Pulse Check

Abstract

In February 2015, the Urban Universities for HEALTH (Health Equity Alignment through Leadership and Transformation of the Health Workforce) learning collaborative site team at the University of Cincinnati held focus groups seeking to understand the contributing factors of underrepresented minority students’ decision to study within the Academic Health Center colleges of Allied Health Sciences, Medicine, Nursing, and Pharmacy. Students identified university and program-level factors as contributing to their perception of a student-centered, quality educational experience. This “pulse check” project with the undergraduate and graduate health-care students affirmed the efficacy of many current recruitment practices and retention strategies. Participant feedback provided rich process improvement data for the Academic Health Center leadership, and the larger urban universities learning collaborative.

Keywords

recruitment and retention urban universities underrepresented minority students health-care professions

The landmark Institute of Medicine (2003) study, Unequal Treatment, highlighted racial–ethnic minority health disparities. The Sullivan Commission on Diversity in the Healthcare Workforce (2004) addressed the urgent need for increasing diversity within the health-care workforce as a means of improving health equity. Seeking to generate more minority health-care providers, the University of Cincinnati (UC) implemented innovative diversity recruitment and retention initiatives within its health profession schools, as did many other institutions (Carpi, Ronan, Falconer, Boyd, & Lents, 2013; Deas et al., 2012; Degazon & Mancha, 2012; Thompson & Campbell, 2013; Toney, 2012).

Despite these momentous documents and the initiatives they inspired, racial and ethnic minorities continue to retain a higher burden of disease and mortality (U.S. Commission on Civil Rights, 2010). According to the Centers for Disease Control and Prevention (2014), 13.5% of Black Americans of all ages had a self-assessed health status of fair to poor. Regarding health equity in Cincinnati, Maseru (2015) observed that African American men live a decade less (63.8 years) compared with their White counterparts (73.8). Furthermore, African Americans in the city have a shorter life expectancy than their racial peers living elsewhere in Ohio and the rest of the nation.

Further hindering health equity, the U.S. Bureau of Labor Statistics (2015) revealed a persistent lack of diversity among health-care practitioners and technical occupations. The predominance of White providers held true across specific occupations: 70.3% pharmacists, 71.4% physicians and surgeons, 87.4% speech-language pathologists, and 78.3% nurses. Results from a comprehensive regional health-care workforce profile solicited by UC mirrored national statistics (Grandmont & Carrozza, 2014). By race designation, 78.3% of physicians in Cincinnati and surrounding areas were White, followed by 16.3% Asian, 3.3% Other, and 2.1% Black. Registered nurses were overwhelmingly White at 91.3%, compared with 6.3% Black, 1.6% Asian, and 0.8% Other.

According to the National Center for Education Statistics (2016), graduation rates within 6 years after starting for U.S. public institutions were 57% Whites compared with 39% for Blacks. In the academic year 2014 to 2015, UC conferred degrees to students at a rate of 72% Whites compared with 7% African American (University of Cincinnati, Office of Institutional Research, 2015). The chronically low number of underrepresented minority (URM) graduates across the health professions (Frenk et al., 2010) is a contributing factor to health inequity and lack of diversity among providers.

Clearly, more work remains to be done toward improving health equity and increasing diversity among health-care providers in this region. The authors hope to provide readers with new information about a learning collaborative multisite project in the United States striving to improve health equity, as well as to share findings from a recent “pulse check” on the efficacy of recruitment and retention efforts among URM students within UC’s Academic Health Center (AHC) Colleges of Allied Health Sciences, Medicine, Nursing, and Pharmacy.

Background

The Urban Universities for HEALTH (Health Equity Alignment through Leadership and Transformation of the Health Workforce) Project was launched in January 2013. This project is a collaboration between the Coalition of Urban Serving Universities, and Association of Public and Land-grant Universities with the Association of American Medical Colleges and the National Institutes of Health. The long-term vision of the project is to expand a culturally diverse health-care workforce aimed at improving the health of communities and reducing health disparities among urban populations (Association of Public and Land-grant Universities, 2015). To do this, Urban Universities HEALTH selected the five “learning collaborative” sites of Cleveland State University/Northeast Ohio Medical University, SUNY Downstate, UC, University of Missouri-Kansas City, and the University of New Mexico to develop, test, and share best-practice solutions to health workforce challenges in urban communities. Specifically, the learning collaborative sites were to capture local data, evaluate current strategies, and drive workforce improvement in their local areas (Urban Universities for HEALTH, 2016). Over the course of the Project, the learning collaborative sites met biannually to identify systemic health workforce goals, develop metrics, identify university strategies that impact outcomes, identify key performance indicators for a dashboard, and analyze effectiveness (Urban Universities for HEALTH, 2016).

In October, 2014, all the learning collaborative sites participated in a “shark tank” competitive activity within the Urban Universities for HEALTH Project. Previous UC health professions admissions offices had surveyed accepted students who chose not to attend UC for factors that entered into their decision. The UC learning collaborative site team identified a gap in understanding of the priorities and factors positively contributing to URM health profession students’ decision to attend and continue at UC. The UC learning collaborative site team received an award to hold focus groups (FGs) among URM students within the AHC Colleges. The aims of this project were to obtain data regarding successful recruitment and retention of URMs within the health professions at UC and to share that information with the Urban Universities for HEALTH learning collaborative. The UC learning collaborative site team vetted the quality improvement project with its executive council including the President, Provost, Chief Diversity Officer, AHC Deans, and the Community Advisory Board. UC’s internal review board deemed it exempt.

Method

Recruitment

The UC learning collaborative site team worked with the AHC college student affairs offices to facilitate participant recruitment. Four FGs were planned with a maximum of 10 participants each. All eligible URM students across all four AHC colleges received a FG invitation; 31 interested students completed an online screening and demographic questionnaire by the deadline and 34 students met the eligibility criteria, which included full-time AHC graduate and undergraduate students from an underrepresentative group: first generation, economically disadvantaged, and racial or ethnic minority. Students who were part-time, had transferred from another university, had deferred a semester, along with international students were excluded.

Data Collection

FGs were organized based upon length of time at UC and academic status (e.g., first year health science undergraduates, returning health science graduate students, etc.). A facilitation guide was developed based upon literature, in addition to input from the AHC deans and the Community Advisory Board. An experienced independent consultant guided the FG discussions after informing the students of the activity’s purpose. Each FG session lasted approximately 90 minutes. At the end, students were invited to ask questions. Each participant received 10 dollars as a token of appreciation and was eligible for a raffle of an additional 20 dollars.

Data Analysis

Several of the UC learning collaborative site team members attended the FG discussions and participated in a debriefing afterward with the facilitator. Each session was audio recorded and transcribed verbatim by a professional transcriptionist. The facilitator verified each transcript, and the UC learning collaborative site team reviewed them. The data analysis followed the seven basic steps for a conventional content analysis (Hsieh & Shannon, 2005), and members of the UC learning collaborative site team included an experienced research project manager, a doctoral nursing student, and a public health graduate student. The coding process occurred over several weeks as team members read the transcripts individually and then met frequently to discuss the content.

Description of Participants

A total of 20 students attended the four FGs. The age of the participants ranged from 18 to 40 years, with a median of 22 years; 80% of the participants were female (n = 16). Interestingly, only the returning graduate and undergraduate FGs had male participants. Returning graduate students comprised the largest group (n = 8), followed by returning undergraduate students (n = 6). The FG participants were from diverse backgrounds, with almost equal representation among self-identified Caucasian (40%) and African Americans (45%), with a few Asian (15%) students; 60% of participants were the first generation in their family to engage in higher education. Regarding financial aid, 75% of the participants qualified for financial aid, such as Pell grants. All of the first year undergraduate participants were receiving financial aid. Only 33% of the first year graduate students received aid, compared with 75% of returning graduate students. The majority of participants were affiliated with the College of Nursing (60%), followed by Pharmacy (20%), then Allied Health Sciences (10%) and Medicine (10%).

Results

During the FGs, the facilitator asked URM participants to reflect upon the factors that influenced their decision to choose UC as their institution for higher education in health care. Students initially listed various aspects about UC that attracted them, which the facilitator wrote on a white board. After some discussion, she asked each group to form a consensus on the top five reasons for choosing to attend UC. The FG process did not support ranking of participant responses. The UC learning collaborative site team analyzed all four transcripts, comparing and contrasting responses between and within the graduate and undergraduate groups. Five predominant reasons emerged, and participants identified choosing to attend and remain at UC because of student-centered quality education, campus, financial considerations, opportunities and resources, and the people at UC (Table 1).

Table 1.

Top Five Reasons URM Students Chose to Attend or Remain at UC.

Student-centered quality education

University or AHC-level factors

Amazing academic support

Reputation of university in community, recruitment by current students and alumni, student-centered

Innovation (e.g., curricular improvement, unique learning activities, teaching methods, use of technology)

Learning options (e.g., range of health-care degree programs and onsite and online learning)

Huge research focus

Program-level factors

Program reputation, accreditation, high licensure and job placement rates after graduation

Prepared for clinical practice, challenging programs

Ability to focus on students’ area(s) of interest, multiple programs of research

Campus

Close proximity (e.g., family, home, other cities)

Convenient (e.g., easy commute to home, work, class, clinical, familiar with area or campus, school and public transportation)

Environment (e.g., pretty campus, urban setting)

Part of the community– “Cincinnati proud”

Financial considerations

Affordable, lower tuition, use of less costly resources (e.g., e-books)

Financial aid options (e.g., grants, graduate assistantships, scholarships, tuition reimbursement)

Reasonable cost of living compared with other cities

Opportunities and resources

Admission process (e.g., direct admission to nursing program, limited graduate school criteria)

Networking or activities (e.g., job opportunities, student organizations, pursue research interests, make friends)

Professional development (e.g., volunteer, specialty certificates, co-op, internships, UC Open School)

Physical resources (e.g., high caliber medical centers, state-of-the-art class, and lab facilities)

The people

UC family

University President (e.g., visibility, interactions)

Faculty (e.g., personality, accessibility, vested interest in students, reservoirs of knowledge, current practice)

Staff (e.g., recruiters, program directors, etc.)

Current students (e.g., engaged upperclassmen, peer support)

Alumni (e.g., proud, actively recruiting family members)

Bearcat community

School spirit (e.g., student pride, community support)

Belonging (e.g., fitting in, warm, feeling of home, welcoming, enjoy classmates)

Note. AHC = Academic Health Center; UC = University of Cincinnati.

Student-Centered Quality Education

Participants indicated feeling the university, as a whole, made students a priority. They also made statements regarding receiving a quality education from the AHC colleges. Examining participant responses for this category, the UC learning collaborative site team noted university and program-level factors students identified as contributing to their perception of a student-centered, quality educational experience (Table 1).

University or AHC Level

Numerous students indicated the importance of academic support. A returning medical student observed, “My top priority was how well can a school help me get through this difficult four years. I was really more concerned about what kind of academic support services were available.” A returning undergraduate student shared how the nursing bridge program, “Gave me a ton of academic support … it’s really made a difference in my education.” Another participant in that group shared that supplemental instruction had been instrumental in making the Dean’s list every semester.

First year graduate students responses included descriptors such as program reputation, recommendations from previous students, as well as the caliber and the reputation the university holds in the community. A peer revealed, “I knew that UC was doing big things as far as healthcare and nursing and medicine. I’ve always wanted to get in over here.” FG participants described their program’s curriculum as innovative and provided examples of specific curricular elements, unique teaching methods, and use of technology. A first year undergraduate participant valued a baccalaureate education, despite family pressure to pursue an associate degree. Several returning and first year undergraduate participants indicated that availability of a range of health-care degree programs was important. A first year graduate student cited the option for onsite, as well as distance learning in the nurse practitioner program was attractive. “I know there’s a lot of push for doing things online, (but) … being able to come onsite was important to me.”

Numerous graduate and undergraduate students mentioned the use of and opportunity to engage in research as an attractive feature in their selection of UC. A first-generation undergraduate participant shared how the college of nursing had arranged student work as a research assistant, which had been a retention factor. Another participant indicated an interest in international research and observed that there were “lots of opportunities to go overseas and study.”

Program Level

Two returning graduate students appreciated the fact that their college(s) had recently been reaccredited. Several FG participants suggested their program’s reputation was influenced by high licensure and job placement rates. For example, undergraduate nursing students indicated that the national council licensure examination (NCLEX-RN® exam) pass rate was important. “That’s something that drew my attention, it was a very high percentage.”

Students expressed feeling prepared for professional practice and cited numerous examples. A returning graduate nursing student proudly asserted, “My opinion is there’s not a nursing college around here that looks better than UC.” A returning Allied Health Sciences undergraduate student stated, “We’re encouraged to shadow and do internship on our own time … within our senior year we have to have so many hours.” A returning pharmacy student indicated that students gain work experience in the local hospitals and businesses during their time at UC. The participant exclaimed, “You’re really applying the stuff that you’ve learned.” A first-year Allied Health Science graduate student mentioned program expectations like grant writing.

Numerous graduate and undergraduate students indicated appreciating interest the AHC colleges took in their personal and professional goals. Graduate students describe their program as “flexible.” These participants expressed appreciation for “opportunities to branch out” and freedom to “specialize in any area you feel you’re drawn to.” A first year undergraduate nursing student expressed, “(We have) clinicals the second year, to give you … better experience so you can know what you want to do by the time you graduate.” Numerous first year undergraduate students and the majority of first year graduate students indicated having their expectations for academic learning met or exceeded.

Campus

The FG participants communicated valuing several aspects about UC’s geographic location and actual campus. They described Cincinnati as a “Midwest city” with an “affordable cost of living,” and an established transportation system. A returning undergraduate student observed, “Cincinnati is in a central location” to other large cities. Several first year and returning undergraduate participants reflected on the fact UC was near to home, yet with enough distance to feel like going away to college, and the benefits of in-state tuition. Reflecting on the initial decision to attend UC for undergraduate studies, a returning graduate student indicated, “I couldn’t imagine myself being 19, new city, no family, living by myself … I was too scared to move.”

Many graduate students identified the campus as conveniently situated to work, class, or clinical. Besides the ability to walk between sites, students also expressed appreciation for the availability of city and campus transportation systems. Some graduate students returned after undergraduate studies citing the convenience of knowing the campus and area.

Several of the first-year undergraduate students indicated that the campus had aesthetic appeal. They liked “the set up” and used descriptors like “pretty,” and even “breathtaking.” A few participants shared the impact of the physical campus during tours. A returning graduate student reflected, “I knew as soon as I toured here, I wanted to go here (for undergraduate studies).” A returning undergraduate student shared, “I think what initially drew me to UC is the campus. It was small. It felt small in a big city.”

Some first year graduate students observed that UC was “part of the community,” compared with some other universities where “the school seems to be the town.” A participant described UC as “Cincinnati proud” and went on to clarify, “it’s proud to be part of the city that it’s in.” Comparing the people of Cincinnati and those within the university with other larger cities with universities, a first year undergraduate expressed feeling the people were more open and hospitable.

Financial Considerations

Undergraduate participants discussed financial considerations as important recruitment and retention factors. A first year undergraduate participant explained how the lower cost of the tuition combined with a scholarship were deciding factors for choosing UC over another university. A couple returning graduate students commented on the reasonable cost of living compared with other major cities as being an attractive feature. A peer indicated its importance tied with the convenience of the campus and location. Undergraduate participants also mentioned appreciating ways the school sought to lower student costs, like using e-books. Returning undergraduate participants were enthusiastic about free items such as football tickets, T-shirts, and food. One student stated, “It’s nice … to be on a college kid’s budget and be able to still attend athletic events.”

Participants discussed the importance of a range of financial aid options. A returning undergraduate nursing student indicated, “without that (scholarship) I wouldn’t even be able to go to school.” A first year graduate student shared how a graduate assistantship had the multifaceted benefit of providing tuition, as well as enabling more engagement within the university graduate assistantship and faculty community. A graduate student reflected receiving information from a professor about scholarships for African American students. “So that made me feel like he’s invested in me as an underrepresented student, and it made me feel so happy. What? An extra scholarship? Yes, I’ll be here.”

Opportunities and Resources

A majority of the FG participants expressed appreciation for essential opportunities and resources found at UC. A first year graduate student shared how the ease of program admission encouraged her to apply to just UC. “I think that’s why I wasn’t worried about applying to multiple places.” A couple of first year undergraduate students indicated that the opportunity for direct admission into the nursing program was a significant deciding factor.

Participants expressed the importance of connecting with people through networking opportunities and social activities. A first year undergraduate student asserted, “Even as a freshman you can get so involved in the nursing program because there are so many groups to join.” A first year undergraduate student expressed appreciation for volunteering opportunities and “being able to meet staff and people that are in the hospital that you will be able to network with when you go to apply for a job.” Undergraduate FG participants emphasized the importance of student life, including social clubs and activities for opportunities to make friends. They also expressed valuing concerts and events within the colleges, as well as other extracurricular activities like international trips and sporting events.

Numerous graduate and undergraduate participants cited opportunities to engage in professional development, while in school. Students indicated that professors encouraged them to work within their fields to gain experience. Participants mentioned engaging in internships at local hospitals, along with having clinical experiences in the University Hospital’s Dedicated Education Unit, and the UC Open School, a community clinic run by an interdisciplinary team of students and faculty. FG participants indicated that these experiences provided opportunities to apply what was learned in class and to grow in their new roles.

Many students reflected upon the work, clinical, and research benefits associated with the presence of several high-caliber regional health centers in the area, and the availability of technological resources. A returning medical student expressed feeling confident in receiving “the appropriate exposure and level of intensity in your training that you need in order to be the best doctor.” A returning undergraduate student observed, “we have this technology available to us and they try to let us use it as much as possible, and incorporate into class time.”

The People

FG participants clearly articulated appreciation for the support they received from faculty and staff to achieve their personal and professional goals. Individuals shared personal narratives highlighting the impact of the people upon their decision to come and stay at UC. They used descriptors like connected, welcoming, and warm in reference to the affective environment. “I heard that the people here were very accepting and loving” stated a first year undergraduate student. “I feel like it’s a big family, everyone seems to get along…overall everyone is very open, and you can always go to someone and learn something new.”

Numerous participants made comments about the visibility and accessibility of the University President. Students mentioned talking with him and observed his presence in the community, as well as on campus. “I didn’t go to the school yet and I saw him on the news.” Students from each FG and every program mentioned the influence of faculty, describing them as dedicated, knowledgeable, caring, and strength of the university. Numerous first year and returning undergraduate students concurred with a peer who stated, “whenever you’re struggling in a class … they definitely do care about how you’re doing in their class.” Regarding a diversity recruiter, a returning undergraduate student said, “when he would come and talk to us at my high school … he really made me feel like, ‘You belong at UC. I really want you to come here.’” Participants from each FG described the influence and support of peers on and off campus. A returning pharmacy graduate student expressed a sense of community within the cohort. The participant also described peer collaboration as, “something you can fall back on.”

Several participants indicated that their decision to attend or remain at UC was influenced by alumni. Several first year undergraduate participants had family members as alumni. Numerous students expressed a sense of “Bearcat” community and mentioned school spirit. A first year graduate student shared, “I had lived in Cincinnati for two years prior to me applying … you just see the Bearcat vibe … it’s its own community, and that was very inviting.” Participants reflected on the obvious pride alumni and present students take in their affiliation with UC. Evidence of this student pride, school spirit, and sense of belonging was obvious in the FGs, captured by one participant statement, “we are the college to go to.”

Discussion

Universities have sought to understand the student decision-making process for selecting an institution for higher education for decades (Corey, 1936). Reasons cited as influencing the URM students’ decision to attend UC were consistent with student recruitment and retention literature around the world (Bowman & Denson, 2014; Cameron, Roxburgh, Taylor, & Lauder 2011). In pursuing higher education for careers in health care, participants indicated specific AHC and program-level factors they perceived as contributing to a high quality, student-centered educational experience. University and program features like reputation, quality of training, along with opportunities to pursue areas of interest were aspects mentioned by several authors (Cameron et al., 2011; Ku, Li, Prober, Valantine, & Girod, 2011).

Bowman and Denson (2014) observed the vast majority of attrition, and graduation research focused on institutional factors, such as candidate selection, size, and faculty:student ratio. They noted that “institution fit” was associated with greater college satisfaction and decreased perceived isolation among students in general. Love, Trammel, and Cartner (2010) noted access to academic networks facilitated success of African American students in Predominately White Institutions. The need for culturally and linguistically relevant discipline-specific academic support was addressed for minority students (Cameron et al., 2011; Testa & Egan, 2014; Thompson & Campbell, 2013).

Participants identified financial considerations such as affordable tuition, and cost of living as important recruitment and retention factors. They also shared insight into the importance of both merit and need-based aid. Conner and Rabovsky (2011) addressed the “politics of aid” where universities seek to attract high achieving students with merit-based aid but which may put higher education beyond the reach of disadvantaged students. They found that various types of financial aid options can improve enrollment among URM students. Kim (2004) determined a combination of grants and loans increased the probability of Asian American students’ selecting their first-choice institution, implying college was seen as an investment regardless of cost. However, African American and Latino students chose other institutions that offered more financial aid-like scholarships.

Access is a multifaceted consideration, including geographic location, intensity of admission process, and actual acceptance into the program or school (Cameron et al., 2011; Kenyon, 2011; Ku et al., 2011). Research related to retention in higher education often focused on potential barriers to inclusion which can be intangible, such as attitudes, policies, curricular issues, as well as tangible issues with lack of funding, inadequate resources, and structures like physical access and lighting (Groggins & Ryan, 2013; Moswela & Mukhopadhyay, 2011). Participants mentioned UC’s geographic location and campus environment as assets. Geographic location is a pragmatic consideration, especially for those relying on public transportation (Kenyon, 2011; Ku et al., 2011). Person-environment congruence is particularly relevant to URM students.

A majority of the FG participants expressed appreciation for essential opportunities at UC, including the admissions process and professional development, along with physical resources like clinical experience in prominent hospitals and innovative simulation labs. Numerous schools have implemented bridge programs (Manusov et al., 2011) and modified admission processes (Cahn, 2015; Thompson & Campbell, 2013) seeking to increase access to disadvantaged students. Strategic partnerships with local institutions may enhance URM recruitment (Carpi et al., 2013; Thompson & Campbell, 2013).

The URM FG participants mentioned the UC community or “family,” which ranged from the University president to faculty, staff, current students, and alumni. Transformational leadership (Love et al., 2010) and relevant institutional policies (Conner & Rabovsky, 2011) facilitate the promotion of diversity. Faculty play a critical role in retention of at-risk students (Meeuwisse, Severiens, & Born, 2010; Morales, 2014; Soria & Stebleton, 2012). Meeuwisse et al. (2010) noted that good formal relationships with faculty and peers helped determine if ethnic minority students felt “at home” in their program.

Compared with the informal recruitment by alumni and student peers, a paid recruiter may not be as influential with URM students. Kim (2004) found that Latino students’ decision whether to attend their first-choice institution was significantly influenced by peer input or not. The literature also indicated that URM students may feel isolated attending a university where they had no peer group and may opt to attend near home to ensure access to friends at the school, and in the local community (Keane, 2009; Pearce, Down, & Moore, 2008; Reay, Crozier, & Clayton, 2010).

Numerous FG participants commented on school spirit and sense of belonging they had in the “Bearcat community.” URM students are prone to feeling socially isolated, and many studies reflected the relevance of a perceived “sense of fit” or “belonging” within a program or university (Bowman & Denson, 2014; Reay et al., 2010; Testa & Egan, 2014), along with feeling “good” about joining a program to student recruitment and retention (Ku et al., 2011). Previous academic-related experiences like summer camp, school presentations, or other interactions with faculty or staff provide initial impressions regarding “fitting in” and can influence student decision making (Bowman & Denson, 2014; Pearce et al., 2008).

The team compared undergraduate and graduate perspectives related to diversity recruitment and retention. Both groups cited difficulties in transferring between institutions as the main consideration for their retention. Graduate participants clearly articulated that the decision to remain at UC actually occurred at recruitment. “That was the point of interviewing all the schools in the first place, was so you could choose the school you wanted to go to” summarized a returning graduate student. The URM undergraduates may be more influenced by institutional retention initiatives throughout their academic experience; graduate student responses suggested retention was predetermined barring unforeseen circumstances.

The UC learning collaborative site team detected two prevailing issues present among all URM FGs, safety concerns, and communication challenges (e.g., excessive emails). The association between urban universities and safety has been a point of discussion for a long time (Spaight, Dixon, & Nickolai, 1985) and remains a research focus (Tomsich, Gover, & Jennings, 2011; Winston, 2010). The URM participant responses related to safety were not surprising, as the FG panels were predominately female. Gender remains the strongest factor associated with increased fear related to crime, despite males being at greater risk. Participant concerns were also consistent with other urban universities (Tomsich et al., 2011).

The evolution of campus information and communication technologies presents new opportunities (Eid & Al-Jabri, 2016), as well as challenges (Maier, Feldmann, Paxson, Sommer, & Vallentin, 2011). The URM participants expressed a desire for increased use of electronic invitations to facilitate automatic event importation to their mobile device calendars. They also cited email overload as a contributing factor to missing important information. Urban informatics is an emerging specialty (Foth, Choi, & Satchell, 2011), and academics are exploring innovative strategies to address techno-overload, stress, and insecurity (Eisel, Schmidt, Nastjuk, Ebermann, & Kolbe, 2014; Yin, Davison, Bian, Wu, & Liang, 2014). For example, Ritchie, Gilleran, Lucas, Woods, and Rivero (2013) tested a new email organization application, TorteMail, among university students. Challenges related to perceived safety and communication within the urban university context appear likely to continue for the foreseeable future.

Next Steps

Throughout the FG discussions, participants provided process improvement feedback, as well as made suggestions for improvement. The UC learning collaborative site team provided the AHC deans with program-specific issues and suggestions. Besides the prevailing issues previously mentioned, various URM undergraduate participants identified improvement opportunities surrounding basic needs like housing, food, environmental factors (e.g., air quality), and transportation. One concern has already been addressed with a recent decision to make the main campus smoke-free.

Limitations

Several limitations exist related to this project. The total number of students engaging in the FGs was small (N = 20), considering the significant number of URM students within the AHC. The project population was strictly URM students pursuing higher education in health-care fields. The FGs lacked equal representations from among the various colleges, as well as the URM groups. The FG facilitator deviated from the discussion guide based on the student responses, thus did not ask each group exactly the same questions in the same way. Besides these limitations, the authors recognized that conclusions could not be drawn nor did they intend findings to be generalized beyond UC.

Conclusion

While enrollment and attrition numbers can assist university leaders in determining the overall effectiveness of URM recruitment and retention efforts, qualitative exploration can facilitate greater understanding (Groggins & Ryan, 2013). Results from this project provided additional validation of what is already known regarding “at risk” student recruitment and retention and provided the other Urban Universities for HEALTH learning collaborative sites with additional data. Committed to promoting diversity and ongoing organizational improvement, the AHC deans took this unique opportunity to do a “pulse check” utilizing FGs of URM graduate and undergraduate health-care students. This brief assessment revealed current diversity initiatives are working. Participant feedback will inform future recruitment and retention efforts within the specific AHC Colleges. More formal research needs to be done regarding the recruitment and retention of URM students pursuing higher education in health care.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Kendra Varner has worked clinically as a nurse for 20 years, and has focused on nursing education, staff development, and patient education over the past decade. She is a 3rd year PhD student, with a research focus on the college to workplace transition and holistic health of the new employee.

Leann Mey was a graduate student worker within the College of Nursing. She recently graduated with a Master in Public Health. She is currently attending the University of California, Los Angeles (UCLA), and plans to pursue a career in medicine.

Tammy Mentzel recently graduated with her Masters in Public Health. She is the manager for the Urban Universities HEALTH project at the University of Cincinnati.

Greer Glazer is dean of the College of Nursing and associate vice president for Health Affairs at the University of Cincinnati. A nationally recognized leader in nursing education, Dr. Glazer has spearheaded the development and implementation of a strategic map aimed to position UC as a leader in the transformation of health care. She has a strong history of developing community, national and international partnerships and securing federal funding for nursing research, scholarship and program implementation. She continues this work in her leadership role at UC.

Barbara Tobias is the Vice Chair of the Department of Family and Community Medicine and is a Robert & Myfanwy Smith Endowed Chair of Family Medicine in the College of Medicine. Her research interests are womens health care, art and the humanities in medical education, disparities in health care access, and teaching medical students.

Tom Seiple graduated from the University of Cincinnati with a Master of Urban Planning. He is currently working at firm in Chicago.

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