculty Survey Results for Cultural Setting Influence 3
Survey # Survey item Count Percentage
Q20

There are alternative criteria that we can
use to assess a minority applicant in
the recruitment process.
11 45%

Note. One respondent did not complete the survey.

Interview Results. The survey was supplemented with an interview question on the need
for alternative criteria. The question is based on Patton’s (2015) advocate-adversary principle.
This advocate-adversary approach was applied to study how the principles established by the
institution advocate alternative methods using alternative criteria in the evaluation of a minority
applicant in the recruitment process. The question here asked whether the organization has
admissions policies that allow for alternative criteria for the recruitment of minority applicants. If
so, they were asked to describe how effective these policies are at facilitating the recruitment of
Latinx students. This question was designed as an open-ended question to understand if there are
any alternative options (resources) for the participant to consider during the recruitment of
Latinx students.
The Use of Alternative Criteria. The results from the senior administrators are as
follows. R1 stated, “The recruitment guidelines are set by the accreditor. We can't waive the
chemistry requirements, for example, or whatever the number of credit hours coming in. We
cannot waive those.” R2 said, “I'm not aware of any specific.” R3 responded with, “I’m not
familiar enough with our admissions policies to really comment on that. I know that from an

198
administrator perspective we're open to it.” R4 shared, “We have admissions policies that allow
for students who come with a different set of academic or professional background. It is up to the
faculty of the program whether they choose to participate in those admissions policies.” R9
mentioned the challenges by the accreditors to pursue diversity initiatives: “Our PA is one of the
stricter accreditors and as a university, we would be fine, looking at the admissions requirements
and especially being data-driven.”
When asking faculty and staff about alternative criteria, R5 stated, “Not at all because the
accreditor dictates what is required and we have to adhere to the accreditors requirements for
admission standards.” R6 mentioned, “No, and that probably has more to do with the PA
program in the accreditation process to fair practices in admissions. We could do it, but it has to
be published.” R7 responded, “Actually, right now, we do not have that.” R8 also responded,
“We did not.” R10 stated, “I am not certain if, institutionally, we have that.” R11 provided
feedback: “We have criteria that our PA setup that we have to follow. They have standard
minimums that we have to follow.” R12 was not clear: “I'm not sure if there's an official
university policy or not.” R13 also stated, “I don't know, but since we don't have any criteria for
anybody, other than PA, I don't think it really matters.” R17 also felt the same way, “I'm not
aware that there is anything like that, at this time, and I know there's nothing for PA like that.”
Finally, the students were asked about their unique attributes that brought them in the
program besides their GPA, and R14 responded, “I've been working in healthcare since I was 18
years old. After that, I worked in a hospital for a long time.” R15 stated, “I would say my life
experiences, such as being an immigrant. I've always had perseverance and resilience and when
it comes to challenging situations and overcoming obstacles, I feel like those define me as an
applicant.” R16 commented, “I was a personal trainer before PA school, so I think that they like

199
to have people in the program who come from all different walks of life. I'm very passionate
about being a provider that can bring awareness to help my patients.”
The Effectiveness of Current Policies. When asking how effective current policies on
acceptance criteria were, R1 stated, “I’m not sure if I'm up to date on the current policies they got
actually in place there, but I haven't sense that we've got a problem generally in selecting and
vetting Latinx students.” R2 said, “I want to give the program faculty and directors the flexibility
to really work within their programs rather than make blanket policies across the board.” R3
said, “I really don't have a frame of reference on that. I don't know if they are effective or not.”
R4 stated that in other programs, “if a student doesn't have all the prerequisites, we success
modules and the students can demonstrate that they have the skills or the capacity to succeed.
We recognize that there's students who haven't gone through a traditional academic path.” R4
mentioned, “Up at the top I've only been there, like 2 years and 5 months, so a lot of this is very
new. Within the last year, we don't have a lot of data so it's very hard to know how effective it's
been.” R9 said, “I'm not positive for MSPA, but I know that for chiropractic we've had an
alternative track for entry into the program. If that's something that could benefit Latinx students
in the PA program would be great.”
When faculty and staff were asked about how effective current policies are in the
recruitment of Latinx students, R5 shared, “I think they're good. We've been pretty good for us
because we've constantly exceeded our goal of recruiting Latinx students.” R6 responded,
I think they're effective. It does make you look at your process, I can’t say I’m going to
take all Latinx applicants, but it does make you look at “am I treating them fairly?” One
thing I've been learning in this DEI space is ways a lot of things are written. And the
applicant process can be exclusionary of Latinx.

200
R7 stated, “I think this is the time frame we're looking at all the criteria to see if there are ways,
we can be more inclusive. Would that negatively affect us or would it positively affect.” R8
stated, “We don't have specific procedures in place for recruitment in general, but we have
specific admissions criteria in place that applicants need to meet.” She added, “The admissions
criteria may be preventing us from enrolling a higher percentage of minorities. It's hard to tell if
it's a pipeline problem or if our admissions process is actually weeding out those applicants.”
Since R10, 11, 13, and 17 stated they were not aware if there were any criteria, there was
no follow-up with the current criteria on their effectiveness. R12 responded with, “having
different standards or lower but different standards for different communities or different
ethnicities would increase the amount of applicants, but would they be successful? That's kind of
our main overarching goal.”
The students were then asked to describe how some of the attributes can help with
increasing diversity in the PA program, and R14 responded, “I think they could help increase
diversity in the program because you will be getting people from many different walks of life.
R16's response was that “I actually became the diversity chair for my class, so it was supposed to
be a way for us to just come together and really just talk about different cultural differences and
similarities,” indicating that her strong leadership skills may have contributed to an attribute that
made her highly selective for the MSPA program. Table 69 captures the emerging themes in the
cultural setting on the needs of alternative criteria.

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Table 69
Emerging Cultural Setting Themes, Alternative Criteria
Theme description Textual evidence
We need to do a good job of setting the
admission standards so they're high
enough that we're confident the
student will be successful.

Students that do not demonstrate a good chance of
success will lead them into debt with student loans.

The challenge is to avoid barriers that block students
that have a chance to succeed.

Expectations must be high enough to guarantee
success, but low enough to provide a fair
opportunity.
Look at standard practices of the Song
Brown Workforce Taskforce in
recruitment strategies.
The Song Brown Workforce Task Force is an office of
statewide policy and planning that helps support the
recruitment and training of underrepresented
minorities

The program can be eligible for $200,000 of funding
cycle.

Underrepresented minorities are tied to a lot of grant
funding, state and federal because they know there's
a need for us to recruit and retain those students.
Interviews can be a ground to identify
characteristics unique to
underrepresented minorities.
In the interview, the program wants to learn more
about the student.

Invest in students with GRIT and distinguish a student
reading about grit from a person who is living grit.

Questions about grit is where the student can get to
personalize their life.

Document Analysis Results. There were no documents available to assess alternative
criteria for the assessment of minority applicants in the MSPA program. There were no
alternative criteria practiced or implemented. A staff member of the MSPA program provided
data that was collected from CASPA, which was evaluated for each class starting with the class

202
of 2018, which was the first class enrolled. The percentage of applicants received was divided by
every minority group. They also looked at the percentage of students that applied, the percentage
that did not meet requirements, the percentage that were interviewed, and the percentage that
matriculated. She mentioned that 14.5% of the applicants for the first class were Hispanic, but
only 9.6% of applicants were interviewed, and then only 3.8% of the people who matriculated
were Hispanic. It was noted in the documentation that a larger percentage applying drops off
throughout the pipeline. There are factors in the pipeline that were raised, such as not
interviewing to HU’s expectations or choosing not to matriculate with HU for a reason not
shared with the university.
In the class of 2019, 17% of applicants were Hispanic and were kept in the interview
process at 17%, and then 25% were matriculated, meeting the targeted goal of increasing beyond
18%. In the most recent performance, 19.5% of applicants were Hispanic, with 18.2%
interviewed, and those who matriculated were 18%, achieving their goal of greater than 18%. It
is not clear if there is a pipeline problem and what factors may be associated with it, but the
organization is utilizing data-driven analysis as a resource to closely monitor the pipeline without
the need for alternative criteria in place. The staff member did mention that the data was cleaned
by standardizing it to how CASPA views the definition of ethnicity and race. In CASPA, there is
a selection for Hispanic and then different types of Hispanic. For example, R7 indicated,
If you looked at the breakdown of Hispanic, it would say yes. So, let's select no. It would
not be filled out at all for Hispanic overall. But then it would say yes to Mexican. So, I
would go back and say yes to the Spanish because, obviously, if they're saying yes to
Mexican, they are, yes to Hispanic. That happened, also to some Asian applicants. They'd
say yes to Filipino, but it would be unchecked as Asian and so I would just clean it up

203
and check it as Asian. There were several individuals who identified as Filipino, and they
put that under Pacific islander but under CASPA it's considered Asian.
Tables 70–76 indicate the data points discussed in the interview and the statistics within the
cohort since the program's inception.

Table 70
HU Analysis on Applicants Matriculated in the MSPA Program
Ethnicity 2018 2019 2020 2021 2022
Hispanic 3.8% 25% 10.4% 12% 18%
American Indian 3.8% 2.8% 0% 0% 2%
Asian 34.6% 25% 37.5% 37.5% 48%
Black 7.7% 0% 2.1% 2.1% 6%
Pacific Islander 0% 0% 0% 0% 0%
White 53.8% 50% 43.8% 43.8% 38%

204
Table 71
HU Analysis on Total Applications to the MSPA Program
Ethnicity 2018 2019 2020 2021 2022
Hispanic 14.5% 17% 16.5% 16.5% 19.5%
American Indian 1.5% 1.6% 1.2% 0.7% 1.7%
Asian 29.3% 29.8% 27.5% 29.8% 31.4%
Black 7.1% 5.7% 7.2% 7.2% 7.2%
Pacific Islander 0.6% 0.6% 0.7% 1.0% 0.7%
White 51.1% 50% 53.2% 55.1% 53.6%

Table 72
HU Analysis Application Process vs Census Population for 2018
Ethnicity M
a
I
b
NI
c
NA
d
TA
e
P
f

Hispanic 3.8% 9.6% 17.5% 21.1% 14.5% 17.6%
American Indian 3.8% 1.9% 1.5% 1.5% 1.5% 1.7%
Asian 34.6% 27.9% 31.8% 25.3% 29.3% 6.4%
Black 7.7% 6.7% 0.7% 17.0% 7.1% 13.9%
Pacific Islander 0% 1.9% 1.0% 2.3% 0.6% 0.4%
White 53.8% 56.7% 46.6% 55.5% 51.1% 75.8%

a
M=Matriculated,
b
I=Interviewed,
c
NI=Not Interviewed,
d
NA=Not Accepted,
e
TA=Total
Applicants,
f
P=Population

205
Table 73
HU Analysis Application Process vs Census Population for 2019
Ethnicity M
a
I
b
NI
c
NA
d
TA
e
P
f

Hispanic 25% 17% 15.8% 34.2% 17% 17.8%
American
Indian
2.8% 2.0% 1.0% 3.2% 1.6% 1.7%
Asian 25% 29.4% 28.1% 34.5% 29.8% 6.5%
Black 0% 5.9% 4.8% 8.1% 5.7% 14%
Pacific
Islander
0% 0.7% 0.6% 2.1% 0.6% 0.4%
White 50% 49.7% 52.7% 42.6% 50% 75.4%

a
M=Matriculated,
b
I=Interviewed,
c
NI=Not Interviewed,
d
NA=Not Accepted,
e
TA=Total
Applicants,
f
P=Population

Table 74
HU Analysis Application Process vs Census Population for 2020
Ethnicity M
a
I
b
NI
c
NA
d
TA
e
P
f

Hispanic 10.4% 10.4% 15.4% 21.4% 16.5% 18.1%
American
Indian
0% 0.9% 1.1% 1.7% 1.2% 1.7%
Asian 37.5% 39.1% 26.6% 27.1% 27.5% 6.6%
Black 2.1% 3.5% 6.3% 11.3% 7.2% 14.1%
Pacific
Islander
0% 0% 0.8% 1.0% 0.7% 0.4%
White 43.8% 50.47% 56.6% 43.6% 53.2% 75.1%

a
M=Matriculated,
b
I=Interviewed,
c
NI=Not Interviewed,
d
NA=Not Accepted,
e
TA=Total
Applicants,
f
P=Population

206
Table 75
HU Analysis Application Process vs Census Population for 2021
Ethnicity M
a
I
b
NI
c
NA
d
TA
e
P
f

Hispanic 12% 17.9% 14.7% 17.1% 16.5% 18.3%
American
Indian
0% 0.7% 0.9% 0.6% 0.7% 1.7%
Asian 24% 28.8% 30.7% 29.6% 29.8% 6.8%
Black 10% 6.2% 5.8% 8.4% 7.2% 14.1%
Pacific
Islander
2% 1.5% 0.8% 0.9% 1.0% 0.4%
White 54% 54.4% 56.1% 54.3% 55.1% 75.1%

a
M=Matriculated,
b
I=Interviewed,
c
NI=Not Interviewed,
d
NA=Not Accepted,
e
TA=Total
Applicants,
f
P=Population

Table 76
HU Analysis Application Process Versus Census Population for 2022
Ethnicity M
a
I
b
NI
c
NA
d
TA
e
P
f

Hispanic 18% 18.2% 20.5% 19.3% 19.5% 18.0%
American
Indian
2% 0.5% 1.8% 2.0% 1.7% 1.7%
Asian 48% 37.4% 31.1% 29.6% 31.4% 6.6%
Black 6% 2.5% 6.1% 9.4% 7.2% 14.0%
Pacific
Islander
0% 0% 0.5% 1.2% 0.7% 0.4%
White 38% 48.5% 54.8% 54.3% 53.6% 75.3%

a
M=Matriculated,
b
I=Interviewed,
c
NI=Not Interviewed,
d
NA=Not Accepted,
e
TA=Total
Applicants,
f
P=Population

207
Summary. The results show the organizational influence around the cultural setting in
the need for alternative criteria for the assessment of minority applicants is validated as a need
for the administration. However, the administrator’s response was very low and was very close
to the staff and faculty. The interviews confirmed this finding by highlighting the challenges to
following the standards and increasing diversity in the program. Since there are standards in the
accreditation for the MSPA program, alternative methods in the assessment of minority students
is not practiced. A few staff and faculty members went as far as to describe the process that may
be preventing potential minority students from moving through the admissions process and have
alluded to the move to a more holistic approach. Documentation analysis shows the performance
of Latinx student matriculations for a variety of cohorts indicating inconsistencies in the process.
Altogether, there is evidence that leads to the conclusion that there must be a mechanism to
better facilitate the evaluation of a Latinx minority student through the admissions process. Thus,
this finding validates the cultural setting for alternative criteria in the assessment of minorities as
a need for the administration.
Influence 4: The Administration Needs a Willingness to Change in Relation to Periodic Audits
of Recruitment Plans
Survey Results. In this assessment, the administrators were asked about periodic audits
in the recruitment process to understand the depth of the cultural setting. The survey item asked
if the administration participated in audit plans necessary to revise procedures for recruitment
planning. There was a lower response rate in agreement of 40% (Table 77). It was slightly higher
for staff and faculty at 55%, but overall, fairly low (Table 78). The students did not participate
since they were not involved in periodic audits of the recruitment plans. These results indicate

208
that there may be a lack of processes in the organization that prompts the organization to
continuously evaluate its recruitment plans to improve strategies and techniques in recruitment.

Table 77
Administration Survey Results for Cultural Setting Influence 4
Survey # Survey item Count Percentage
Q21

There are audit plans we follow to
continually revise procedures in the
recruitment plan when necessary.
5 40%

Note. One respondent did not complete the survey.

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Table 78
Staff and Faculty Survey Results for Cultural Setting Influence 4
Survey # Survey item Count Percentage
Q21

There are audit plans we follow to
continually revise procedures in the
recruitment plan when necessary.
11 55%

Note. One respondent did not complete the survey.

Interview Results. The survey was supported with an interview question related to
periodic audits of the recruitment process. The question is based on Patton’s (2015) experience.
This experience approach was applied to study how often the participant engages in a reflective
type of process. The question was two-fold in series with the first one addressing their level of
engagement in periodic audits and the second question on their focus of areas to improve
periodic audits. This question was designed as an open-ended question to determine if the
participant engages in periodic audits of recruitment plans.
Engaging in Periodic Audits. When the senior administrators were asked about engaging
in periodic audits in the recruitment planning, they responded as follows. R1 stated, “I don't
directly, no.” R2 stated, “I specifically don't.” R3 also stated, “ I have not done any of that
work.” R4 also confirmed for senior administration:
We don't do periodic audits. We have something we call a pre-enrollment planning
process; we look very carefully at our admissions goals. Every year, then we look weekly
at how we're doing against those admissions goals, but they tend to be about the

210
enrollment funnel, and they are not, at this time, focused on recruiting any particular
population.
R9 also was not aware of periodic audits: “I don't know if they do or not it's not anything that
I’m in.”
When the faculty and staff were asked about their engagement in periodic audits,
interestingly, R5 confirmed, “We do it annually at the faculty retreat.” R6 stated, “Well, we don't
call them audits. We do a review of our admissions and recruitment process.” R7 stated, “I
would probably say at minimum every 3 months we're checking in and evaluating criteria and
processes, reevaluating our goal our mission.” R8 said, “that might be a better question for the
actual admissions team. I'm not really involved in the actual admissions department,” which
indicated there may be a disconnection between the admissions department and the PA
department.
R10 stated she does not participate in periodic audits. R11 indicated, “All the faculty
members are engaged in the recruitment planning, the tools, looking at the interview, the
candidates from start to finish.” R12 stated, “We're changing. Our team with applicants does
three or four interview sessions a week for about 3 or 4 weeks and again there's a debrief at the
end of each one” but was not consistent with a periodic audit of the process, just describing the
process of interviewing candidates. R13 stated he does not participate in periodic audits. R17
stated that she does not engage in periodic audits, but others in a different department do: “I
know one criterion that we were looking at for a grant.”
Areas of Improvement for Periodic Audits. When the senior administrators were asked
about three areas of improvement they would focus on for periodic audits, R1 stated,

211
I think audits are fine, but we do have a challenge with actually getting to our data and
making sure the data is accurate. It's taken me 6 years to understand the value of business
intelligence, the value of having informed evidence to help us drive decisions and make
adjustments.
R2 stated, “In the recruitment planning we're always looking at the accreditor standards change
about recruitment. We're always looking at our processes. We're always checking our
recruitment strategies.” R3 did not have any input to recommendations on periodic audits. R4
mentioned, “Certainly if we were to add some more analysis around our ability to be an inclusive
environment, that's one area. We do already look at whether or not our student population is vis-
a-vis the national population.” R9 described the admissions funnel a stage process that goes from
inquiry to application to accepted, and stated, “I look at the average conversion, what percentage
proceeds from one step to the next step by ethnicity. Maybe there's something that we're not
aware of in our process which is not equitable.”
When faculty and staff were asked about three areas of improvement, R5 stated, “I would
say more investment in creating that pipeline to community colleges. I would say putting more
effort in going to these universities and participating in them.” In regard to the faculty retreat,
when R5 was asked how often colleagues are engaged, he stated, “All faculty are required to
participate. It's part of the standards that faculty retreat needs to occur. All of your principal
faculty need to be engaged in the conversation so it's a requirement, so I'd say 100%
engagement.” R5 confirmed if that would include faculty and administrators and stated, “In some
instances, yes.” R6 stated, “We haven't been intentionally recruiting and we need to do that. The
institution hasn't done it because we have such a large applicant pool, and they don't have a

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problem filling their class.” She also stated, “We do a better job if we get the resources from the
institution to market and to intentionally recruit.”
R7 stated, “I don't think we're well-known right at this point. So, whether it's advertising
marketing or getting directly involved doing more pre-PA events or going to more schools. I
think that would be one area we could improve.” R7 stated, “More support for our students,
whether that scholarship or better financially,” suggesting help with housing.” R8 mentioned,
“One is transparency and having an actual plan set forth by the university and then having the
resources, both time and monetary to fulfill any recruitment plans and the clear outline of who is
responsible for that.” R11 mentioned, we revamped our mission. Maybe we can start this process
a little bit earlier. I can't really say three things.” R11 mentioned the admissions leader has
already looked at the “holistic review” and “revamped our interview scenarios,” and “we've
revamped our rubrics in terms of grading them.” R12 mentioned, “I don't know, because we're
not really looking at ethnicity. Maybe that's something that we should kind of put higher on our
radar list.” Since R13 did not participate in periodic audits, the follow up question of
improvement to the process was not asked. R17 stated, “different departments need to
collaborate a little more and take in the information that's given so if PA was more aware of the
statistics that admissions got and vice versa, I think that that would be better.” Another
suggestion offered by R17 was “Taking an intentional look at the applicants and trying to
increase that diversity … with Community outreach or different areas.” She stated for the last
one, “to just constantly really keep taking a look at things, comparing it from cycle to cycle.”
The emerging themes are listed in Table 79 as it relates to the cultural setting on the willingness
to change periodic audits.

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Table 79
Emerging Cultural Setting Themes, Periodic Audits
Theme description Textual evidence
The university has to set goals. More clear direction from the University is needed on
the recruitment goals.

The University can't just set goals and never talk to
the program.

Collaboration between the actual university at large,
and then the program’s individuals is important.
Students are evaluated based on their
high school performance.
Evaluate if the student went to a high school that was
underserved or underrepresented.

Evaluate if the student went to a high school that
didn't have a certain percentage of students that
graduated from high school.

Evaluate if the high school have the same resources as
other high schools.
Having awareness of student perception
of the university’s criteria might
encourage applicants.
Applicants look for certain criteria online that may
encourage them to apply.

There's a lot of group chats on social media about PA
school, one of them known as the PA board.

Understanding the program’s negativity through
online social media can make the PA program
aware of how to improve.

Document Analysis Results. There was no documentation related to formal periodic
audits that were documented or assessments of the recruitment process. It was clear from the
interviews that there is no practical process supporting periodic auditing. The HU institutional
plan indicates that the faculty performance assessment process was updated to support the
increase in scholarship and research. However, this does not indicate the process related to the

214
recruitment process is considered. The institutional plan does have a generic clause indicating the
development and implementation of an annual review process, as well as rewards and
recognition to align with values. Moreover, interviews support the 100% participation of faculty
and staff members at the annual faculty retreat, which may be used to align according to the
institutional plan and how it relates to the MSPA program.
Summary. The results for the cultural setting within the organization in the willingness
to change in relation to periodic audits show it is validated as a need for the administration. The
administrator’s agreement response was very poor, indicating there is no formal process that
provides an opportunity for a periodic audit. The staff and faculty responded with mixed results
indicating in some parts of the interview that periodic audits happen at faculty retreats and others
refer to periodic audits as a review of the admissions and recruitment process and, in some cases,
unbeknownst to them of a periodic audit existing. The review of documentation analysis did not
provide any document related to periodic audits of the process, but the institutional plan did state
a generic clause in having an annual review process to ensure programs, in general, are aligned
with the organizational values. There was nothing concrete in the documentation of periodic
audits and the willingness to change the process to help facilitate the intake of Latinx students.
Thus, the organizational influence in the cultural setting of having periodic audits of the
recruitment process is validated as a need.
Influence 5: The Administrators Need the Sociocultural Interactions to Overcome
Socioeconomic Determinants in the Context of Developing a Recruitment Plan
Survey Results. In this final survey question, the cultural setting was examined to
understand the level of sociocultural engagement the participants have in overcoming
socioeconomic factors and how it may affect the development plans for recruitment. The

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administration felt 80% agree that there are socioeconomic determinants at play in the Latinx
community that must be considered in the development of recruitment planning for Latinx
students (Table 80). The staff and faculty shared the same point of view, scoring 82% in
agreement (Table 81). The students were also asked the same question to understand if their
perception is viewed in a similar way, and they responded with 71% in agreement that these
socioeconomic determinants affecting the Latinx minority communities should be considered in
recruitment planning (Table 82). These results indicate the organization is in agreement for the
most part in setting the environment to consider socioeconomic factors and determinants in the
development of recruitment planning.

Table 80
Administration Survey Results for Cultural Setting Influence 5
Survey # Survey item Count Percentage
Q23

There are socioeconomic determinants in
the Latinx community that I must
consider in the development of a
recruitment plan for Latinx students.
5 80%
Note. One respondent did not complete the survey.

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Table 81
Staff and Faculty Survey Results for Cultural Setting Influence 5
Survey # Survey item Count Percentage
Q23

There are socioeconomic determinants in the
Latinx community that I must consider in
the development of a recruitment plan for
Latinx students.
11 82%

Note. One respondent did not complete the survey.

Table 82
Student Survey Results for Cultural Setting Influence 5
Survey # Survey item Count Percentage
Q15

There are socioeconomic determinants in
the Latinx community that must be
considered in the development of a
recruitment plan for Latinx students.
21 71%

Note. One respondent did not complete the survey.

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Interview Results. The survey was further supported with interview questions on the
sociocultural interaction of HU administration overcoming barriers that minority students
experience in the recruitment process. The question is based on Patton’s (2015) opinions
principle. This opinion approach was applied to study the cognitive and interpretive process of
people in their thoughts and opinions. The question followed a three-step series in asking them
how they overcome socioeconomic determinants in recruitment planning, followed by how
socioeconomic determinants affect the recruitment process, and the last question on if there was
an opportunity for improvement in considering these socioeconomic determinants, what would
they focus on. This question was designed as an open-ended question to determine if the
participant was able to describe the level and depth of understanding the challenges and barriers
associated with Latinx minority communities.
Overcoming Socioeconomic Determinants in Recruitment Planning. In the first
question of the series, the senior administrators were asked how they overcome socioeconomic
determinants in recruitment planning, R1 suggested, “We haven't done a whole lot of tuition
discounting that can be pick up. Whether they're funded by us or $1,000 to fund them, I think
some of those things we picked up.” Another item R1 suggested was to “allow part time for this
particular Latinx where work is almost critical to a lot of people who also want to be students to
uplift their lifestyles. We still are only attracting those students who can really commit full time
and that can be challenging for the cultural aspect of Latinx.” R1 indicated that there are
limitations to what the accreditation allows and hopes to “build a more open minded” approach
with the accreditor, but “we can't do a part time program, but I don't believe when I read all the
rules and regulations, there was a part time option in there.” R2 mentioned, “Grant opportunities,
that would help us with the infrastructure. Financial aid aspect, both internal and external

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through the federal government. These are ways in which we can specifically combat that
deterrence, of the social economic impact of underserved communities.” R3 stated, “that's a hard
one for me to answer because I'm not really involved in the recruiting plan.” R4 stated, “I don't
have a good answer, because with PA, you got thousands of applicants. Success modules. We
don't rely upon standardized tests, it's a lot more about the university and our academic leaders
developing relationships with other institutions.” Senior administrator R9 mentioned, “Tuition is
very expensive at any program, especially graduate programs. They're like, how am I going to
pay for this? I do think that's probably a big barrier.”
When the faculty and staff were asked about how they overcome the challenges of
socioeconomic determinants in recruitment planning, R5 mentioned, “We do have scholarships.
We actually have a new scholarship that's focused on diversity as well, so we do have a
mechanism for folks. If they do get accepted into the university that can help them with costs.”
“R6 responded, “I would say the biggest one is making sure the financials are easy.” R7 stated,
“I don’t think at this point in time, that there is discussion or if it's used in our decision making.
We do not at this point in time.” R8 stated,
We have certain prerequisite courses that all applicants have to have completed prior to
enrollment in the program, but we don't have any preference for like for your universities
versus community colleges. I think that helps us to not unintentionally deter people from
lower socioeconomic backgrounds from applying.
R10 stated, “I can't respond to that because I'm not directly involved in that recruitment process
at that level.” R11 shared, “I got to be better in terms of making sure that the seat that I have is
done well. We're in the seats that we can effect change." R12 stated, “I don't think I’m aware of
them necessarily.” R13 said, “I don't have anything to do with recruitment planning.” R17 stated,

219
I think, making the students applicants, or whoever, whatever the group is making them
feel comfortable that they can share whatever is happening to them. Then, you can
resolve the issue so if it's a financial issue, counseling. The barrier is letting them know
that they can be comfortable asking questions, and I think a lot of times they're just very
nervous to even ask me a question. If you don't fit this criteria, you're never going to be a
PA and that's just not true, you know.
Socioeconomic Determinant Impact in Recruitment Planning. In the second question of
the series, the senior administrators were asked how the socioeconomic determinants affect the
recruitment process for the intake of Latinx students. R1 address underrepresented and
underserved minorities, “There’s financial constraints there. With Latinx, you bite into a cultural
issue, they do not like borrowing money. We’ve got to think about more scholarship or grant
structures and discounts to help facilitate that better. R2 also echoed the issue of access to funds,
“It's expensive. Can they have access to the financial aid or qualify for GRAD plus loans, which
becomes much more difficult to get. Grants that help with the tuition would help.” R3 stated,
“We do have financial aid available through the federal government that is sufficient for a
student to come and enroll at HU and participate in the program. In terms of addressing
economic disadvantages, we're in pretty good shape.” R4 focused more on information
accessibility: “Make sure that it's a family friendly enrollment process to make sure that there
were bilingual materials available even having a bilingual financial aid person. It helps the
students bring their family into the discussion.” R9 mentioned, “Talking to the financial aid team
early on to understand how you can get loans. You may be going into a lot of debt for this
program to make a ton of money. Educating people is important.”

220
When the faculty and staff were asked about how socioeconomic determinants affect the
overall recruitment process, R5 felt, “I don't think it affects us, because we have a lot. I'm
assuming that out of those 2,000 we have a significant amount of Latinx students, but I don't
know what the statistics are for that.” R6 said, “They will decline. So, the money has to be there.
They can't get the money. You lose them.” R7, stated, “We just have financial aid. We don't have
additional things to offer like scholarships and we've found that to be a huge barrier for our
students.” In contrast, R8 stated, “We do have several, they're called HRSA [Health Resources
and Services Administration] indicators that are available for review on the CASPA application.”
R10, stated, “I am not intimately involved in this particular process. HRSA speaks to
socioeconomic backgrounds and so that criteria are a consideration for our admissions process.”
R11 felt socioeconomic determinants will impact a Latinx student and so victories are
celebrated: “We are very cognizant of what it took for them to get to the seat and then we're also
looking for me to celebrate like say first-gen DACA.” R12 responded,
PA school is not cheap. Living in southern California is not cheap. The financial aid
packages weren’t enough to live because this is Southern California. The cost of living
here is horrible. There was a veteran that was kind of getting the short end of the stick
from the financial aid side and he didn't have much to eat. I mean, we saw him lose
weight over the semester and we put together collecting and got food and just took it to
him, and that's what we were kind of talking about having some of the grant money for
an emergency fund. That's a very important factor.
R13 stated, “Well they're going to pay tuition. So, the more money you have to help you
just pay tuition. Maybe it could lead to some financial aid for some students.” R17 said felt it
was miscommunication from the student to better understand their problem: “The barrier is that

221
students or applicants don't want to tell the university what's going on with them. Understanding
cultural differences and making sure that you're open and available and helpful. Not judging
negatively.”
Improving Socioeconomic Determinants in Recruitment Planning. The last question in
the series asked the senior administrators what they would focus on if there was an improvement
in considering socioeconomic determinants. R1 mentioned, “In our case, probably the tuition
discount. They would be probably the path I would head down most easily. In addition, R1
mentioned forming “partnership” between the student, the family and HU for grants discussion
and assess any financial stress they may have. R2 shared, “Getting into the communities where
we can show a more diverse professional. Helping with the grants and tuition assistance and to
help them on each step along the way, whether it's academic or financial.” R3 stated, “It would
be great to have scholarship or grant money available. There may be scholarship opportunities
available for the students who could apply to independent scholarships.” R4 stated, “It's much
more about partnering with the right institutional or community organizations. If you have those
kinds of partnerships, can you spark in somebody earlier in their academic career that they have
a pathway to become a PA.” R9 indicated, “Maybe financial literacy. Being financially healthy
and savvy that's probably something that would benefit all our students to look at. Financial
health and success in the future.”
When the faculty and staff were asked what they would focus on when considering
socioeconomic determinants, R5 stated, “I would just hope that all students, like Latinx students,
would have the means to apply. Have the funding, to apply and if not, maybe we develop a
mechanism for them.” R6 stated, “Scholarships! Making sure they knew about the National
Health Service Corps.” She described that the corps helps students after they graduate: “They

222
can get a lot of their debt canceled so they'll go and work in like a 50 federally qualified health
center. So, identifying those kinds of opportunities and making them available.”
R7 mentioned, “I definitely think more resources and support for our students. My first
concern would just be financial support for our students and how we can support them.” R8 said,
“You tend to have greater diversity in universities or programs who use holistic admissions
where they don't do scoring like we do, but they do an actual comprehensive review of the
application from the very beginning.” R10 shared, “We have to be intentional, and we have to
have the appropriate personnel to adequately engage with the student population and or those
organizations that support them that we would like to see in our program.” R11 focused on
increasing awareness to the public and faculty representation: “We don't have the visibility to
where am I looking. I’m recruiting over here but everybody's over there. Making sure that we
have representation on the faculty who shares my commonalities.” R12 said, “I think I've just
honestly thought that you know financial aid will take care of that.” R13 said, “The more
information we can find out about our students, the better. Provide more resources for them to
help out in advising and in our studies of trying to figure out what went wrong.” R17 stated, “I
would want to know what the information is for myself. What was the money? what was the
parental education? Maybe even have them write an essay about what brought you here and what
got you this far.” R17 also stated, staff members should be more aware of the cultural
background of the students, “whatever the situation is don't bring in their own biases or their own
experiences. Listen to whatever the issue is first and then try to address it in a helpful polite
professional way.”
Emerging themes related to the cultural influence on sociocultural interactions to
overcome social economic determinants were captured in Table 83.

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Table 83
Emerging Cultural Setting Themes – Sociocultural Interactions
Theme description Transcript evidence
Exploring cultural exposure
to the university
community will help
overcome socioeconomic
determinants.
An affiliation with somebody else that does to help these students
to meet the barriers of the academic piece.

Need to explore student support on campus to make it a satisfying
experience for the student population that you're trying to
recruit.

Cesar Chavez holidays sends a positive message to the Latinx
community in the recognition of an important figure that came
from underrepresented and underserved communities.
Graduate programs have
limited funds.
There are less funds available for graduate programs in
comparison to undergraduate programs.

The federal grant money that an institution can receive is based on
diversity so that's another reason to strive for ethnically and
culturally diverse student populations.
Engage the community and
build connections.
Expanding our recruitment efforts to the community builds
relationships.

Talking to teachers, attending teacher meetings, and visiting
health science programs helps engage the community.

if an institution doesn't support that level of engagement, I think
we missed the mark.

Document Analysis Results. There was no documentation supporting sociocultural
theory or the cultural setting related to socioeconomic factors. However, the scholarship response
in the interview was one idea of improving the recruitment plan. R6 shared a website of the
National Health Service Corps as an organization that helps students apply for a scholarship to
help minority students afford the program and housing. Staff member R8 shared how the process
works in selecting based on GPA and clinical hours. She mentioned that there are no published

224
standards for PA programs. However, the MSPA program developed internal assessments and
has been improving it along the way. One of the respondents provided the following explanation
on the scoring method:
We have two sets of scores that we provide. We have a pre-interview score, which is
based on faculty review of GPA and clinical experience and then the post-interview score
includes a set of noncognitive variables. The pre-interview score includes the time of the
individuals last paid position so whether it was within 1 year or greater than 1 year since
their last paid clinical position. The highest clinical categories. So, we have broken this
down into categories A through E. We also have categorization one through five for
clinical location. We prefer individuals from Location 1, which would be hospital
outpatient clinic urgent care. GPA. We have a minimum of 3.0 for both overall and core
science prerequisite GPA. Overall, GPA is both calculated by CASPA, and you input
every single college course you've ever taken. We have a number of total number of paid
clinical hours. What happens is that you have this component score that we've set in
CASPA. How many points we want them to give each person for these different
categories that ultimately result in a final pre-interview score. For interviews, you would
have the interview score along with leadership and volunteer experience, which again is
categorized by a certain score.
The staff member was asked if she was the only one who scored or if a pool of faculty and staff
worked on scoring, she responded,
Historically, all faculty have reviewed the applications for the pre-interview score. This
year, we decided that it made more sense to have one person do it, so that everyone was
being scored consistently and interviews are conducted by all the faculty, including

225
adjunct faculty. We want consistency for the initial scoring, but then we'd like to have a
variety of people ultimately assess the individual and provide scoring and
recommendations for admission after their interview. There's always two individuals
interviewing one person, and they have to come to an agreement on whether they want to
recommend them for admission, put them in a maybe pile or decline them for admission.
The faculty of the MSPA ultimately say recommend, not recommend, maybe with each
of those sections.
Summary. The results in this study show the organizational influence under the construct
of cultural setting is validated as an asset for the administration to consider sociocultural
interactions to overcome social determinant factors during recruitment planning. The
administrators showed a generally acceptable response in agreement to support the need to
consider sociocultural interactions. The staff and faculty also provided a similar response. The
administrators felt the way to improve sociocultural interactions and engagements to overcome
socioeconomic factors that may impede Latinx students through the process is by offering
scholarships. The documentation analysis did not produce any document showing sociocultural
interactions. However, the interviews did provide examples from the admissions process of how
clinical hours, GPA, and scholarship awards are factors that impact minority students through
matriculation. Therefore, the data gathered in this final section of the study validates the cultural
setting influence of sociocultural interactions to overcome socioeconomic barriers as an asset for
the administration.

226
Summary of Validated Influences
In this section, the following tables show the validation of the KMO influences as an
asset or need. The determination of the validation is determined by the cut score strategy and the
analysis of interviews and document analysis as applicable per Tables 84–86.

Table 84
Assumed Knowledge Influences: Validation of Assets or Needs
Assumed knowledge influences
Assumed knowledge influences Asset or need Validation
Factual
HU administrators need factual language
knowledge for recruitment planning.
Need Partially validated
Conceptual
HU administrators need conceptual knowledge for
a strategic enrollment plan.
Need Validated
Procedural
HU administrators need procedural knowledge on
the steps to recruit Latinx minorities.
Need Validated
Metacognitive
HU administrators need self-awareness in their
effectiveness to collaborate with others in
shaping a recruitment plan that promotes student
diversity.
Need Validated

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Table 85
Assumed Motivation Influences: Validation of Assets or Needs
Assumed Motivation Influences
Assumed motivation influences Asset or need Validation
Self-efficacy
HU administrators need to increase self-efficacy
measures to develop recruitment plans for Latinx
minorities.
Need Validated
Utility
HU administrators need to see the usefulness of a
recruitment plan to increase student diversity.
Asset Validated
Attainment
HU administrators need to increase attainment value
to promote innovative behavior for the
development of a recruitment plan.
Asset Validated
Goals
HU administrators must have clear goals in
increasing diversity in the MSPA program.
Need Validated
Goal orientation
HU administrators possess mastery orientation in
relation to new recruitment strategies for Latinx
students.
Asset Partially validated

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Table 86
Assumed Organizational Influences: Validation of Assets or Needs
Assumed organizational influences
Assumed organizational influences Asset or need Validation
Cultural model
The administration needs the organization to value
cultural representation to support the recruitment
plan for Latinx students.
Asset Partially validated
Cultural setting
The administration needs partnerships in
developing a recruitment plan for minorities.
Need Validated
The organization needs alternative criteria for the
assessment of minority applicants.
Need Validated
The administration needs a willingness to change in
relation to periodic audits of recruitment plans.
Need Validated
HU administrators need sociocultural interactions
to overcome socioeconomic determinants in the
context of developing a recruitment plan.
Asset Partially validated

The quantitative analysis from surveys and the qualitative analysis from interviews were
used to validate the influences that were established in Chapter Two. The data were used to
identify gaps in the current operations of the organization that will help in the development of a
recruitment plan for Latinx students. One of the challenges in the focus of administration in this
study is that they do not actively participate in recruitment strategies because it is not their
primary focus. The strategy for the study was to assess the staff and faculty and to incorporate
student perceptions to help support the data that could strengthen recommendations for the
administration. The administration was selected as the primary stakeholder because they
influence the mission and values of the organization by projecting it to the overall community

229
within the organization. The intent was to evaluate the administration’s practices in alignment
with diversity initiatives for the organization and their participation on recruitment strategies.
Without the input from the staff and faculty as well as the students in this study, the gaps found
in the performance of the administration may not have been evident. The outcome of the results
found in Chapter 4 provides an in-depth analysis found in the clear gaps that the administration is
facing in the organization so that appropriate recommendations are presented in Chapter 5.
As a result, the gap analysis in this study found more needs in the knowledge and
organizational dimensions than those identified in the motivation dimension. The influences that
were validated as a need in the motivation dimension were self-efficacy and goals. In most
instances, the organization performed well in the motivation dimension under utility, attainment,
and goal orientation constructs. The recommended solutions focus on the procedural, conceptual,
and metacognitive constructs for the knowledge influences. The motivational solutions focus on
the self-efficacy and goal orientation dimensions. In the organizational dimension, the cultural
model and settings constructs had identifiable gaps in cultural representation, collaboration
through partnerships, alternative pathways in the evaluation of minority students, and periodic
audits of recruitment strategies. In the next chapter, the recommended solutions to the KMO
influences will be presented based on the empirical evidence identified in the design of this
study.

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Chapter Five: Discussion and Recommendations
In Chapter 4, the KMO assumed influences were validated by addressing research
questions with results and findings from surveys, interviews, and documentation analysis. The
assumed influences were categorized under KMO challenges as an asset or a need for the senior
administrators at HU. The research questions were intended to understand the KMO needs of the
senior administrators to help lead efforts in developing a recruitment plan for Latinx students.
In this chapter, recommended solutions are provided for the assumed KMO challenges to
fulfill the final research question in this study. Chapter Five begins with a summary of the
organization, performance goals, and stakeholder groups, followed by the purpose of this project
and the research questions. The chapter continues with recommended solutions to address each
validated need from the research and findings in Chapter Four. The recommendations are
coupled with a proposed integrated implementation and evaluation plan using the new world
Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016). The final component of this chapter will
present the study's strengths and weaknesses, limitations and limitations, future research
recommendations, and the conclusion to close this study.
Organizational Context and Mission
HU is an organization that was established in 1911 as one of the oldest medical training
facilities to train students’ leaders in integrative healthcare. It is recognized as one of the medical
training facilities focused on complementary and alternative medicine. The mission and vision
for HU are to provide the highest level of patient care with excellence in evidence-informed
practice to help transform and redefine health and healthcare education.
The HU is organized into five branches: board of regents, senior administration, staff -
chairs & institute directors, clinical research centers, and faculty council. The academic

231
programs are organized into four colleges and accredited by WASC. Each academic program has
its own specific departments that report to the dean, who reports to the provost, who then reports
to the president and the cabinet for a total of five senior administrators. The senior administration
is 60% male and 40% female. This is a highly centralized structure that is overseen by HU’s
board of regents. The staff includes chairs, deans, associated professors, associate deans,
assistant deans, institute directors, project coordinators, clinical coordinators, and research
coordinators. The staff is 57% (24) female and 43% (26) male.
HU is in the Southern California area in a predominantly dense in Latinx community.
The senior administration ethnicity make-up is 80% White and 20% of two or more races not
Hispanic or Latino. The faculty diversity at HU overall holds a full-time track of 63.9% (27)
Whites, 24.7% (12) Asian-American, 1% (8) Hispanic or Latino, and 12% (4) African American,
Native Hawaiian or Other Pacific Islander (1; National Center for Education Statistics, 2021).
The mission of HU is to educate students as competent, caring, and successful integrative
healthcare practitioners and professionals. The vision is to transform and redefine health and
healthcare education. The values in the desire for excellence and the need to respond to a
changing environment include integrative health education, evidence-based practice, health
equity, and inclusivity.
Organizational Performance Goal
The stakeholder goals for each group that makes the leadership at HU are indicated in
Table 87 and describe the organizational mission, global goal, and stakeholder performance
goals. The HU organization is divided into three main groups of members as administration, staff
and faculty, and students. These three groups are distinct and engage with the mission of the
organization at different levels, whether leading the objectives of the organization, implementing

232
strategies, or simply training and molding the mission and values as a student. The alumni and
the surrounding community were not evaluated in this study.
The focus of the intended groups (administration, staff & faculty, and students) was
based on the consistent contribution they will make to the organization on an annual basis. The
focus of the performance goals is to help improve the representation of Latinx students in the
MSPA program.

Table 87
Organizational Mission, Global Goal and Stakeholder Performance Goals
Administration Faculty Staff
By December 2022, 100%
of the HU administration
will develop a new Latinx
MSPA recruitment plan.
By December of 2022, 100%
of HU faculty will double
their recruitment contact
time.
By December 2022, 100% of
the staff will participate in
recruitment strategy surveys.

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Description of Stakeholder Group
In this study, the senior administrators were the focus. The reason the senior
administrators were based on their leadership as organizers, developers, and strategies of the
organization's performance goals. It is important for the senior administrators to help guide the
mission statement of the organization. The staff and faculty can help implement the mission
statement.
Although a staff and/or faculty member can help implement the strategy, the influence
they may have to mold the mission statement into a strategy may be challenging. Additionally,
students are known to voice opinions and feelings towards a particular mission not being met;
however, the revision of the strategy to realign the mission values can also pose a challenge.
Since the administration has more control over the mission statement and values, it is important
to evaluate how they view the representation of Latinx minorities in the MSPA program. This
will help determine if the increase in Latinx students is considered in the development of a
recruitment plan to support the demand of trained physicians assistants to reflect the surrounding
Latinx community in California.
Goal of the Stakeholder Group of the Study
The stakeholder goal is to develop a new Latinx MSPA recruitment plan by December of
2022 for the intake of Latinx students to its MSPA program. It is important to identify the needs
of the administrators that will help guide them to create a recruitment plan in alignment with the
diversity mission and vision of the organization. The senior administrators’ participation in the
development of the Latinx minority recruitment plan is one response to fulfilling the needs of its
mission at HU for its MSPA to continue educating students through its integrative health
program. The administration serves as influencers in the organizational culture that can support

234
and drive diversity initiatives. The 100% participation of administrators in the development of a
recruitment plan for Latinx students will help bring a well-balanced strategy to the organization.
Purpose of the Project and Questions
The purpose of this project was to study the administration’s performance related to a
larger problem of practice and to evaluate the program to improve minority student enrollment.
The analysis will focus on the assets in the areas of knowledge and skills, motivation, and
organizational resources at HU. While a complete study would focus on all stakeholders, for
practical purposes, the administration was the focal point to increase Latinx representation in the
MSPA program.
The questions that guided the improvement study that address KMO influences on the
administration at HU re as follows:
1. What are the administrators’ knowledge, motivation, and organization needs related
to the development of a new Latinx MSPA recruitment plan?
2. What are the recommended knowledge, motivation, and organizational solutions?
Knowledge Recommendations
The three major influences on improving development and performance are found as
dimensions in learning and KMO (Rueda, 2011). These dimensions can be diagnosed to identify
performance gaps to implement improvements per Clark and Estes (2008) and can be applied to
organizational assessment in promoting diversity in medical school programs. According to
Clark and Estes (2008), “knowledge and motivation systems are the most vital facilitators or
inhibitors of work performance” (p. 43). There are five different types of knowledge: factual,
conceptual, procedural, strategic, and belief-based (Mayer, 2011, p. 60). Mayer (2011) described
learning as a process of change in what the learner knows caused by the learner’s experience (p.

235
14). According to Rueda (2011), one implication from Mayer is that a key goal of learning is
knowledge. Clark and Estes (2008) described knowledge as an “engine and transmission” system
that is the main driver in an individual to achieve their performance goals. Therefore,
understanding how, what, when, why, where, and who is working toward achieving these
performance goals is an essential determination in the gap analysis of knowledge.
The knowledge influences listed in Table 88 represent the assumed knowledge influences
and their respective validation based on data collected from surveys, interviews, and
documentation analysis. According to Mayer (2011), factual information is discrete and isolated
information, conceptual knowledge is complex and organized information, procedural
knowledge is how to do something, strategic knowledge is methodical, and belief-based
knowledge is metacognitive knowledge. In this section, knowledge influences are listed in Table
88 linked to principles and context-specific recommendations in implementing strategies to
better understand the gaps in knowledge influences.
The knowledge influences that are regarded as high priority are those validated as needs
and encompass conceptual, procedural, and metacognitive knowledge, as indicated in Table 88.
Conceptual Knowledge is needed to understand how various plans can be utilized in the
recruitment of Latinx students. Knowledge and skill must be transferable and applicable to new
contexts (Deans for Impact, 2015), in this case, the context of selecting a plan that is most
suitable in the recruitment effort of a Latinx minority applicant. The procedural knowledge on
the process of recruitment planning is highly prioritized first because it was found inconsistent
with the diversity toolkit that is recommended for most medical school educational programs per
AAMC. The final influence is metacognitive knowledge in terms of the need for administrators’
self-awareness in their effectiveness to collaborate with others in shaping a recruitment plan that

236
promotes student diversity. The factual knowledge influence is not prioritized based on data
gathered from surveys if it is validated as an asset. However, the inconsistent interviews do
recommend this knowledge dimension be explored further to understand how language content
can help the program appeal to minority students (Table 88).

Table 88
Summary of Knowledge Influences and Recommendations
Assumed knowledge
influence
Validated

Priority

Principle and citation Context-specific
recommendation
HU administrators
need factual
knowledge of
language for
recruitment
planning. [F]
N N Information learned
meaningfully and
connected with
prior knowledge is
stored more quickly
and remembered
more accurately
because it is
elaborated with
prior learning
(McCrudden et al.,
2006).

How individuals
organize knowledge
influences to
reinforce or
facilitate how they
learn and apply
what they know
(McCrudden et al.,
2006).
Provide HU
administrators
information
pamphlets around
marketing
language, content,
and phrases that
help construct
meaning toward
diversifying the
program.

Provide HU
administrators
with a job aid by
listing category
statistics on
language found in
Latinx
communities.
HU administrators
need conceptual
knowledge of the
different types of
plans utilized for
Latinx students [C].
N Y Managing intrinsic
load by segmenting
complex material
into simpler parts
and pre-training,
among other
strategies, enables
learning to be
Provide HU
administrators
with a simplified,
focused, and
segmented
recruitment plan
for minorities that
will assist in

237
Assumed knowledge
influence
Validated

Priority

Principle and citation Context-specific
recommendation
enhanced (Kirshner,
et al., 2018).

Decreasing extraneous
cognitive load by
effective instruction
(particularly when
intrinsic load is
high) enables more
effective learning
(Kirshner et al.,
2018).
learning
effectively to
distinguish
various strategies
suitable for the
recruitment of
minorities.

Provide HU
administrators
with worked
examples that
help introduce the
elements of a
recruitment plan
addressing the
challenges for
minorities in the
pipeline.
HU administrators
need procedural
knowledge of the
steps to recruit
Latinx students [P].
N Y How individuals
organize knowledge
influences how they
learn and apply
what they know
(McCrudden et al.,
2006).

Continued practice
promotes
automaticity and
takes less capacity
in working memory
(McCrudden et al.,
2006).
Provide the HU
administrators
with information
transfer through
formal training
and the
appropriate
application of
diversity and
inclusion strategic
planning toolkit
offered by
AAMC.

Provide the HU
administrators
with a visual aid
from diversity and
inclusion strategy
planning toolkit
that provides the
steps in
developing a
recruitment plan

238
Assumed knowledge
influence
Validated

Priority

Principle and citation Context-specific
recommendation
to increase
student diversity.
HU administrators
need self-awareness
in their
effectiveness to
collaborate with
others in shaping a
recruitment plan
that promotes
student diversity
[M].
Yes Y The use of
metacognitive
strategies facilitates
learning (Baker,
2006).

Metaskills (or
metacognitive
knowledge)
involves knowledge
of when to use, how
to coordinate, and
how to monitor
various skills in
problem solving
(Mayer, 1998).
Provide
opportunities for
HU
administrators to
reflect on the
importance of
diversity and
inclusion with
Deans, Chairs,
and President to
enrich culture and
language
followed by self-
reflection on the
implications of
diversity.

Provide HU
administrators
opportunities to
reflect on the
consequences of
not including DEI
in a plan that
promotes
diversity.

Note. [F] means factual, [C] means conceptual, [P] means procedural, and [M] means
metacognitive; A means asset, N means need; Y means yes, and N means no.

Conceptual Knowledge Solutions
The results and findings of this study indicated that 60% of the senior administrators need
more in-depth conceptual knowledge of the various strategic plans available for the recruitment
of Latinx students. A recommendation rooted in the cognitive load theory has been selected to

239
close this conceptual knowledge gap. Kirshner et al. (2018) indicate that managing intrinsic load
by segmenting complex material into simpler parts and pre-training, among other strategies,
enables learning to be enhanced. Kirshner et al. (2018) also explained that decreasing extraneous
cognitive load by effective instruction enables more effective learning. This implies that
providing the HU administration with a simplified, focused, and segmented recruitment plan for
minorities will assist in learning effectively to distinguish various strategies suitable for the
recruitment of minorities. The recommendation then is to provide the HU administration with
worked examples that help introduce the elements of a recruitment plan that explains the
challenges for minorities in the pipeline.
Gonzaga (2020) provided a recruitment framework for inclusive graduate medical
education programs focused on increasing diversity. In the framework, investing in trainee
success will help overcome pitfalls associated with discrimination and microaggressions
(Gonzaga, 2020). The 5-point inclusive recruitment framework for diversifying the healthcare
workforce is based on setting diversity as a priority, seeking out candidates, implementing
inclusive recruitment practices, investing in trainee success, and building the pipeline (Gonzaga,
2020). Clayborne et al. (2020) focused on training on racial disparities and bias to build positive
relationships and using implicit bias training to target individual practitioners effectively. Clark
and Estes (2008) recommended training to provide information along with guided practice and
corrective feedback to help achieve specific goals. A comprehensive review of worked examples
is available that can present information in manageable parts, as suggested by Mayer (2011), to
effectively help the senior administrators construct new knowledge of the elements in
recruitment planning. This will help the HU administration provide adequate feedback to a
conceptual process of defining a strategy for the intake of Latinx students to the MSPA program.

240
Procedural Knowledge Solutions
This study indicated a 30% agreement with procedural sequences related to diversity and
inclusion strategic planning per AAMC (2021c). A recommendation rooted in information
processing theory has been selected to close the procedural knowledge gap. McCrudden et al.,
(2006), explain how individuals work to organize knowledge influences how they learn and
apply what they know to a particular process. They also mentioned that continued practice
promotes automaticity and takes less capacity in working memory (McCrudden et al., 2006).
This implies that providing the administration with information transfer through formal training
will assist in learning the proper steps in effective recruitment, promoting automaticity in the
application of the new knowledge. Therefore, the appropriate applications in the diversity and
inclusion strategic planning toolkit offered by AAMC is an excellent way to train the HU
administration on the procedural steps in setting off these initiatives as well as supplying job aids
from the toolkit.. The recommendation then is to provide the administration with information
transfer through formal training and job aids to become acquainted with the appropriate steps in
the diversity and inclusion strategic planning toolkit offered by AAMC.
It is essential for the administration to understand the concept of health disparities in
order to help improve the selection of minority students (Thomas, 2014). Integrating health
disparity courses into the medical education curriculum is one way to attract minority medical
students (Figueroa, 2014). In a study by Vela et al. (2010), survey findings revealed that a
majority of matriculating underrepresented minority students reported that knowledge of a
course on health disparities” positively influenced their decision to matriculate to the school.
McCrudden et al. (2006) explained how individuals organize knowledge in the way that it is
learned and applied. According to Mayer (2011, p. 3), it is important to strategically apply

241
instructional methods such as the incorporation of self-reflection on the information required as
it applies to their job function. The administration (learners) can build on existing knowledge on
health disparities using learning strategies such as organization, inferences, and elaboration to
improve information processing.
AAMC (2021c) provides a strategic planning guide that helps institutions build a case for
participating in diversity initiatives, such as accreditation needs, such as reflecting the mission
statement, a means of a social contract, and commitment to the community to diversity across
students, faculty, staff, and administration. Clark and Estes (2008) recommend job aids as the
best alternative when people need to perform a new procedure in a job area in which they already
have a lot of experience or for important tasks that are rarely encountered. In this context, the
administrators at HU can utilize visual job aids offered by AAMC’s diversity and inclusion
strategic planning toolkit. The training sessions would allow the use of various job aids that the
administration can use to guide the proper strategy to achieve the performance goal in
participating in the development of a recruitment plan for minority students. The
recommendation is to provide the administration with a visual job aid with formal training from
the AAMC diversity and inclusion strategy planning toolkit that provides the steps in developing
a recruitment plan to increase student diversity.
Metacognitive Knowledge Solutions
The results and findings of this study indicated that 60% of the senior administrators need
self-awareness in their effectiveness to collaborate with others to shape a recruitment plan that
promotes diversity. A recommendation rooted in metacognitive theory has been selected to close
this metacognitive knowledge gap. Baker (2006) stated that the use of metacognitive strategies
facilitates learning. Additionally, Mayer (1998) indicated that metacognitive knowledge is the

242
ability to know when to use, how to coordinate, and how to monitor various skills in problem
solving. This would suggest that providing opportunities for HU administrators to reflect on the
importance of diversity and inclusion with deans, chairs, and the president will help enrich
culture and language, followed by self-reflection on the implications of diversity. This allows the
HU administrators an opportunity to engage in conversations with their staff on the importance
of diversity and inclusion to help with knowledge transfer on recruitment strategies for the
student pipeline. Therefore, by allowing administrators to have personal connections to reflect on
their self-awareness in how effectively, they can practice collaborating with others to make
evidence-based decisions can help for recruitment planning efforts. The recommendation is to
provide HU administrators opportunities to reflect on the consequences of not including DEI in a
plan that promotes diversity.
Baker (2006) discussed that metacognition is thinking about thinking, and in this context,
administrators should think through recruitment strategies that can be built and geared towards
minority students. Mayer (2011) referred to metacognition as awareness of one’s cognitive
processing and control of one’s cognitive processing. Capers et al. (2018) shared a strategy when
voting anonymously for the candidacy of students is done in a fashion that requires each
admissions committee member to think independently, and private thoughts are grouped into one
decision that turns into a mental schema. Additionally, they indicate that reducing bias against
non-traditional applicants can help increase the consideration of disadvantaged students (Capers
et al., 2018). Scott and Palinscar (2013) found that social interaction, cooperative learning, and
cognitive apprenticeship facilitate the construction of new knowledge. A shadow program is a
great opportunity for administrators to fulfill the construction of new knowledge in the elements
described by Scott et al. (2013) in social interaction, cooperative learning, and cognitive

243
apprenticeship. A shadow program or mentorship program can be built with the opportunity for
self-reflection in engaging with others to foster ideas toward recruitment planning for minority
students.
Therefore, strategies that support the administrators in having engagement conversations
about diversity that induce thinking per Baker (2006) will help reduce bias in the traditional
student and help increase the mental capability to value diversity. Thus, the metaskill described
by Mayer (1998) as cognitive knowledge can help enrich the culture and language of the
organization by improving the awareness of personal capabilities of achieving tasks devoted to
promoting diversity.
Motivation Recommendations
Motivation is the second dimension of improving the development and performance of an
organization in this literature review. Rueda (2011) described motivation as “the process
whereby goal-directed activity is instigated and sustained” (Schunk et al., 2009, p. 4). Rueda also
highlights that motivation is inherently cultural, and the motivational beliefs stem from the
environment per Rueda (2011), which can be further explored with the HU administrators. Clark
and Estes (2008) portrayed motivation as the internal, psychological process that gets one going,
keeps one moving, and helps one get the job done (Clark & Estes, 2008). The senior
administrators’ motivation was examined further in this study to determine the persistence in
fostering change and growth in the representation of Latinx students.
Mayer (2011) described motivation as an internal state that initiates and maintains goal-
directed behavior and breaks it into four components: motivation is personal, activating,
energizing, and directed. Personal motivation is characterized by what occurs within the learner,
activating motivation is what instigates the behavior, energizing motivation is what fosters

244
persistence and intensity, and directed motivation is aimed at accomplishing the goal (Mayer,
2011). The assumed motivational influences examined in this study were self-efficacy, utility
value, attainment value, goals, and goal orientation to evaluate the needs of the administration
toward participating in the development of a Latinx minority recruitment plan. Here, the leaders
at HU were evaluated on their personal motivation toward increasing minority student
representation, and context-specific recommendations are listed in Table 89.

Table 89
Summary of Motivation Influences and Recommendations
Assumed motivation
influence
Validated Priority Principle and
citation
Context-specific
recommendation
HU administrators need to
increase self-efficacy
measures to develop
recruitment plans for
Latinx minorities. [SE]
N Y Learning and
motivation are
enhanced
when learners
have positive
expectancies
for success
(Pajares,
2006).

Feedback and
modeling
increases self-
efficacy
(Pajares,
2006).
Provide HU
administrators
goal-directed
practice coupled
with frequent,
accurate,
credible,
targeted and
private feedback
on progress in
learning and
performance.
HU administrators need to
see the usefulness of a
recruitment plan to
increase student diversity.
[UV]
A N Rationales that
include a
discussion of
the importance
and utility
value of the
work or
learning can
help learners
develop
Provide HU
administrators
with
opportunities to
increase staff
meeting and
discussion
frequency about
the value of
improving

245
Assumed motivation
influence
Validated Priority Principle and
citation
Context-specific
recommendation
positive values
(Eccles, 2006;
Pintrich,
2003).

Activating and
building upon
personal
interest can
increase
learning and
motivation
(McCrudden
et al, 2009).
student diversity
including the
stakeholder
benefits and
risks as it aligns
to meeting
accreditation
standards.
Provide HU
administrators
with recruitment
materials and
activities that
are interesting
to increase
Latinx
representation
necessary to
help meet the
accreditation
standards.
HU administrators need to
increase attainment value
to promote innovative
behavior for the
development of a
recruitment plan. [AV]
A N Higher
expectations
for success
and
perceptions of
confidence
can positively
influence
learning and
motivation
(Eccles,
2006).

Learning and
motivation are
enhanced if
the learner
values the task
(Eccles, 2006)
Provide staff
members with
rationales on the
importance of
recognizing the
input of their
respected peers
that can serve as
innovative
models from
culturally
disadvantaged
backgrounds
that can foster
positive
values toward the
development of
a plan.

Provide HU
administrators
role models
who exemplify

246
Assumed motivation
influence
Validated Priority Principle and
citation
Context-specific
recommendation
the importance
of engaging in
innovative
behavior for the
development of
a recruitment
plan.

Provide HU
administrators
with the
opportunity to
attend cultural
leadership
seminars that
provide the
importance of
engaging in
innovative
behavior for the
development of
recruitment
planning in the
context of the
surrounding
communities.
HU administrators must have
clear goals in increasing
diversity in the MSPA
program. [G]
N Y Organizational
effectiveness
increases
when leaders
help the
organization
set clear,
concrete, and
measurable
goals, aligned
with the
organization’s
vision.
Provide the HU
administrators
with SMART
specific goals
related to the
recruitment of
Latinx students.

HU administrators possess
mastery orientation in
relation to new recruitment
strategies for Latinx
students. [GO]
A N Focusing on
mastery,
individual
improvement,
learning, and
Provide HU
administrators
with task,
reward, and
evaluation

247
Assumed motivation
influence
Validated Priority Principle and
citation
Context-specific
recommendation
progress
promotes
positive
motivation
(Anderman et
al., 2012)
structures that
promote
mastery,
learning, effort,
progress, and
self-
improvement
standards in
relation to new
recruitment
strategies for
Latinx students.

Note. [SE] means self-efficacy, [UV] means utility value, [AV] means attainment value, [G]
means goals, and [GO] means goal orientation; A means asset, N means need; Y means yes, and
N means no.

Self-Efficacy Solutions
The results and findings of this study indicated that 20% of the senior administrators felt
confident about their ability to develop a recruitment plan for Latinx students, indicating this
assumed motivational influence as a need. A recommendation from the self-efficacy theory has
been selected to close this motivational performance gap. Pajares (2006) indicates that learning
and motivation are enhanced when learners have positive expectancies for success. He also
indicates that feedback and modeling increase self-efficacy (Pajares, 2006). Therefore, by
providing HU administrators goal-directed practice coupled with frequent, accurate, credible,
targeted, and private feedback on progress in learning and performance.
Albert Bandura described human behavior and motivation under social cognitive theory
as a set of beliefs that provide the foundation for human motivation, well-being, and personal

248
accomplishment (Pajares, 2006). Bandura (1986) defined self-efficacy as “people's judgments of
their capabilities to organize and execute a course of action required to attain designated levels of
performances (Rueda, 2011, p. 39). Rueda stated that individuals with higher self-efficacy,
greater belief in their own competence, and higher expectancies for positive outcomes will be
more motivated to engage in a given task (Rueda, 2011, p. 40). These positive outcomes can be
tracked with feedback on the progress of learning and performance as it relates to confidence on
the job.
Additionally, Clark and Estes (2008) described self-confidence as people’s beliefs about
whether they have the skills required to succeed, which drives their commitment to work tasks
and the quality and quantity of mental effort invested in the work. Therefore, it is recommended
that administrators engage in training modules around diversity and inclusion and increase their
confidence in their abilities to improve the selection process for Latinx students. The application
of the training modules into practice can be guided through a performance development plan,
where the administration is consistently receiving feedback on their learning and performance as
it relates to recruitment strategies to help increase enrollment of Latinx students.
Goals Solutions
The results and findings of this study indicated that 80% of the senior administrators were
clear on goals related to the recruitment of Latinx students to increase diversity; however, only
two out of the five administrations (40%) were clear on specific goals related to diversity from
interviews. A recommendation from the leadership toolkit in which organizational effectiveness
increases when leaders help the organization set clear, concrete, and measurable goals, aligned
with the organization’s vision was selected to close this motivation influence gap. Pintrich
(2003) discusses that goals help motivate and direct students. Another recommendation stems

249
from the communication theory that effective leaders are aware of the power of influence and its
impact on the change process within an organization (Conger et al., 1991; Denning, 2006; Lewis,
2011; and Fix et al., 2006). By incorporating the senior administrators’ influence around the
development of SMART goals, this strategy is posed to effect a positive change in the
organization. Therefore, the recommendation is then to provide the HU administrators with
SMART specific goals related to the recruitment of Latinx students.
In the absence of clear goals and feedback, people are not committed to their work and
are not motivated to target business goals with their best effort in mind (Locke et al.. (1990).
Setting specific goals means that goals have sufficient detail that can be clearly underwood,
which can result in higher team performance (Posthuma et al., 2012). Clark and Estes (2008) also
suggest that clear work goals accompanied by effective work procedures, motivational support
for everyone, and the assessment of results increases the likelihood to achieve improvement and
efficiency in the organizational change effort. A survey of university administrators regarding
leadership indicated that setting clear expectations is a leadership skill (Morris et al., 2015).
According to Lewis et al. (2017), “establishing and widely communicating clear, well-defined
criteria in the institutional mission and goals enables reviewers to ground their assessment of
applicants in a shared understanding of what the school is seeking.” In addition, Morphew et al.
(2006) pointed to the relevance of goals in mission statements to external constituencies such as
accreditation agencies and prospective students. According to Hadwin et al. (2011), self-
regulation of learning includes motivational and emotional processes toward the completion of
an academic task or goal. Regulation references a standard or goal against actual performance,
making regulated learning goal-directed (Hadwin et al., 2011; Schoor et al., 2015).

250
Clark and Estes (2008) categorized motivation into three influences: working towards a
goal, persisting until the goal is achieved, and mental effort investment in completing the work.
Clark and Estes (2008) indicated that vagueness and inconsistency in a work environment can
lead to people to substitute their own goals or deviate from the intended business goal. Increasing
motivation by clarifying goals involves team-building efforts that help describe the skills
required to achieve the performance goals with consistent monitoring of individual performance
with proper feedback.
Saha et al. (2008) evaluated a racially and ethnically diverse student body and found their
goals in medicine help prepare them for diversity-related outcomes. They suggested that it is
important to start implementing meaningful a conversation through staff meetings and
discussions that can help motivate the administration toward clarifying goals and making them
specific. Therefore, motivation is also tied to a communication process in an organization, and
thus the feasibility by which an organization promotes goal-oriented behavior and adaptation to
changing environments where decision-making channels positively affect goal achievement
(Dorsey, 1957). Besley (2020) studied five key lessons learned from how scientists and science
communicators think about communication strategy:
● Problem 1: Inadequate identification of communication goals.
● Problem 2: Inadequate identification of communication objectives.
● Problem 3: Inadequate identification of communication tactics.
● Problem 4: Scientists’ inadequate use of strategic science communication expertise.
● Problem 5: Scientists’ inadequate access to communication expertise (p. 156 – 159).
Translating this communication strategy to the administration and altering the problem
from scientists to administration in respect to developing a communication training to couple the

251
way goals are presented is one recommendation to help with this effort. Thus a recruitment plan
for Latinx students can increase diversity-related outcomes through the clarification of specific
goals (SMART) through communication strategies geared toward the development of a
recruitment plan for increasing diversity.
Organization Recommendations
The organizational influences are based on the Clark and Estes (2008) framework to help
identify the performance gaps in an organization for increasing the pipeline of Latinx minorities
into the MSPA program. Gallimore and Goldenberg (2001) purported two types of units of
analysis in an organization, which are cultural settings and cultural models. The cultural models
of an organization are the shared mental schema of how the world works or ought to work,
whereas the cultural setting is defined as a setting by which people come together, over time, to
accomplish a task (Gallimore et al., 2001).
In this section, the administration’s assumed organizational influences were examined
under the cultural model and cultural setting construct. The data reported in this study validate
the cultural model and cultural setting influences as organizational needs. Here, the cultural
model is based on the need that cultural representation is needed in the MSPA program to
facilitate the development of a Latinx minority recruitment plan. The cultural setting was
evaluated through four organizational needs: to form partnerships, develop alternative criteria for
the assessment of minority applicants, and conduct periodic audits of the recruitment process.
The sociocultural interactions to overcome socioeconomic factors affecting the recruitment of
Latinx students to the MSPA program was validated as an asset, and thus, no further
recommendations are offered in this study. Table 90 provides a summary of these influences and

252
their respective context-specific recommendations to mitigate the gaps associated with
improving organizational performance.

Table 90
Summary of Organization Influences and Recommendations
Assumed organization
influence
Validated Priority Principle and
citation
Context-specific
recommendation
The administration
needs the
organization to value
cultural
representation to
support the
recruitment plan for
Latinx students.
[CM]
Y N Effective change
begins by
addressing
motivation
influencers; it
ensures the
group knows
why it needs
to change. It
then addresses
organizational
barriers and
then
knowledge
and skills
needs (Clark
& Estes,
2008).

Understanding
the meaning of
equity,
diversity and
access in your
organizational
context
enhances the
capacity to
improve
organizational
climate and
outcomes.

Provide HU
administrators with
opportunities to be
involved in the
improvement process
related to DEI
initiatives that
articulates the
challenges and
barriers in the
recruitment for
Latinx students.

Provide HI
Administrators with
ways to identify
indicators in the
organization that
show progress
towards institutional
goals related to
cultural
representation to
ensure
accountability.

Provide HU
administrators
policies, procedures,
and resources to
promote a culture of
inclusion in decision-
making.

253
Assumed organization
influence
Validated Priority Principle and
citation
Context-specific
recommendation
Equity, diversity,
and access are
important
goals in
private and
public sectors
(Darling-
Hammond,
2007; Lim et
al., 2013).

Effective leaders
demonstrate a
commitment
to valuing
diversity
through
inclusive
action. They
promote an
organizational
culture that
promotes
equity and
inclusion and
cultivate an
atmosphere
where
diversity is
viewed as an
asset to the
organization
and its
stakeholders.
(Angeline,
2011; Prieto,
Phipps, &
Osiri, 2009).
The administration
needs partnerships in
developing a
recruitment plan for
minorities. [CS]
Y Y Effective change
efforts are
communicated
regularly and
frequently to
all key
Provide HU
Administration
should a committee
of individuals aimed
at forming
partnerships to

254
Assumed organization
influence
Validated Priority Principle and
citation
Context-specific
recommendation
stakeholders
(Clark &
Estes, 2008).

Effective leaders
are aware of
the power of
influence and
its impact on
the change
process within
an
organization.
(Conger,
1991;
Denning,
2006; Lewis,
2011; Fix &
Sias, 2006).
secure metrics for
increasing diversity
with the
development of a
recruitment plan for
minorities.

Provide HU
Administration with
opportunities to
secure metrics for
increasing diversity
with the
development of a
recruitment plan for
minorities.
The organization needs
alternative criteria
for the assessment of
minority applicants.
[CS]
Y Y Effective change
efforts use
evidence-
based
solutions and
adapt them,
where
necessary, to
the
organization’s
culture (Clark
& Estes,
2008).

Effective change
efforts in an
organization’s
culture are
best
implemented
when
organizations
practice
evidence-
Provide HU
administrators an
evidence-based
assessment method
with a checklist of
criteria that broadly
considers the totality
of circumstances in
admissions
decisions.

Provide HU
administrators with a
data-driven
benchmarking
technique that
utilizes a metric by
which minority
student applications
are reviewed as part
of improving
organizational
performance.

255
Assumed organization
influence
Validated Priority Principle and
citation
Context-specific
recommendation
based research
and solutions
(Clark &
Estes, 2008).

People are more
productive
when goal
setting and
benchmarking
are essential to
evaluating
progress and
driving
organizational
performance
in
accountability.
(Dowd, 2005;
Levy &
Ronco, 2012).
The administration
needs a willingness
to change in relation
to periodic audits of
recruitment plans.
[CS]
Y Y Organizational
effectiveness
increases
when leaders
ensure that
employees
have the
resources
needed to
achieve the
organization's
goals (Clark &
Estes, 2008).

Insuring staff’s
resource needs
are being met
is correlated
with increased
student
learning
Provide HU
administrators an
informal audit of the
policies and
procedures in the
admissions process
to check for
alignment with
organizational goals
to improve the
representation of
Latinx students.

Provide HU
administrators a
budgetary allocation
of resources with the
goals and priorities
of the organization.

256
Assumed organization
influence
Validated Priority Principle and
citation
Context-specific
recommendation
outcomes
(Waters et al.,
2003).

HU administrators
need sociocultural
interactions to
overcome
socioeconomic
determinants in the
context of
developing a
recruitment plan.
[CS]
Y N N/A Not a priority

Note. [CM] means cultural model, and [CS] means cultural setting; A means asset, N means
need; Y means yes, and N means no.

Cultural Model Solutions: Increase the Value of Cultural Representation in Support of the
Development of Recruitment Plans for Minorities
The results and findings of this study indicated that 100% of the senior administrators
agreed that cultural representation is integrated into recruitment plans for minority students.
However, the survey indicated the senior administrators are not culturally represented within its
cabinet, with only 20% from an ethnic background. A recommendation rooted in diversity and
accountability theory was selected to close this organizational gap. According to Angeline
(2011) and Prieto et al. (2009), effective leaders demonstrate a commitment to valuing diversity
through inclusive action. In addition, understanding the meaning of equity, diversity, and access
in the organizational context enhances the capacity to improve organizational climate and
outcomes (Darling-Hammond, 2007; Lim et al., 2013). The recommendation is for the senior

257
administrators to provide the HU administration with opportunities to be involved in the
improvement process related to DEI initiatives that articulate the challenges and barriers in the
recruitment of Latinx students.
Rueda (2011) indicates that cultural models help shape the ways that an organization is
structured, including the values, practices, policies, and reward structures. Therefore, making
structural changes to support organizational goals is one way to strengthen performance (Rueda,
2011). Clark and Estes (2008) indicated that effective change begins by addressing motivational
influencers to ensure the stakeholders know why the change is needed, followed by addressing
organizational barriers and then the knowledge and skills needed (Clark & Estes, 2008).
The cultural models of an organization are the shared mental schema per Gallimore and
Goldenberg (2001), and garnering support by administrators to fully promote initiatives geared
toward increasing Latinx student representation is necessary to close the gap in organizational
performance. Rueda (2011) described cultural models as the shared mental schema or normative
understandings of how the world works or ought to work. Clark and Estes (2008) best describe
an organization’s culture as the core values, goals, beliefs, emotions, and processes learned as
people develop over time in their working environment. The cultural model was validated in the
interviews as an asset, and it is highly encouraged that the HU administrators be provided with
opportunities to be continually involved in the improvement process of DEI initiatives that
articulates the challenges and barriers in the recruitment of Latinx students. It is highly
recommended that HU administrators have policies, procedures, and resources to promote a
culture of inclusion in decision-making.

258
Cultural Setting Solutions: Increase Organizational Support for Partnerships in the
Development of Recruitment Plans for Minorities
The results and findings of this study indicated that 80% of the senior administrators felt
they engaged in the formation of partnerships in outreach and recruitment efforts for prospective
minority students. However, the interviews indicated no evidence that these partnerships were in
place to assist in these efforts. A recommendation rooted in the communication theory has been
selected to close this organizational gap. Effective leaders are aware of the power of influence
and its impact on the change process within an organization. (Conger, 1991; Denning, 2006;
Lewis, 2011; Fix et al., 2006). The recommendation is for the senior administrators to establish a
committee of individuals aimed at forming partnerships by using communication as a power of
influence to secure process changes for the development and adoption of a recruitment plan for
minorities.
According to Clark and Estes (2008), effective change efforts are communicated
regularly and frequently to all key stakeholders. Therefore, effective communication is key in
establishing partnerships involved as key stakeholders. In a study led by Achenjang et al. (2016),
the stakeholders at the University of Kentucky Medical Education Development Program formed
a recruitment body of minority pre-medical students who worked in partnership with the
admissions office to enrich the community with individuals with diverse backgrounds to
successfully bridge the gap of minority student matriculation into medical schools. In Georgia,
the Health Professions Partnership Initiative to increase the number of underrepresented minority
Georgia residents in healthcare worked in collaboration with MCG Schools of Medicine and
Nursing (Fincher et al., 2002). These initiatives were successful in making a difference in the
community and were funded by the American Medical Colleges and Robert Wood Johnson

259
Foundation. In a study by Wittenberg et al. (2016), nurses reported concerns over goals-of-care
communication in the function, structure, and process of care. Similarly, a communication plan
that is structured around the function, structure, and process of recruitment for Latinx minorities
can be integrated into these partnerships. These partnerships can be linked to communities of
minorities formed as a student body group that can extend recruitment efforts to develop
minorities in public health professions (Krueter et al., 2011). Therefore, the recommendation for
the senior administrators at HU is to form a committee focused on the development of
partnerships to foster diversity initiatives for the development of a recruitment plan for Latinx
students.
Cultural Setting Solutions: Improving Admission Policies That Allow for Alternative
Criteria for the Assessment of Minority Applicants
The results and findings of this study indicated that 40% of the senior administrators felt
they had alternative criteria they could use to assess a minority applicant. A recommendation
rooted in the accountability theory was selected to decrease the organizational performance gap.
According to Dowd (2005) and Levy et al. (2012), there is greater productivity in driving
performance in accountability when goal setting and benchmarking are assessed. This suggests
that administrators can develop goals for alternative criteria in the assessment of minority
students, such as alternative classes to be considered to justify low academic performance in the
portfolio. The recommendation is for the administrators to adopt a data-driven benchmarking
technique as alternative criteria based on a holistic review approach to evaluating minority
students.
According to Clark et al. (2008), effective change efforts use evidence-based solutions
and adapt them, where necessary, to the organization’s culture. Lakhan (2003), indicated that

260
poor GPA and MCAT performance does not accurately depict success as a practicing physician.
Lakhan (2003) advocated for the implementation of race-conscious affirmative action programs
that results in diversifying the medical field and improvements in communities that are
underserved by increasing biomedical research and engagement in a multicultural society. In a
study by Coplan et al. (2021), a holistic review approach for the admission of underrepresented
minorities to PA programs resulted in moderately higher URM matriculation. The elements
identified in a holistic approach by Coplan et al. (2021) were based on the following:
• linking admissions decisions to institution or program goals,
• having formal statements that articulate the benefits of diversity,
• considering how an applicant would contribute to the learning environment,
• considering how an applicant would contribute to the field after training, and
• considering the race and ethnicity composition of the entering class, where legal.
• mode of selection of applicant for an interview,
• the approach to the initial screening process in regards to meeting the criteria for
admission.
• The consideration of nonacademic criteria related to the student background or
experience considered in the initial admission screening process.
• The consideration of the program’s policies and processes incorporated in the holistic
review of applicants,
• The level of impact to the program attributed to the holistic review as part of the
admissions process (pp. 12–13).
Nakae et al. (2021) presented a holistic review framework that is integrated into the
enrollment management system following 4 M’s: Mission, Market, Means, and Metrics to

261
improve the capacity for medical schools to matriculate a more diverse study body. According to
Artinian et al. (2017), the failure of a holistic review process to increase URM students
specifically to a PA program may be attributed to challenges associated with a lack of resources
and a conceptual framework to guide implementation. It is important to hold the stakeholders of
a framework accountable, as, per Elmore (2002), accountability is increased when the roles and
expectations of individuals are aligned with the mission statement and business objectives of the
organization. Addams et al. (2010) indicated that the framework of experience, attributes, and
academic metrics for evaluating applicants should be aligned with the program’s mission and
goals. Clark and Estes (2008) suggested that effective change efforts in an organization’s culture
are best implemented when organizations practice evidence-based research and solutions. Thus,
one way to establish a framework based on the evidence-based research presented by Coplan et
al. (2021) is to hold individuals accountable by coupling an incentivizing rewards system for
using a holistic approach in the recruitment of Latinx minorities to the MSPA program.
Cultural Setting Solutions: Increase Periodic Audits of the Recruitment Process
The results and findings of this study indicated that 40% of the senior administrators felt
there are audit plans in place that allow for the revision of procedures in the recruitment plan. A
recommendation rooted in the leadership toolkit has been selected to close this organizational
gap. According to Waters et al. (2003), learning outcomes are correlated with the resources staff
are able to provide. This suggests that organizational effectiveness increases when leaders ensure
that employees have the resources needed to achieve the organization's goals. Thus, the
recommendation for the senior administrators is to engage in periodic audits to evaluate the
recruitment process to ensure resources are adequately applied to successfully develop a
recruitment plan for Latinx students.

262
Clark and Estes (2008) indicated that organizational structures and policies can be a
hindrance to improved performance and meeting goals, and this is a reason why audits of
recruitment plans can help bring the policies in alignment with the organizational goal. In 1994,
about 80% of all colleges and university were revising mission statements, goals, and curricula to
align with strategic planning and accreditation agencies (Association of American Colleges,
1994; Morphew et al., 2006). Rummler and Brache (1995) share how a mapped organization
helps ensure organizational accountability on resources and ensure processes produce
productivity on deliverables. Similarly, periodic audits of recruitment plans can be used to align
structures and the processes of the organization to meet the desired goals, according to Rueda
(2011). Organizational effectiveness increases when leaders ensure that employees have the
resources needed to achieve the organization's goals per Clark and Estes (2008) and can be
evaluated through periodic audits. According to Richardson (2009), managing and effecting a
recruitment process must be supported through a documentation trail that allows for proper
evaluation and auditing. However, a recruitment infrastructure must be in place for proper
auditing, very similar to clinical recruitment plans presented by Chatzidamianos (2014), as an
output report to auditing a recruitment infrastructure for a clinical study. Gallimore et al. (2001)
suggested that these processes represent shared ways of perceiving, thinking, and storing
possible responses to adaptive challenges and changing conditions. Therefore, implementing
periodic audits of the recruitment process can allow for collaboration between stakeholders to
improve policies and their effectiveness in the assessment of prospective minority applicants.

263
Integrated Implementation and Evaluation Plan
Implementation and Evaluation Framework
The integrated implementation and evaluation plan for this study will be grounded on the
new world Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016) to determine the effectiveness
of the recommended strategies. The new world Kirkpatrick model is an evaluation framework
that is based on four levels: reaction, learning, behavior, and results (Kirkpatrick & Kirkpatrick,
2016). Each level is groomed to deliver specific and well-defined indicators through a standard
method intended to link the expected outcome to a targeted metric. The new world Kirkpatrick
model is the evaluation technique that will capture the HU’s stakeholder initiatives to increase
the representation of Latinx students in the MSPA program at HU through the four levels of
framework planning.
In Level 1, the reaction principle is the degree to which participants find the training
favorable, engaging, and relevant to their jobs (Kirkpatrick & Kirkpatrick, 2016). At this level,
the evaluation is applied to training to determine the engagement, relevance, and satisfaction of
the HU administrators. At this level, the training effectiveness can be gauged to demonstrate the
overall value the training has brought to the organization.
In Level 2, the learning principle is the degree to which participants acquire the intended
knowledge, skills, attitude, confidence, and commitment based on their participation in the
training (Kirkpatrick & Kirkpatrick, 2016). This level is intended to close the gap between
learning and behavior and to prevent the cycle of waste when training is repeated for people who
possess the knowledge and skills but fail to perform on the job (Kirkpatrick & Kirkpatrick,
2016). At this level, the evaluation can gauge how well valuable knowledge is acquired,
maintained, and applied by the HU stakeholders.

264
In Level 3, the behavior principle is the degree to which participants apply what they
learned during training when they are back on the job (Kirkpatrick & Kirkpatrick, 2016). Level 3
is a critical level as it defines and shapes the expected external and internal outcomes in Level 4.
At the behavior level, the assessment of the individual’s behavior can control and dictate the
health of the organization’s success through required drivers and on-the-job training (Kirkpatrick
& Kirkpatrick, 2016).
Finally, in Level 4, the “Results” principle is defined as the degree to which targeted
outcomes occur as a result of the training and the support and accountability package
(Kirkpatrick & Kirkpatrick, 2016). It is at this level that the effectiveness of the training can be
assessed to determine the leading indicators and the desired organizational change outcomes as a
result of the training. The leading indicators are observations and measurements that suggest that
critical behaviors are on track to create a positive impact on organizational outcomes, which is
why Levels 3 and 4 are transitionary.
In this evaluation study, increasing student diversity at HU is dependent on the
administrator’s KMO influences around recruitment planning for Latinx students to the MSPA
program. The application of the new world Kirkpatrick model for training evaluations will be
examined in the reverse order from Levels 4 to 1 as the new practical view follows this sequence.
This way, the approach begins with a goal in mind, and this is considered the signature of the
model (Kirkpatrick & Kirkpatrick, 2016).
Organizational Purpose, Need, and Expectations
The organizational goal is to increase Latinx student representation at HU to promote
diversity in the MSPA program. This initiative requires the senior administrators to understand

265
the knowledge, skills, and motivation to promote diversity by participating in the development of
a Latinx minority recruitment plan.
The organizational performance goal is to have a recruitment plan for the intake of Latinx
students within its MSPA program by December of 2022. HU’s mission is to include the
integration of health sciences into medical education to transform and redefine health and
healthcare education.
The expectation is that increasing diversity as an initiative in recruitment planning helps
with meeting accreditation standards for student diversity as the healthcare system is challenged
by health disparity issues related to various minority groups. With this expectation, the
recruitment strategy is intended to implement a planned approach to improve the representation
of Latinx students, which aligns with the organizational goal of promoting diversity within the
MSPA program and addresses health disparity challenges in the Latinx community.
Level 4: Results and Leading Indicators
The outcomes, methods, and metrics are the points of analysis in this approach that is
applied to identify the leading indicators that impact the administration at this level. This
assessment is divided between the external and internal outcomes that are used to understand
how the stakeholder benefits and responds to the performance in the organization and within its
culture (Kirkpatrick & Kirkpatrick, 2016). The KMO influences are referred to align the
recommendation for organizational improvement per Clark and Estes (2008).
In this study, the internal outcomes must materialize into recruitment strategies for the
administration to help them interact with the external organization and prepare internally for the
organizational initiative in the recruitment plan for the intake of Latinx students. Thus, external
outcomes are crafted in a way that aligns with the internal outcomes to validate the training

266
strategy at Level 4 (Kirkpatrick & Kirkpatrick, 2016). Therefore, a focus on cultural alignment
between staff and the organization’s values, mission, and vision to support diversification efforts
for Latinx students is one objective for the internal outcome. Another outcome is to implement a
recruitment strategy that improves the gaps found in the KMO influences that will help drive the
increase of Latinx students in the program. A third outcome is to increase awareness of goals
related to increasing minority representation in the MSPA program as the driver for the
justification of increasing Latinx students. Finally, the last outcome is to increase the diversity in
the administration pool to provide an environment open to inclusion and diversity. A summary of
the internal and external outcomes is listed in Table 91.

Table 91
Outcomes, Metrics, and Methods for External and Internal Outcomes
Outcome Metrics Methods
External outcomes
Expand recruitment
strategies to
underserved schools in
Southern California
Number of colleges targeted for
recruitment from underserved
communities.
Quarterly updates to targeted
schools using burn-down
charts.
Increase organizational
funding for recruitment
strategies.
Number of Department budgets
increases.
Quarterly budget reports with
transparency to itemized
budgeting.
Increase student
awareness on health
disparities at local
colleges in underserved
communities.
Frequency of college visits for
seminars and conferences.
Quarterly deep dive
presentations by staff
members promoting health
disparities.
Increase health disparity
awareness within the
HU community.
Number of community
awareness events increased.
Quarterly seminars at local
communities about health
disparity and recruitment
strategies.
Increased number of
recruiters focused on
Frequency of recruiters hired for
recruiting from educational
Human resource performance
development management

267
Outcome Metrics Methods
recruitment strategies
from colleges located in
underserved
communities.
institutions with underserved
minority student communities.
plans with semi-annual
updates on productivity and
time spent on activities
related to this effort.
Internal outcomes
Increase training on new
recruitment strategies
geared toward minority
representation
Percent completion of all new
training of procedures related
to this initiative.
Online training modules, In-
Class training, or seminars
related to recruitment
strategies.
Increase training on
AAMC diversity and
inclusion strategic
planning.
Attend a conference related to
Diversity and Inclusion
Professional Development.
Annual attendance to a
conference.
Increase engagement of
conversations at the
performance
development level.
Percent of conversations related
to the development of a
recruitment plan and
performance development.
Quarterly self-reflection
reports.
Increase staff meetings
with administration to
discuss the tasks related
to recruitment planning.
Frequency of meetings related to
development planning for
recruitment.
Bimonthly meetings tracked
through minutes of all
actions discussed.
Develop SMART specific
goals around the
organization's mission
and vision with
performance
development plans.
Number of performance
objectives achieved.
Performance development
management; Peer-to-peer
reviews.
Increase diversity and
inclusion awareness
within the
administration through
the DEI chair.
Attendance of seminars around
diversity, equity, and
inclusion.
Attendance of an annual
seminar.
Develop partnerships with
the administration,
faculty, and staff with
students and/or the
community.
Formation of committees and
frequency of groups
established.
Quarterly reports on
partnerships formed.
Implementation of holistic
review
Number of holistic reviews
completed.
Quarterly review of checklists
utilized in the selection of
students.

268
Outcome Metrics Methods
Increase periodic audits of
the recruitment process.
Frequency of meetings related to
periodic audits.
Quarterly review of the
recruitment process.

Level 3: Behavior
Critical behaviors. Critical behaviors relevant to the success of the organization are
explored in Level 3 and evaluated to measure the acquired knowledge and skills from the
training per the new world Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016). At this level, it
is important to understand how well the training was received and if the individuals were able to
apply what they learned to their daily tasks to extract the value from the training and deliver it to
the organization’s success. In this model, the critical behaviors must be observable, specific, and
achievable to successfully unpack the internal and external outcomes (Kirkpatrick & Kirkpatrick,
2016). In this study, the administrators at HU must engage with their staff in regular meetings to
discuss the efforts and progress around recruitment strategies for minority students. Regular
meetings and stand-up briefings of everyone’s role integrate all specific roles along with new
recruiters to understand everyone’s strengths and delivery to the organizational goal.
Another critical behavior that will bring value to the organization is the participation of
the administration in actual recruitment efforts. Although this role is strictly for the recruiter, it is
important that administrators experience the challenges of the initiative to help bring about
solutions. This critical behavior can be built into Vygotsky’s zone of proximal development
where guided learning is achieved through the experiences of staff members that engage in the
recruitment plans as experts in the process as illustrated in Figure 5 adapted from Vygotsky
(1978) and Wass et al, (2014). The ZPD model requires collaboration and the transfer of

269
responsibility for effective development (Holaday et al., 1994). The ZPD model can be leveraged
as a critical behavior to improve sociocultural interactions in response to barriers and challenges.

270
Figure 5
Proposed Zone of Proximal Development for the HU Administration

Note. Adapted from “Sharpening a Tool for Teaching: The Zone of Proximal Development” by
R. Wass and C. Golding, 2014, Teaching in Higher Education, 19(6), 671–684 and Mind and
Society: The Development of Higher Mental Processes by L. S.Vygotsky, ,1978, Cambridge
University Press.

A third critical behavior is the integration of goals related to recruitment planning for the
educational program. This effort provides insight to the staff and its implementation to bring
awareness to the clarification of goals as it relates to DEI in the medical program. Finally, the
What I can do.
• Leadership
• Influence
What I can do with
guidance.
• Zone of Proximal Development
• Assistance with Subject Matter
Experts
What I cannot do alone.
• Areas of Improvement
• Challenges and Barriers

271
last critical behavior is the administration's engagement with their staff in aligning their
performance development plans to the organizational goals. Performance development plans
using SMART goals can help assist how effective the administration was in guiding the staff to
meet the deliverables of the objective. It also provides a bird’s eye view of how the staff is
positioned to deliver on organizational success. These key behaviors that the stakeholder of focus
will have to demonstrate to achieve the outcomes are listed in Table 92.

Table 92
Critical Behaviors, Metrics, Methods, and Timing for Evaluation of HU Administration
Critical behavior Metrics
Methods
Timing
HU administration
analyzes
language content
from marketing
pamphlets found
in Latinx
communities.
Number of pamphlets
analyzed.
Design review reports Semester
HU Administration
engages with
regular staff to
discuss
performance
development
plans and
alignment to
organizational
objectives.
Frequency of
meetings relevant to
the topic of
professional
development and
advancement in
accordance with the
objective to
increase student
diversity.
One-on-one meetings Weekly
HU administration
correctly
identifies the
process from the
diversity and
inclusion
strategic toolkit.
Percentage of
milestone
completions.
Project management,
Gantt chart
Weekly

272
Critical behavior Metrics
Methods
Timing
HU administration
engages in self-
reflection toward
recruitment
planning
improvements.
Percentage of
participation in
online reflection
surveys.
Reporting of surveys to
department
Quarterly
HU administration
research worked
examples of
recruitment
strategies as
evidence-based
best practices.
Number of literature
relevant to
recruitment
strategies for
minority students.
Presentations to
department
Quarterly
HU administration
participates in
college visits
geared toward
increasing
minority
representation.
Percentage of
participation of all
administrators to
visit a college
campus at least
once with the goal
to help drive
recruitment of
Latinx students.
Burn-down charts
presented at town
halls.
Quarterly
Integration of
specific diversity
goals related to
the MSPA
program that is
focused on the
Latinx minority
representation.
Number of new
diversity goals
related to the
MSPA program that
is focused on the
Latinx minority
representation.
Recruitment office
reports
Quarterly
HU administrators
engage in regular
meetings with
staff to discuss
roles that
increase
diversity within
the organization.
Number of staff
meetings in which
more than 75% of
staff are present.
Attendance sheets Monthly
HU administrators
participate in
policies,
procedures, and
resources in
Number of documents
revised.
Reporting Quarterly

273
Critical behavior Metrics
Methods
Timing
recruitment
planning for
increasing
minority
representation.
HU administration
forms
partnerships to
secure metrics
for diversity
initiatives.
Number of
partnerships
formed.
Reporting Quarterly

Required Drivers. According to Clark and Estes (2008), an effective organization
ensures that the organizational message, rewards, policies, and procedures are aligned with the
organizational goals and values. The efforts in helping the administration achieve the outcomes
in this study are best coupled with required drivers that can help critical behavior stay aligned to
the expected outcomes. In Level 3, the critical behaviors can be coupled with required drivers
that may manifest in the form of reinforcing, encouraging, rewarding, and monitoring the
behavior to achieve success (Kirkpatrick & Kirkpatrick, 2016). Rationales that include a
discussion of the importance and utility value of the work or learning can help learners develop
positive values (Eccles, 2006; Pintrich, 2003). Similarly, discussions about the importance and
utility value of increasing the number of minority students can help administrators coach and
mentor others to develop the motivation to carefully assess the culturally disadvantaged student.
Higher expectations for success and perceptions of confidence can positively influence learning
and motivation (Eccles, 2006). Therefore, a shadowing program can help respected peers model
leaders from culturally disadvantaged backgrounds that can foster positive values toward health
disparity awareness.

274
Effective leaders promote an organizational culture that cultivates an atmosphere where
diversity is viewed as an asset to the organization and its stakeholders. (Angeline, 2011; Prieto et
al., 2009). Therefore, the participation of effective leaders in recruitment efforts to seek out
disadvantaged minority students that hold a promise to excel in medical education cultivates this
type of atmosphere and presents value to the organization. According to Clark and Estes (2008),
effective change efforts use evidence-based solutions and adapt them to the organization’s
culture. Therefore, the senior administrators must demonstrate an evidence-based review of the
applications that help overcome the barriers that challenge the minority student and integrate this
practice into policy and procedures.
These influences can be provided with required drivers that can be reinforced,
encouraged, rewarded, and monitored, according to the new world Kirkpatrick model. Table 92
presents the drivers that can be employed to help support and provide accountability to the
critical behaviors crucial for the organization’s performance goals (Kirkpatrick & Kirkpatrick,
2016). The required drivers are introduced in Table 93 as an integrated package critical to
success as methods and systems to positively support the performance and hold the individual
accountable for the critical behavior (Kirkpatrick & Kirkpatrick, 2016).

Table 93
Required Drivers to Support Critical Behaviors of HU Administrators
Methods Timing
Critical behaviors
supported
Reinforcing
Analysis of marketing pamphlets geared toward
Latinx communities.
Weekly 1
Self-assess recruitment plans strategies directed
toward minorities.
Daily 4

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Methods Timing
Critical behaviors
supported
Team meetings to troubleshoot collaboratively and
for additional training around health disparities.
Ongoing 2, 4
Team meetings with new and experienced
reviewers to establish goals and time frames as it
relates to performance feedback.
Daily 2, 3, 8
Communities of practice in the preparation of
presentations to the community or integration of
health disparity education.
Monthly 1, 2, 3, 10
Job aid that includes listing of key terms found in
the language of Latinx communities.
Daily 1
Job aid that outlines worked examples that help
introduce elements of recruitment planning
explaining the challenges for minorities in the
pipeline.
Daily 1
Job aid on the steps toward diversity and inclusion
strategic planning per AAMC toolkit.
Daily 5
Guided review of discussions to enrich culture and
language through self-reflection.
Daily 4
Personal reflection on the consequences of not
including DEI initiatives in recruitment planning.
Daily 4
Encouraging
Provide goal-directed feedback on learning and
performance.
Weekly 2, 4
Communicate benefits and risks toward improving
student diversity through recruitment planning.
Weekly 3, 7
Provide guided recruitment materials aligned with
accreditation standards.
Monthly 10
Coaching by program instructors in private
conversations specifically addressing
comprehension gaps and discussing areas to
improve progress in learning and performance.
Weekly 1, 4
Mentorship opportunities to build confidence and
establish network opportunities with new
stakeholders and partnerships.
Daily 2, 3
Observe cultural leadership seminars to drive
innovative behavior and engagement for the
development of new recruitment plans aimed at
increasing student diversity.
Ongoing 5, 6, 7

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Methods Timing
Critical behaviors
supported
Guided feedback on SMART specific goals related
to recruitment planning initiatives to increase
student diversity.
Weekly 1, 2, 8
Rewarding
Recognition through awards and days off for
exceptional contribution meeting milestones in
recruitment strategies.
Monthly 1, 2, 3, 4
Pay for performance through salary increases and
promotions for achieving high ratings in
achieving organizational objectives.
Quarterly 1, 2, 3, 4
Incentivize participation in research grants aimed to
increase diversity initiatives such as NIH
support.
Ongoing 2, 6
Monitoring
Observe seminars related to DEI initiatives that
articulate challenges and barriers in recruitment
planning efforts.
Ongoing 2, 8
Action plan monitoring of established committees
designated to manage goals and incentives in
securing metrics for increasing diversity within
the program.
Monthly 1, 2, 3, 4, 9
Key performance indicators set against
benchmarking techniques by evidence-based
research that can be used as a metric to drive
institutional goals related to diversity outcomes.
Weekly 1, 2, 3, 4, 10
Work review of policies and procedures in the
recruitment process to check for alignment with
organizational goals to improve representation of
Latinx students.
Weekly 1, 3, 4
Monitoring data-driven benchmarking techniques
to establish methods for improving minority
student representation.
Weekly 9
Monitor periodic audits to check for alignments of
organizational goals to mission and vision.
Quarterly 9, 10
Monitor budget allocations of resources critical to
organizational performance.
Monthly 9

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Organizational Support. The organization may support the administrations’ critical
behavior through overcoming challenges such as time, accessibility, and level of control by
“monitoring” and “adjusting” (Kirkpatrick & Kirkpatrick, 2016). The organization must be fully
capable of providing resources, support, funds, and time allocation to explore the strategy in a
way that planning effectively positions the organization to deliver on the internal and external
outcomes (Kirkpatrick & Kirkpatrick, 2016). An organization must be able to support
recruitment strategies with resources to help fund trips and meals and make time available for
employees to deliver on this task. The organization should be able to allocate the time needed to
spend improving recruitment strategies, presenting the results, and offering training that is
practical for everyday use. The organization should also be able to provide a level of access to
information that can help drive decisions. Finally, the organization must be able to allow for a
level of control that can help adjust individual performance, adjust, and adapt to ensure evidence-
based practices.
In order to develop an organizational culture that can provide this type of environment,
the engagement of the president to support and influence the initiative of increasing Latinx
students to the MSPA program will help effect positive change to create a culture of diversity
and inclusion. A specialized committee of diverse individuals aimed at representing the goals
and incentives in securing the metrics for increasing diversity within the program, particularly
for Latinx student representation, may form within the organization to drive this initiative. The
committee can be based on seasoned administrators with experience or a contracted firm that is
able to provide professional consultants that are experts in the field of diversity and inclusion.
Additionally, efforts to generate a plan to demonstrate an evidence-based review of
minority applicants can help drive this commitment to diversity and inclusion. This can be done

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by capturing procedures, policies, and processes that aim to highlight strengths in the
applications of minority students, particularly of those represented by the Latin-based
communities. The assessments can be benchmarked against other institutions that employ
improvements to this metric to show the organization is making efforts to improve the
representation of Latinx students in medicine.
Finally, all actions within the organization are subject to a formal audit of the policies and
procedures in the admissions process to check for alignment with organizational goals to
improve the representation of Latinx students. If the organization finds a low performance
against KPIs in the recruitment efforts, then new strategy developments can be planned to better
align the institutional goals towards increasing the application pool for Latinx students. This can
be done through evidence-based research for government-funded incentives through NIH grants
or publication of literature to indicate the practice of organizational change to promote student
diversity.
Level 2: Learning
Learning Goals. In Level 2, the evaluation of knowledge, skills, attitudes, confidence,
and commitment is the goal in the new world Kirkpatrick model (Kirkpatrick & Kirkpatrick,
2016). Clark and Estes (2008) indicate that effective change efforts ensure that everyone has the
resources (equipment, personnel, time) needed to do their job and that if there are resource
shortages, then resources are aligned with organizational priorities (Clark & Estes, 2008). This is
an important note because according to the New Kirkpatrick Model, not all resources are needed
or available for Level 2 because the evaluation can be performed without the consideration of the
overall goal of the program of increasing performance or increasing organizational results

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(Kirkpatrick & Kirkpatrick, 2016). Therefore, it is important to focus on the resources available
to perform the critical behaviors.
In this study, the stakeholders need to know the knowledge and skills, motivational, and
organizational influences that can be considered as a point of focus for the critical behaviors. In
knowledge and skills influences, administrators at HU must know (a) the factual knowledge
about language in the context of recruitment planning for Latinx communities, (b) the conceptual
knowledge needed to understand the various recruitment plans available that can facilitate the
intake of Latinx students (c) in relation to improving the recruitment process steps, and (d) the
metacognitive capabilities in achieving the tasks related to improving the pipeline in Latinx
representation.
Clark and Estes (2008) describe motivation as the product of an interaction between
people and their work environment. Spitzer (1995) found that many organizations base their
motivational systems on outdated, wrong, or incomplete strategies. Therefore, to improve
motivation, the goal is to indirectly influence people’s understanding of the impressions they
create in others, their own ability to do a job, and their beliefs about the benefits of the work
(Clark & Estes, 2008). In the motivational influences, the administrators at HU must (a) believe
in their ability to increase Latinx student representation, (b) value the need to increase Latinx
student enrollment within the program, and (c) value the goals of increasing Latinx minority
representation in the MSPA program.
The stakeholders need to know and be able to do the following implementation of the
program as their learning goals to perform the critical behaviors listed in Table 92 based on
Anderson and Krathwhol’s (2001) taxonomy for learning, teaching, and assessing:

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1. Know the steps in the recruitment process to improve recruitment planning for Latinx
students (procedural knowledge).
2. Reflect on one’s biases to analyze the overall structure and purpose in achieving tasks
and strategies needed to improve the Latinx student pipeline (metacognitive
knowledge).
3. Believe in their abilities to increase the enrollment for Latinx students (self-efficacy).
4. Set clear goals toward increasing diversity in the MSPA program (goals). Engage in
cultural representation efforts to support recruitment plans for Latinx students
(cultural model).
5. Promote internal and external partnerships in the development of a recruitment plan
for minorities (cultural setting).
6. Utilize a holistic review approach as an alternative method to utilize a criteria in the
assessment of minority applicants (cultural setting).
7. Participate in periodic audits to consistently monitor and revise procedures in support
of recruitment planning for Latinx students (cultural setting).
8. Form sociocultural interactions to overcome socioeconomic factors that should be
considered in the recruitment plan, such as financial assistance for financial hardships
(cultural setting).
Program. Clark and Estes (2008) indicated that effective change begins by addressing
motivation influencers; it ensures the group knows why it needs to change. It then addresses
organizational barriers and then knowledge and skills needs (Clark & Estes, 2008). In order for
the program to work, the organization must be committed to supporting the achievement of the
administration’s learning goals around the knowledge and skills, motivation, and organizational

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influences. The focus here is to address the motivational influences to understand the level of
support by the organization for the program. To this effect, the HU administrators need to (a)
understand self-efficacy in their ability to increase Latinx students’ enrollment, (b) understand
the utility value of increasing Latinx student enrollment, (c) understand the attainment in tasks
involved in recruitment planning for minority groups, (d) establish SMART goals directly
associated with program objectives and organizational mission and vision, and (e) possess
mastery goal orientation to improve, learn new material, and master the tasks set in relation to a
recruitment strategy plan for minority students.
The organization’s goal is to have a recruitment plan for the intake of Latinx students
within its MSPA program by December of 2022. During this time, the organization should take
the time to prepare the resources in regard to funds, people, and materials to meet this initiative.
The program delivery method will encompass a variety of training, assessments (quizzes, tests),
presentations, action planning, surveys, interviews, demonstration/performance tests, and focus
group interviews. The training will consist of job aids related to the AAMC diversity and
inclusion toolkit that describes the process in strategic planning. The toolkit will encourage HU
administrators to be involved, engaged, and participate in the improvement process of DEI
initiatives when they return to work. Therefore, the motivational factor to support these activities
and the overall attitude by all administrators to help success in the critical behavior that is
aligned with the organizational goals.
Evaluation of the Components of Learning. Clark and Estes (2008) state that effective
organizations ensure that organizational messages, rewards, policies and procedures that govern
the work of the organization are aligned with or are supportive of organizational goals and
values. This evaluation is used to understand the confidence and commitment by administrators

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that will effectively support the components of learning within the organization for this initiative.
This is the bridging point to which the abstract proposed solutions are translated into concrete
methods and activities to evaluate the learning goals of the organization. In this study, the
organization needs to (a) share cultural representation beliefs and mental schemas toward the
support of a recruitment plan for Latinx students, (b) form new partnerships in the development
of a recruitment plan, (c) a holistic review policy that allows for alternative criteria for
assessment of minority applicants, (d) periodic audits in the recruitment process, and (e)
sociocultural interactions to overcome socioeconomic determinant barriers for Latinx students
worked into the recruitment plan.
The Level 2 learning, per the new world Kirkpatrick model, provides formative and
summative methods for evaluation of the learning goals listed in Table 94.

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Table 94
Evaluation of the Components of Learning for the Program
Methods or activities Timing
Declarative knowledge “I know it.”
Knowledge test/check prior to program initiative. Before and after
Discussion around knowledge of health disparity issues on 1:1
basis based on the knowledge/test check results.
During
Individual discussions around the capabilities of achieving tasks
related to improving the pipeline of Latinx students.
Before, during, and after
Group activities around the mission and vision of the
organization and how it aligns to the program initiative.
Before and during
Procedural skills “I can do it right now.”
Demonstration and performance test around the procedures
related to the program initiative.
During
Action planning on their capabilities to position resources
around the program’s initiative.
Before and during
Presentation of program initiatives related to procedures in place
to support the program initiative.
During
Attitude “I believe this is worthwhile.”
Attitude “I believe this is worthwhile”
Survey about individual’s goals of the program’s initiative. Before and during
Survey about individual’s self-efficacy in the program’s
initiative.
Before and during
Individual discussion on the goals and self-efficacy in the
program’s initiative.
Before and during
Confidence “I think I can do it on the job.”
Teach Back: teach portions of the material related to the
program’s initiative to their peers to confirm understanding.
During and after
Presentation of program initiative related to recruitment
strategies.
During and after
Action planning on the attitude to position resources around the
recruitment strategies of the program.
Before and during
Demonstration/Performance test related to the objectives of the
program as it aligns with the individual’s confidence.
Before and during
Commitment “I will do it on the job.”
Knowledge test/quiz/post-test to understand the growth of the
learning goals.
Before and after
Action planning with the individual on the objectives of the
program in performance development plans.
Before, during, and after
Interview with the individual around the abilities and confidence
in the completion of the task.
Before, during, and after
Focus group interview with teams identified to implement
recruitment strategies.
Before, during, and after

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Level 1: Reaction
Level 1 Reaction is the evaluation of all three components as it relates to the recipient of
the training with a focus on engagement, relevance, and customer satisfaction experienced by the
trainee in the new world Kirkpatrick model (Kirkpatrick & Kirkpatrick, 2016). In the new world
Kirkpatrick model, Level 1 is to quickly and efficiently get the information needed to confirm
the quality of the program and the instructor as acceptable (Kirkpatrick & Kirkpatrick, 2016).
There are two methods that are used to evaluate the program at this level and involve both
formative and summative approaches. The goal of this study is to confirm that the administrators
at HU experienced a training program that brings value to the individual and to the organization
by assessing the experience as it relates to the program’s training approaches per the New World
Kirkpatrick model. The engagement, relevance, and customer satisfaction experiences are listed
in Table 95 as it relates to the method used to determine the trainees’ reaction to the program
learning initiatives.

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Table 95
Components to Measure Reactions to the Program
Method(s) or Tool(s) Timing
Engagement
Instructor observation to determine the degree of class engagement. Ongoing
Pulse Check to see if the class is learning and grasping the
information that is built into the program design.
During
Dedicated observer to see the level of depth of training and
interaction.
During
Relevance
Dedicated observer that sits in the training to get a third-person
perspective on the effectiveness of the training to the class.
During
Post-training evaluation for the instructor. After
Customer Satisfaction
Post-training survey evaluation. After
Post-program survey evaluation. After
Focus group interview. After
Lessons learned interview. After

Evaluation Tools
Immediately Following the Program Implementation. The evaluation tools used in
this study involved both formative and summative methods that make up both Levels 1 and 2 for
“Reaction” and “Learning” according to the new world Kirkpatrick model. In Level 3, the study
goes beyond comprehensive, continuous performance monitoring and improvement systems by
incorporating reinforcement drivers to critical behaviors necessary for organizational value
through support and accountability strategies (Kirkpatrick & Kirkpatrick, 2016). The work at
Level 3 truly validates the final phase, which is Level 4, results, following the validation of
leading indicators for internal and external outcomes (Kirkpatrick & Kirkpatrick, 2016). At
Level 1 Results, the degree to which participants find the training favorable, engaging, and
relevant to their jobs is captured.

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To evaluate the impact of engagement, formative and summative methods are applied to
evaluate the effectiveness of the training. Using the formative techniques of (a) instructor
observations, (b) pulse-checking, and (c) dedicated observations, the interactions of the
administration and the lead trainer will be captured to characterize the quality of the training on
health disparities, recruitment strategies, and administrators’ performance development. The
summative methods are used through interviews and surveys on a 1:1 basis as well as focus
groups to understand the engagement by all administrators specific to the mission and vision of
the organization. The engagement is captured during the implementation of the training program
and is an ongoing process. In this way, the participation, responses, and the degree of
effectiveness are captured based on depth, interaction, and interest in the training. This
information is summarized, presented, and discussed to describe the level of engagement
experienced by the administrators at HU with the training program.
The training program uses summative methods through a series of surveys and individual
and focus groups to understand the connection and gaps associated with the training program.
This effort is captured at the beginning, during, and after the training program. Online training
modules and in-class training modules will determine how relevant the material is regarding to
health disparities and recruitment strategies as it pertains to the organizational goal. The trainers
of each module, whether online or in-class, are also evaluated through a value survey by the
trainees to help the trainer improve strategies and techniques in the training delivery.
Finally, the customer satisfaction of the overall program is captured through summative
methods after the training is complete. A post-program survey is completed by all trainees
around questions related to the overall satisfaction of the training. The results are then shared
through meetings with the administration and staff to understand the strengths and weaknesses of

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the overall satisfaction of the training. A lesson learned is then shared with the trainers of the
program as it relates to health disparities and recruitment strategies to improve the delivery of the
training techniques. The overall input from the customer satisfaction survey and discussions
through staff meetings are then incorporated into a meaningful 1:1 discussion between
administration and staff to update the performance development management plan to improve
the metric in the overall performance of the organizational goal.
The level of engagement, relevance, and customer satisfaction is designed for the
program to capture the integration of the training to the trainees. The integration of all these
levels through engagement, relevance, and customer satisfaction bridges the change efforts to the
overall organizational goals and the value of the training program (Kirkpatrick & Kirkpatrck,
2016). At the end of the study, these efforts reassure stakeholders that the program is
contributing to key organizational outcomes (Kirkpatrick & Kirkpatrick, 2016). Appendix G lists
the evaluation immediately following the program implementation.
Delayed for a Period After the Program Implementation. Once the implementation of
the program initiative has progressed through mid-year and at the end of the year, an evaluation
will consist of post-training and post-program surveys around the 4-Levels of the new world
Kirkpatrick model. The survey involves a series of questions regarding the (Level 1) overall
satisfaction of the training as it relates to recruitment strategies and health disparities (Level 2),
how the learning of new material relates to the administrator’s position (Level 2 and 3), the
relevance to the new information against their critical behaviors to meet the organizational goals,
(Level 3) how effective are the reinforcing behaviors, and (Level 4) the overall program health
results as it aligns with the goals of the organization. The degree of confidence, commitment,
attitudes, procedural skills, and declarative knowledge are all points of interest for the survey to

288
capture from a quantifiable point system to detect areas of improvement and effectiveness. A
final presentation formed by an internal committee, or a consultation group shall provide the
overall results to the organizational leaders and administration to set the stage for next year’s
strategic planning and improvement strategies. Appendix H provides the list for the delayed
blended evaluation.
Data Analysis and Reporting
In the new world Kirkpatrick model, there are a series of evaluations from each of the
four levels that require data analysis and reporting. First, the formative assessments require much
preparation regarding analyzing the data, organizing them to find trends, and cleaning the data
for presentation. Figures, graphs, and charts shall be used as instruments that extract meaningful
data for stakeholders to make decisions around organizational change efforts. Additionally, the
summative data will require data analysis through coding for trends that may impact the
organizational change in both positive and negative ways.
The evaluations will be gathered before, during, and after the execution of the
recommended solutions through post-program surveys and interviews that will be used to
validate the information through quantitative and qualitative analysis, respectively. The
evaluation of the program is based on using Levels 1 and 2 to determine the effectiveness of
reaction and learning to characterize the response of the organization with respect to the need to
increasing diversity in the medical program. The data reported here will consist of monthly and
quarterly data that will help with adjustments to meet the organizational goal with a focus on
declarative knowledge, procedural skills, attitude, confidence, and commitment.
The evaluation of Levels 3 and 4 will validate the internal and external outcomes based
on the performance of the critical behaviors and required drivers through reinforcing,

289
encouraging, rewarding, and monitoring methods. These data will be categorized and presented
as the duration of the data gathered before, during, and after the program execution. The overall
results will show how successful organizational change efforts using the New World Kirkpatrick
model were able to positively impact the stakeholder and organizational goal to increase student
diversity at HU. The findings of the internal outcomes will be reported using a strategic
dashboard regarding the intervention plan for immediate and delayed instruments. The data
gathered for the strategic dashboard will be managed by a selected committee to oversee the
management of the implementation strategy for the improvement plan. The strategic dashboard
shall be updated on a quarterly basis and shall include deep-dive meetings with all stakeholders
of the program. An example of the sample report utilizing the strategic dashboard method is
found in Figure 6.

290
Figure 6
Sample Report of HU Administration on Recruitment Planning Performance.

Summary
The new world Kirkpatrick model was used as an effort to implement an organizational
change by facilitating learning components and evaluating methods that effectively demonstrate
value to the organization. In this study, the KMO model by Clark and Estes (2008) was used to
identify performance gaps, which are evaluated and validated using the new world Kirkpatrick

291
model. To achieve the stakeholder and organizational goal, the KMO influences were examined
to understand the gaps in the organization’s performance.
Context-specific recommendations were provided for the performance gaps that
encompass the organizational culture at HU, the policy and procedures that govern the program,
and the stakeholder’s capability to facilitate change. The New Work Kirkpatrick Model is used
throughout the program initiative to understand how well the organization is adapting to the new
initiative in promoting diversity in the medical program.
The evaluation plan, once implemented, will follow a 4-level assessment effort to gather
valuable data to determine the effectiveness of the intervention plans as dictated by the external
and internal outcomes of the training program. This fulfills the organization's efforts in looking
for valuable change efforts that bring it closer to the organization's needs and goals as it aligns
with its mission and vision in the integration of health and the importance of diversifying the
community
Strengths and Weaknesses of the Approach
Strengths of the study include complete access to the senior administrators and full
participation, triangulation across the stakeholders with perspectives from staff and faculty and
the students, which encompasses the entire organization. Evaluation of documentation of
analysis to validate the KMO influences were available through the CASPA system and the
public domain of the National Center for Education Statistics through the Integrated
Postsecondary Education Data System. Another study strength was the experimental design in a
mixed-methods approach that provided quantitative and qualitative analysis, providing extensive
data to validate the influences in this study. Weaknesses of the study include sample size, for all
groups in the assessment were small. Most MSPA programs in the United States hold very small

292
cohort, faculty, staff, and administrator sizes. Another weakness of the study was the low
participation from student interviewees. A weakness of the study was related to the COVID-19
pandemic that did not allow access to campus or in-person interviewing that may have captured
behavioral cues as well as artifacts associated with the cultural model of the institution. Another
weakness in this study is the poor participation of Latinx participants in the study, which were
absent for interviews and limited to a small percentage in surveys.
Limitations and Delimitations
Not all studies are designed and conducted perfectly, and thus, limitations are reported
here on the accessibility of documentation. Minutes of stakeholder meetings and confidential
information on infographic material could not be shared. There were limited questions available
to better understand the cultural models of the institution, and the study was heavily leveraged on
the cultural setting. Another limitation was the scope of the study involved only three
stakeholder groups and left out other groups of interest, such as alumni and external communities
like clinical residency leadership in the MSPA program.
In regard to delimitations, the study involved a very small organization with a senior
administration sample that was small and not reflective of normally distributed data that may
follow a central limit theorem. Another delimitation is the cross-institutional interactions and
activities associated with the schools were outside the scope of refer to how you bounded your
study. A geographical study should be considered for schools that share demographics with
challenges in diversity to understand how the perspectives of the administration differ when the
diversity representation of the student cohort does not conform to accreditation standards.

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Future Research
In general, there are various categories of topics that could be discussed in this section for
the dissertation in practice. First, one key area would be the need to examine the HU
administrations in other programs of the institution. This assessment allows for the MSPA
program to run a benchmark and calibration analysis against other programs that may be
performing better, worse, or at par. Second, an examination of motivational incentives of HU
administration using goal orientation theory can capture more data around incentivizing efforts
and incorporating them into the goals of the organization such as the perception of a reward
system toward increasing diversity initiatives Third, is the intent to capture the HU
administration’s perspectives in the context of engagement, participation, representation, and
leadership focused on diversity initiatives within the community. Fourth, a focus group study of
the administration can help provide insight into how the HU administrators influence each other
on decisions critical toward improving diversity goals within the organization. A fifth area of
future research is exploring the recommended solutions for the HU administration to serve as a
modeling agent for programs to increase diversity. A sixth area is to explore and understand the
participation and access of Latinx participants. The low participation of Latinx participants did
not capture their perceptions in alignment with the strategies presented in this study. In addition,
the evaluation of emerging theories that were captured from interviews can be investigated
thoroughly in separate studies to understand how it influences organizational performance.
Finally, the model represented by the HU administration in this study can be used for initiatives
intended to increase the diversity of other underrepresented groups of interest.

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Conclusion
In the last 40 years, multiple attempts to improve representation of minorities in the
healthcare system has been acknowledged, researched, and addressed resulting in continued poor
representation of Latinx health professionals. The Latinx health professions representation
problem is more severe in the state of California, which holds one of the largest Latinx
populations in the nation. Today, we continue to experience a good number of Latinx patients
that require assistance by a family member, loved one, staff, or even another patient to help
translate and connect with the primary care physician to effectively communicate their ailments.
Multiple medical programs have initiated core competency skills in culture, health disparity
courses, and even Spanish medical terminology in response to prepare healthcare staff to
improve patient relationships and care for the Latinx community.
Although much progress in curricula has been made, the problem of poor representation
of Latinx health professionals still lingers across the board from physicians to pharmacists, to
physician assistants, to nurses, etc. It is clear there is a disconnection between the mission and
vision of medical organizations and the commitment of goals and organizational performance to
effectively address the problem of poor Latinx representation at medical institutions. It is also
evident that some medical institutions are not effectively representing the communities within
the vicinity of their operations, with some institutions existing near communities with a Latinx
population of over 60% yet graduating less than 10% Latinx minority students. Based on
scientific literature presented in this study, a strong case is made to place the senior
administration at the center of the study to better understand the leadership gaps acting as
barriers within the process of strategic planning for the recruitment and enrollment of Latinx
students.

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The Clark and Estes (2008) gap analysis model was used to evaluate the KMO influences
that serve as barriers in the strategic recruitment and enrollment plans of Latinx minority
students in the MSPA program at HU. This study focused on the senior administration
performance to assess the organizational leadership and the exploration of outcomes in the
strategic planning for the representation of Latinx students. A comprehensive evaluation was
performed on the senior administrators with respect to their perspectives and experience in their
participation with strategic recruitment planning, coupled with the perspectives of staff, faculty,
and students to reinforce and better assess the gaps of the administration. The senior
administrators were selected based on their leadership and influence to align the organizational
mission and vision to meet the organizational goals within the MSPA program. The study was
further fortified by the triangulation of data gathered from surveys, interviews, and document
analysis to provide a robust context specific recommendation.
The results indicated the validation of the needs and assets identified in the KMO
conceptual framework necessary to develop a strategic recruitment plan to help increase the level
of diversity of Latinx students in the MSPA program. The knowledge dimension was addressed
by the cognitive load and information processing systems theory to better understand the needs
to develop a recruitment plan for Latinx students with the administration participation. The
motivational factors were addressed by the expectancy value to improve self-efficacy of the
administration in the belief to attain a recruitment plan and leadership theories to guide SMART
goals across the entire organization. Finally, the cultural model and setting influences were
addressed by diversity, communication, accountability, and leadership theories to close the gaps
in the cultural and mental schemas and resources the administration needs from the organization
for the development of a Latinx minority recruitment plan.

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The outcome of this study presents a novel and innovative approach in the application of
Clark and Estes’s (2008) model across three main stakeholders that involves the administration,
staff and faculty, and the students. The analytical methods employed in this investigation
successfully gathered the perspectives of all stakeholders with supported institutional
documentation, surveys and interviews. The results of the analysis provided a detailed robust
implementation and evaluation plan using the Kirkpatrick et al. (2016) New World Model to
help the administration in assessing efficiency and effectiveness of the context-specific solutions.
It is encouraged for institutions that are experiencing a similar problem to utilize or
follow a redefined conceptual framework that will help identify gaps within the organizational
performance and implement recommended strategies to address the needs for the institution. The
model presented in this study can generally apply to a variety of underrepresented populations to
help other programs in meeting accreditation standards in diversity initiatives. The model can
also apply to multiple programs across professional health professions to address issues of
diversity, equity and inclusion, health disparities, and cultural representation across multi-faceted
health professions institutions.
As this study comes to an end in 2022, the Latinx student representation is no longer a
minority group in some states like California and Texas, but an emerging majority. It is
imperative that our medical educational institutions are ready in their strategic planning to create
an organizational infrastructure that will help prospective Latinx students nurture their passions
to help make a difference in their communities. These diversity, equity, and inclusion initiatives
must be driven by the top senior administrations to help align the mission and vision and goals to
effect organizational change. After multiple decades of Latinx communities struggling to
effectively communicate with their language and culture, it is time to address these problems by

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effecting organizational changes, exercising innovative strategies, and implementing solutions in
our medical educational institutions to prepare more Latinx health professionals in these efforts.
In this generation, we continue to find our communities looking for assistance in
translations and connecting with medical practitioners that can better understand our Latinx
fathers, mothers, family members and friends. It is the hope that in generations to come, our
Latinx communities suffering from ailments, medical conditions, and terminal illness can make
better informed decisions with their families in their treatments and recovery as they are fully
connected, integrated, and culturally accepted by their medical institutions and well trained
medical health professionals.

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Appendix A: Survey Protocol
Thank you for your participation in this survey. This survey is intended to support
research around the knowledge and skills, motivation, and organizational influences on the
administration’s support for a strategic enrollment recruitment plan for Latinx minorities in the
MSPA program. Your input is highly valued, and the survey is anonymous. Your information
will be encrypted and password-protected to ensure confidentiality. By taking this survey, your
valuable feedback will help contribute to strategic recruitment plans for the MSPA program
based on your experiences and can help bring improvement and recommendations to
administrators. With your consent to participate in this study, you may move forward with this
survey. We greatly appreciate your time.

338
Table A1
Survey Items
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
Demographics:
sample description
N/A Are you a student?
Yes
No
Nominal Percentage, Frequency Table, pie chart
Demographics:
sample description
N/A Are you an
employee?
Yes
No
Nominal Percentage, frequency Table, pie chart
Demographics:
sample description
N/A How many years
have you worked
for HU?
Interval Percentage, frequency,
mode, median, mean,
standard deviation, range
Table
Demographics:
sample description
N/A What is your
position at HU?
Nominal Percentage, frequency Table, pie chart
Demographics:
sample description
N/A How many years
have you worked
in your current
role?
Interval Percentage, frequency,
mode, median, mean,
standard deviation, range
Table
Demographics:
sample description
N/A My age group is:
18–24 years
25–34 years
35–44 years
45–54 years
55–70 years
above 70 years
Interval Percentage, frequency,
mode, median, mean,
standard deviation, range
Table
Demographics:
sample description
N/A I am Bilingual: Yes
No
Nominal Percentage, Frequency Table
338

339
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
If bilingual, indicate
language(s):
Demographics:
sample description
N/A I am:
Female
Male
Other
Prefer not to say
Nominal Percentage, frequency Table, pie chart
Demographics:
sample description
N/A Race & Ethnicity:
Hispanic or
Latino of any race
American Indian
or Alaska Native,
not Hispanic or
Latino
Asian, not
Hispanic or
Latino
Black, not
Hispanic or
Latino
Native Hawaiian
or Other Pacific
Islander, not
Hispanic or
Latino
White, not
Hispanic or
Latino
Two or more
races, not
Nominal Percentage, frequency Table, pie chart
339

340
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
Hispanic or
Latino
Nonresident
Alien
Not reported
(Race & Ethnicity
Unknown).
Prefer not to say
HU administrators
need knowledge of
the language for
recruitment
planning.
K-F I am aware that
Spanish content is
important for
recruiting students
from Latinx
communities.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Nominal Percentage, frequency Table, pie chart
HU administrators
need conceptual
knowledge of the
different types of
plans utilized for
Latinx students.
K-C I can choose
different types of
recruitment plans
to facilitate an
increase in Latinx
students.

Strongly agree
Agree
Neutral
Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
340

341
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
Disagree
Strongly disagree
HU administrators
need procedural
knowledge on the
steps to recruit
Latinx minorities.
K-P Place the following
steps in order of
sequence:

Establish criteria
for appointing
and evaluating
the
performance of
the
organization.
Use the mission
and values to
guide academic
decision-
making and
resource
allocation.
Understand the
needs of the
regional
economy with
respect to
contributing to
the
development of
sustainable
communities.
Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
341

342
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
Establish roles
and
responsibilities
for faculty
members,
administrators,
staff, and
trustees.
Perform
assessment of
institutional
performance
and
effectiveness
and student
outcomes.
Understand
knowledge and
competencies
that are
expected of
academic
leaders, faculty,
staff, and
trustees.
HU administrators
need self-
awareness in their
effectiveness to
collaborate with
others in shaping a
K-M I take time to reflect
on my interactions
with others after
collaboratively
working on
recruitment plans.
Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
342

343
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
recruitment plan
that promotes
student diversity.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
HU administrators
need to increase
self-efficacy
measures to
improve
recruitment plans
for Latinx
minorities.
M-SE I feel confident
about my ability to
develop a
recruitment plan for
Latinx students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Percentage, frequency,
mode, median, range
Table, pie chart
HU administrators
need to increase
utility value for a
recruitment plan to
increase student
diversity.
M-UV A Latinx focused
recruitment plan will
provide me with
more options to help
increase student
diversity.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Percentage, frequency,
mode, median, range
Table, pie chart
343

344
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
HU administrators
need to increase
attainment value
to promote
innovative
behavior for the
development of a
recruitment plan.
M-A It is important for
me to apply new
ideas in
recruitment
planning
that increases
diversity in the
MSPA program.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Mean, standard deviation,
range
Table, stacked bar
chart
HU administrators
must have clear
goals to increase
diversity in the
MSPA program.
M-G The goal of
recruiting Latinx
students to
increase diversity
is clear to me.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Mean, standard deviation,
Range
Table, stacked bar
chart
HU administrators
possess mastery
orientation in
relation to new
recruitment
M-GO I like to learn more
about recruitment
planning for
Latinx students
despite how
Interval Percentage, frequency,
mode, median, range
Table, pie chart
344

345
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
strategies for
Latinx students.
challenging it may
be.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
The administration
needs the
organization to set
partnerships in
developing a
recruitment plan
for minorities.
O-CS I collaborate with
others in new
projects involving
development of
recruitment plans
and strategies for
minority students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Mean, standard deviation,
range
Table, stacked bar
chart
The administration
needs the
organization to
provide alternative
criteria for the
assessment of
minority
applicants
O-CS There are alternative
criteria that we
can use to assess a
minority applicant
in the recruitment
process.

Strongly agree
Agree
Ordinal Mean, standard deviation,
range
Table, stacked bar
chart
345

346
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
Neutral
Disagree
Strongly disagree
The administration
needs the
organization to
have periodic
audits of
recruitment plans.
O-CS There are audit plans
we follow to
continually revise
procedures in the
recruitment plan
when necessary.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Nominal Percentage, frequency Table
The administration
needs the
organization to
have cultural
representation to
support
recruitment
planning for
Latinx students.
O-CM There is cultural
representation
integrated in the
recruitment plan
for Latinx
students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
The administration
needs the
organization to
provide training to
O-CS There are
socioeconomic
determinants in
the Latinx
Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
346

347
Research Question/
Data Type
KMO
Construct
Survey item
Scale of
measurement
Potential Analyses
Visual
representation
overcome
socioeconomic
determinants in
the context of
developing
recruitment plans?
community that I
must consider in
the development
of a recruitment
plan for Latinx
students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

K-C=Knowledge-Conceptual, K-P=Knowledge-Procedural, K-F=Knowledge-Factual, M-A=Attribution, M-GO=Goal Orientation, M-
SE= Self-Efficacy, M-UV= Utility Value, O-CM=Cultural Models, O-CS=Cultural Settings

347
348
348
Appendix B: Student Survey Protocol
Thank you for your participation as a student in this survey. This survey is intended to
support research around the knowledge and skills, motivation, and organizational influences for
the administration. Your perspectives as a student can help as feedback for the administration as
it relates toward strategic enrollment recruitment planning in the Latinx community for the
MSPA program. Your input is highly valued and the survey is anonymous. Your information
will be encrypted and password-protected to ensure confidentiality. By taking this survey, your
valuable feedback will help contribute to factors that can help the administration with strategic
recruitment plans for the MSPA program. Your experiences and can help bring
recommendations and improvements on student diversity for the administrators to consider in the
recruitment efforts for new cohorts. With your consent to participate in this study, you may move
forward with this survey. We greatly appreciate your time.

349
Table B1
Survey Protocol Questions
Research
question/Data type
KMO
Construct
Survey item
Scale of
measurement
Potential analyses
Visual
representation
Demographics:
sample
description
N/A Are you a student?
Yes
No
Nominal Percentage, frequency Table, pie chart
Demographics:
sample
description
NA How many years have you
attended HU?
Interval Percentage, frequency,
mode, median, mean,
standard deviation,
range
Table
Demographics:
sample
description
NA My age group is:
18–24 years
25–34 years
35–44 years
45–54 years
55–70 years
above 70 years
Interval Percentage, frequency,
mode, median, mean,
standard deviation,
range
Table
Demographics:
sample
description
N/A I am Bilingual:
Yes
No
If bilingual indicate
language(s):
Nominal Percentage, frequency Table
Demographics:
sample
description
N/A I am:
Female
Male
Other
Prefer not to say
Nominal Percentage, frequency Table, Pie chart
349

350
Research
question/Data type
KMO
Construct
Survey item
Scale of
measurement
Potential analyses
Visual
representation
Demographics:
sample
description
N/A Race & Ethnicity:
Hispanic or Latino of any
race
American Indian or Alaska
Native, not Hispanic or
Latino
Asian, not Hispanic or Latino
Black, not Hispanic or Latino
Native Hawaiian or Other
Pacific Islander, not
Hispanic or Latino
White, not Hispanic or Latino
Two or more races, not
Hispanic or Latino
Nonresident Alien
Not reported (Race &
Ethnicity Unknown).
Prefer not to say
Nominal Percentage, frequency Table, Pie chart
HU administrators
need knowledge
of the language
for recruitment
planning.
K-F I am aware that Spanish
content is important for
recruiting students from
Latinx communities.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Nominal Percentage,
frequency
Table, Pie chart
HU administrators
need conceptual
knowledge of the
K-C There should be
different recruitment efforts
Ordinal Percentage, frequency,
mode, median, range
Table, Stacked bar
chart
350

351
Research
question/Data type
KMO
Construct
Survey item
Scale of
measurement
Potential analyses
Visual
representation
different types of
plans utilized for
Latinx students.
to facilitate the increase for
minority students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

HU administrators
need self-
awareness in their
effectiveness to
collaborate with
others in shaping
a recruitment plan
that promotes
student diversity.
K-M I have been able to
collaborate with the
department to help with
recruitment efforts.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Percentage, frequency,
mode, median, range
Table, Stacked bar
chart
HU administrators
need to increase
self-efficacy
measures to
improve
recruitment plans
for Latinx
minorities.
M-SE I feel confident the
administration’s ability to
develop a recruitment plan
for Latinx students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

Ordinal Percentage, frequency,
mode, median, range
Table, pie chart
351

352
Research
question/Data type
KMO
Construct
Survey item
Scale of
measurement
Potential analyses
Visual
representation
HU administrators
need to increase
utility value for a
recruitment plan
to increase student
diversity.
M-UV A Latinx focused recruitment
plan will help increase
student diversity.

Strongly Agree
agree
Neutral
Disagree
Strongly disagree

Ordinal Percentage, frequency,
mode, median, range
Table, pie chart
HU administrators
must have clear
goals to increase
diversity in the
MSPA program.
M-G The goal of recruiting Latinx
students to increase
diversity is clear to me.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

Ordinal Mean, standard
deviation, range
Table, stacked bar
chart
The administration
needs the
organization to
have cultural
representation to
support
recruitment
planning for
Latinx students.
O-CM There should be cultural
representation integrated in
the recruitment efforts for
Latinx students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree

Ordinal Percentage, frequency,
mode, median, range
Table, stacked bar
chart
352

353
Research
question/Data type
KMO
Construct
Survey item
Scale of
measurement
Potential analyses
Visual
representation
The administration
needs the
organization to
provide training to
overcome
socioeconomic
determinants in
the context of
developing
recruitment plans?
O-CS There are socioeconomic
determinants in the Latinx
community that must be
considered in the
development of a
recruitment plan for Latinx
students.

Strongly agree
Agree
Neutral
Disagree
Strongly disagree
Ordinal Percentage, frequency,
mode, median, range
Table, Stacked bar
chart

K-C=Knowledge-Conceptual, K-P=Knowledge-Procedural, K-F=Knowledge-Factual, M-A=Attribution, M-GO=Goal Orientation, M-
SE= Self-Efficacy, M-UV= Utility Value, O-CM=Cultural Models, O-CS=Cultural Settings

353
354
354
Appendix C: Interview Protocol
Thank you so much for your participation today. We value your presence here today and
the contribution you will provide to the study. I feel grateful for the opportunity to interview you,
as [HU] is the first and only PA program to immerse students in integrative healthcare. I greatly
value your time here today to participate in this study. The interview should be no longer than 45
minutes of your time.
The purpose of this study is to identify factors that can help the administration promote
the development of a strategic enrollment plan focused on the Latinx representation within the
MSPA program. My research will include interviewing administrators, faculty, staff, and
students. In this interview, we will engage in conversations around knowledge and skills,
perceptions, and experiences around recruitment planning for increasing student diversity. The
organization will be referred to under a pseudonym.
Your name will be kept confidential, encrypted, and coded in a way that your response
will not be traceable. After the study is complete, the recordings and transcripts will be deleted.
All information gathered in this interview will be kept confidential. You can decide not to
answer any questions at any time during the interview. You also have the choice of withdrawing
from the study at any point as you wish. Do you consent to participate in this study?
Before we begin, are you okay with recording the interview session? If you are okay, I
will notify you when the tape recorder is on and when it is off. The information carried on the
tape recorder will also be kept confidential and the purpose is to get all the details of the
interview while I can carry on a more focused discussion with you. I can provide you with a
copy of the transcript if you would like one. This will give you the opportunity to review your
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responses and update as you wish. Do you have any questions for me before we proceed? [At
this point I will maintain brevity in my responses to their questions].
I will start the recorder now.
“Please do understand the importance of your participation is intended to improve
performance-related issues in the areas of minority representation in the MSPA program through
innovative ways in strategic recruitment planning. We appreciate having you here today and we
value your input on this topic. Let’s begin!”

Table C1
Interview Protocol Questions
Influence Question Type
K-F
For the record, what is your position? (Patton –
Background)
How long have you been a part of this organization?
(Patton, experience)
How long have you been involved in recruitment
planning? (Patton, Experience)
Can you share your view on how language is used in
developing recruitment plans for minorities?
(Patton, experience)
Probe

This question is
intended to
determine if the
participant has
experience in
recruitment
planning.
K-C
Judge your own leadership style in promoting
diversity in the MSPA program..

Can you talk to me about the different forms of
recruitment strategies that are utilized for Latinx
students? (Patton, experience)
Probe

This question is
intended to
determine if the
participant has
knowledge of
different types of
recruitment plans
for minority
students.
M-SE
Can you describe how you feel about your ability to
increase the intake of Latinx students? (Patton,
Experience)
Open-Ended

This question is
intended to
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Influence Question Type
determine the
confidence the
participant has in
increasing Latinx
students.
M-UV
What are your thoughts around developing a new
recruitment plan for Latinx students for the MSPA
program? (Strauss et al., Ideal)
Open-Ended

This question is
intended to
determine if the
individual values
the need for a
recruitment plan
geared toward the
intake of Latinx
minorities.
K-P
Can you provide an example of how the recruitment
process works for Latinx students?

Can you walk me down the steps on how Latinx
students are recruited for the MSPA program?
(Patton, Values)

Diversification includes ethnic diversity and the
promotion of multiple ethnic cultures.

What are the program principles that advocate for a
recruitment plan that promotes diversity?
(Strauss et al., devil’s advocate)
Open-Ended

This series of
questions is
intended to see if
the participant
knows the
procedures in the
recruitment
process.
M-AV
Can you share with me any value that you would
personally find, if any, in a strategic recruitment
plan for Latinx students? (Patton, values)
Open-Ended

This question is to
understand if the
participant feels it
is important to
increase student
diversity
particularly in the
Latinx
communities in
the MSPA
program.
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Influence Question Type
K-M
Can you share your experience in collaborating with
others in developing recruitment strategies for
minorities? (Patton, experience)

Open-Ended

This question is to
understand if the
participant is
aware of their
effectiveness to
collaborate with
others in shaping
a new recruitment
plan to increase
student diversity.
O-S
Describe the organizational partnerships or
collaborations in the community that are needed in
the outreach and recruitment for prospective Latinx
students (Strauss et al., Hypothetical)
Open-ended

This question is to
understand if the
administrators have
external
collaborations that
support recruitment
planning for the
increase in student
diversity...
M-G
How did you perceive the goal to be in respect to
increasing diversity in the MSPA program?

Were the goals of increasing diversity within the
MSPA program with respect to Latinx students
clear or challenging to you?

If so, what was the percentage of the goals that was
clear?

What was the percentage of the goals that were
challenging? (Patton, feelings)
Probe

This question is to
understand if the
participant is clear
on goals designed
to increase student
diversity.
O-S
Does the organization have admission policies that
allow for alternative criteria for the recruitment of
minority applicants? (Strauss et al., devil’s
advocate).

If so, can you describe how effective these policies
are at facilitating the recruitment of Latinx students
in your experience? (Patton, experience)

Probe

This question is to
understand if there
are any alternative
options
(resources) for the
participant to
consider during
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Influence Question Type
the recruitment of
a Latinx minority
student.
M-G
Can you share with me your reasons for participating
in recruitment planning efforts? (Patton, opinions)
Can you share with me how you have responded to
any failures in recruitment planning efforts? what
are your chief ends in If you had the opportunity to
add more to the goals on recruitment planning for
Latinx minorities, what would it be? (Patton,
opinions)
If there was something wrong in the recruitment
process how would you go about addressing the
issue? (Patton, opinions)
Open-ended

This question is to
identify mastery
goal orientation
around the
recruitment
process in
general.
M-GO
That admissions to PA schools is a highly
competitive and rigorous program. Most applicants
who apply to HU exceed the minimal entrance
requirements. HU’s goal is to enroll students
reflective of the current demographic make-up of
the U.S. HU consistently exceeds the national
averages in diversity.

As such, what type of goals would you consider
effective for increasing the intake of Latinx
students to the MSPA program? (Patton, feelings)
Open-ended

This question is to
determine if the
participant agrees
with leadership
diversification
positively
impacting student
diversification.
O-S
Do you engage in periodic audits in the recruitment
planning and if so, how often?
What are the three areas of improvement that you
focus on? ? How often do you engage in this type
of reflective process? (Patton, experience)
Open-ended

This question is to
determine if the
participant
engages in
periodic audits of
recruitment plans.
O-M
What are your thoughts on the cultural representation
of your peers when it comes to recruitment planning?
(Strauss et al., ideal).
Open-ended

This question is to
determine if the
participant is able
to describe the
representation of
culture within the
organization in the
context of
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Influence Question Type
recruitment
planning.
O-S
Tell me, what are ways that you overcome
socioeconomic determinants in recruitment
planning? (Patton, opinions)
How do socioeconomic determinants affect the
recruitment process for the intake of Latinx
students? (Patton, opinions)
If there was an improvement in considering
socioeconomic determinants, what would you
focus on? (Patton, opinions)
This question is to
determine if the
participant is able
to describe the
level and depth of
understanding the
challenges and
barriers associated
with Latinx
minority
communities.

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Appendix D: Student Interview Protocol
Thank you so much for your participation today. We value your presence here today and the
contribution you will provide to the study. I feel grateful for the opportunity to interview you, as
a student at [HU] and your experience through the recruitment process in the PA program. I
greatly value your time here today to participate in this study. The interview should be no longer
than 45 minutes of your time.
The purpose of this study is to identify factors that can help the administration promote
the development of a strategic enrollment plan focused on the Latinx representation within the
MSPA program. My research will include interviewing administrators, faculty, staff, and
students. In this interview, we will engage in conversations around your perspectives through the
recruitment process in the PA program and the factors that relate to student diversity. The
organization will be referred to under a pseudonym.
Your name will be kept confidential, encrypted, and coded in a way that your response
will not be traceable. After the study is complete, the recordings and transcripts will be deleted.
All information gathered in this interview will be kept confidential. You can decide not to
answer any questions at any time during the interview. You also have the choice of withdrawing
from the study at any point as you wish. Do you consent to participate in this study?
Before we begin, are you okay with recording the interview session? If you are okay, I
will notify you when the video recorder is on and when it is off. The information carried on the
video recorder will also be kept confidential and the purpose is to get all the details of the
interview while I can carry on a more focused discussion with you. I can provide you with a
copy of the transcript if you would like one. This will give you the opportunity to review your
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responses and update as you wish. Do you have any questions for me before we proceed? [At
this point I will maintain brevity in my responses to their questions].
I will start the recorder now.
“Please do understand the importance of your participation is intended to provide a
perspective that can help provide another perspective as a best practice for the administration
toward recruitment planning in the representation of minority students in the MSPA program.
Your perspective may contribute toward factors the administration can find useful using
innovative strategies toward recruitment planning. We appreciate having you here today and we
value your input on this topic. Let’s begin!”

Table D1
Interview Protocol Questions
Influence Question Type
K-F For the record, what is your current year in the
program? (Patton, background)

Did you go through a recruitment process when
applying to the PA program at HU? (Patton,
experience)

If so, can you share what language was used
through the recruitment process as it relates to
minorities? (Patton, experience)
Probe

This question is intended to
determine if the student
participant experienced a
recruitment effort by HU.
M-SE Can you describe how you feel about the
administration’s ability to increase the intake
of Latinx students?
(Patton, experience)
Open-ended

This question is intended to
determine the student
participant’s perspective in
the ability for the
administration to increase
Latinx students.
M-UV What are your thoughts around the
administration looking to develop a new
Open-ended

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Influence Question Type
recruitment plan for Latinx students for the
MSPA program? (Strauss et al., ideal)
This question is intended to
determine the participant’s
perspective toward the
administration’s values for
a recruitment plan geared
toward the intake of Latinx
minorities.
K-P Can you share your experiences of how you
were recruited to the MSPA program?

Can you recall anything that stood out through
the recruitment efforts as it relates to
diversity? (Patton, Values)

Diversification includes ethnic diversity and the
promotion of multiple ethnic cultures.

What do you think are important elements for
the program that can help promote diversity?
(Strauss et al., devil’s advocate)
Open-ended

This series of questions is
intended to see if the
student participant
experienced the practice of
the administration’s
procedures in the
recruitment process.
M-AV Can you share with me any value that you would
personally find, if any, in a strategic
recruitment plan for Latinx students? (Patton,
values)

Open-ended

This question is to understand
if the student participant
feels it is important to
increase student diversity
particularly in the Latinx
communities in the MSPA
program.
K-M As a student in the program, have you been able
to share your experience by collaborating with
the administration in recruitment efforts? If so,
what were key factors you focused on in the
recruitment effort? (Patton, experience)

Open-ended

This question is to understand
if the student participant
has collaborated with
administrators in the
recruitment process.
O-S Describe any collaborations you have had in the
community as part of outreach and
recruitment efforts for prospective minority
students? (Strauss et al., hypothetical)
Open-ended

This question is to understand
if the administrators have
opportunities for students to
engage in collaborations
that support recruitment
planning for minority
students.
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Influence Question Type
O-S Aside from GPA, what are other unique
attributes that you were able to bring to the PA
program that has helped you succeed? (Strauss
et al., devil’s advocate)
Can you describe how some of the attributes that
can help with increasing diversity in the PA
program? (Patton, experience)

Probe

This question is to understand
if there are any alternative
options (resources) from
the participant’s experience
that can be considered by
the administration’s
strategic recruitment plans.
O-M What are your thoughts on the cultural
representation of your peers in the PA
program? (Strauss et al., ideal).
Open-ended

This question is to determine
if the student’s participant
perspective if the cultural
representation within the
organization can provide
the administration with
improving its recruitment
planning toward cultural
diversity.

K-C=Knowledge-Conceptual, K-P=Knowledge-Procedural, K-F=Knowledge-Factual, M-
A=Attribution, M-GO=Goal Orientation, M-SE= Self-Efficacy, M-UV= Utility Value, O-
CM=Cultural Models, O-CS=Cultural Settings

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Appendix E: Information Sheet For Exempt Research
Study Title: The Emerging Majority in the United States Health Professions: A Gap
Analysis Innovation Model for Latinx Recruitment Planning within Higher Education.
Participation is voluntary with further information below. Please pause with any
questions you may have along the way.
Purpose of the Study
This study aims identify factors that can help with the administrators with the
development of a Latinx recruitment plan for the MSPA program. You are invited as a possible
participant because [list the main qualification for participation].
Participant Involvement
If you agree to be in this study, you will agree to participate in a video conversation with
the researcher. The general topic will look at factors associated with strategic enrollment plans
for Latinx students in the MSPA program. It will take no more than 45 minutes of discussion.
Confidentiality
The members of the research team and the University of Southern California Institutional
Review Board (IRB) may access the data. The IRB reviews and monitors research studies to
protect the rights and welfare of research subjects.
When the results of the research are published or discussed in conferences, no identifiable
information will be used. Information gathered during this research study will only be used for
this study. It will not be shared with other researchers. Any identifying information obtained in
connection with this research will remain confidential. Your responses will be coded with a
pseudonym and maintained separately from the published research. Any video recording or
transcripts will be destroyed once the study is complete.
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Investigator Contact Information
If you have any questions about this study, please contact Principal Investigator, Astor
Suriano, via email at asuriano@usc.edu or faculty advisor, Dr. Adrian Donato at
adonato@usc.edu.
IRB Contact Information
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.
Statement of Consent
I have read (or someone has read to me) the information provided above. I have been
given a chance to ask questions. All my questions have been answered. By signing this form, I
am agreeing to take part in this study.

Name of Research Participant Signature Date Signed
(and Time*)

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Appendix F: Document Analysis Protocol
Documents and artifacts were used as part of a gap analysis to understand KMO
influences through patterns, concepts, and themes that stem from interviews and surveys. The
documents include confidential internal infographics, pamphlets, brochures, bulletins, posters,
emails, organizational website, recruitment plans, marketing material, institutional plans, and
promotional documents. Artifacts include viewing symbols, emblems, bookstore, library, and
classroom as they are presented on the website to support cultural settings and models. The
artifacts as presented on the website were evaluated for patterns that emerge in the representation
of organizational culture, language, and diversity.

Table F1
Influences and Assessment

KMO influences Documents utilized for assessment
Knowledge
HU administrators need factual knowledge of
language for a strategic enrollment recruitment
plan.
Employee handbook
Student handbook
Internal statistical information
Internal infographics
HU administrators need conceptual knowledge of
the different types of recruitment plans utilized
for Latinx students.
Enrollment plans
Marketing plans
Brochures
Pamphlets current plan
Prior enrollment plans
HU administrators need procedural knowledge on
the steps to recruit Latinx minorities.
Recruitment plans
Institutional plans
HU administrators need self-awareness in their
effectiveness to collaborate with others in
shaping a recruitment plan that promotes
student diversity.
Interview transcript
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KMO influences Documents utilized for assessment
Motivation
HU administrators need to increase self-efficacy
measures to develop recruitment plans for
Latinx minorities.
Interview transcript
Emails
HU administrators need to have utility value for a
recruitment plan to increase student diversity.
Surveys
Institutional plans
HU administrators need to have attainment value
to promote innovative behavior for the
development of a recruitment plan.
Surveys
Interviews
Institutional plans
Town halls
HU administrators must have clear goals in
increasing diversity in the MSPA program.
Key performance indicators
SWOT analysis
Metric plans
Emails
HU administrators need to possess mastery
orientation in relation to new recruitment
strategies for Latinx students.
Interview transcript
Town hall records
Emails
Organizational
The administration needs the organization to set
partnerships in developing a recruitment plan
for minorities.
Promotional documents
Marketing documents
Posters
Recruitment plans
Strategy plans
The administration needs the organization to
provide alternative criteria for the assessment
of minority applicants.
DEI plans
The administration needs the organization to have
periodic audits of recruitment plans.
Recruitment plans
Institutional plans
The administration needs the organization to have
cultural representation to support the
recruitment plan for Latinx students.
Organizational website
Mission & vision statements
Emails
The administration needs the organization to
establish sociocultural interactions to overcome
socioeconomic determinants in the context of
developing a recruitment plan.
Training plans
Training material

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Appendix G: Immediately Following the Program Implementation
After the program
Declarative Knowledge (I Know It)
Describe what you learned about the type of language needed for strategic recruitment
planning of minorities.
In detail describe worked examples from the training that can be used for recruitment planning
of minorities.
Procedural knowledge (I Can Do It)
I can provide examples from my own work following diversity and inclusion strategic
planning principles from the AAMC toolkit training.
I correct errors that I find in DEI strategic plan submissions.
Attitude (I believe this is worthwhile)
I feel the training program was valuable and relevant to my workstreams?

1 2 3 4
strongly disagree strongly agree
I plan to apply all the principles from the training in my everyday work?

1 2 3 4
strongly disagree strongly agree
Confidence (I think I can do it)
I feel confident in forming partnerships that help secure metrics for diversity initiatives.

1 2 3 4
strongly disagree strongly agree
I feel confident about the success of the program in diversifying the student body.

1 2 3 4
strongly disagree strongly agree
Commitment (I will do it on the job).
How committed are you about integrating the training into your job function?

1 2 3 4
strongly disagree strongly agree
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After the program
How likely are you to remain committed to the new recruitment strategies taught in the
program?

1 2 3 4
strongly disagree strongly agree
Engagement
Was there anything distracting that interfered with your learning during the training? If so,
what was it?
What was the most effective activity in your training that was most valuable to you?
I am very interested in visiting a college campus as part of a recruitment strategy for
minorities.

1 2 3 4
strongly disagree strongly agree

Relevance
What was the most relevant topic in your line of work?
I feel that the training I have received is relevant for the improvement of my on the job
performance.
Customer Satisfaction
I will definitely recommend my training in this program to my colleagues.
Would you take this training program again? Why or why not?
I would recommend this training to anyone involved in recruitment strategies for diversifying
the student program.

1 2 3 4
strongly disagree strongly agree

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Appendix H: Delayed Blended Evaluation
Question After the program
L1: Reaction What I learned in the training program continues to be valuable in
establishing goals relevant to strategies for recruitment planning of
minority students.

1 2 3 4
strongly disagree strongly agree
L2: Learning I continue to apply new techniques in recruitment strategies for minority
students.

1 2 3 4
strongly disagree strongly agree
L3: Behavior My peers and I have regular staff meetings to discuss performance
development plans and alignment to organizational objectives

1 2 3 4
strongly disagree strongly agree
L4: Results I am able to 100% participate in the development of a recruitment plan
geared toward minority students.

1 2 3 4
strongly disagree strongly agree

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Asset Metadata

Creator Suriano, Astor Jonathan (author)

Core Title The emerging majority in the United States health professions: a gap analysis innovation model for Latinx recruitment planning within higher education

School Rossier School of Education

Degree Doctor of Education

Degree Program Education

Degree Conferral Date 2022-08

Publication Date 07/14/2022

Defense Date 04/07/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Administration,diversity,gap analysis,health disparities,health equity,health professions,Higher education,Latinx,minorities,OAI-PMH Harvest,PA,physician assistant,program evaluation,recruitment plan,underrepresented minorities

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Donato, Adrian J. (committee chair), Canny, Eric A. (committee member), Yates, Kenneth A. (committee member)

Creator Email ajsuriano@gmail.com,asuriano@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111371446

Unique identifier UC111371446

Legacy Identifier etd-SurianoAst-10829

Document Type Dissertation

Format application/pdf (imt)

Rights Suriano, Astor Jonathan

Type texts

Source 20220715-usctheses-batch-953 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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