Adapt your project to a mixed methods approach and explain the logic used to integrate those methods. Do you think this approach will help or hurt your research project?workinprogress

Null Hypothesis: There is no significant difference in Adverse Childhood Experiences (ACE) score for African/Black women and their White counterparts in the United States.

Alternate Hypothesis: African/Black women in the United States have higher Adverse Childhood Experiences (ACE) scores than their White counterparts.

Null hypothesis: Cultural competency does not play a role in ACE score among African/black women in the United States compared to white women.

Alternate hypothesis: African/black women are more likely to have higher ACE score.

Adverse Childhood Experiences (ACEs), a collection of bad events and processes that a person may experience during childhood and adolescence, have been related to an elevated risk of a variety of unfavorable health outcomes and conditions when children reach adulthood and beyond. Ultimately, the goal is to build and implement culturally competent methods/ tools for preventative interventions in order to better understand the link between ACEs and culture also, their related risk factors and the associated health effects.

Adverse Childhood Experiences (ACEs) are attributabed to social determinants of health which includes institutional racism, poverty, and resource availability. African/black women are more likely to have experienced childhood trauma, such as physical, emotional, or sexual abuse, or to have grown up in a household with a parent or guardian who struggles with drug addiction or mental health concerns (Greeson & Lewis-Fernández 2015). They are also more likely to be poor, which increases their chances of developing ACEs, Understanding, and treating ACEs among African/black women requires cultural competency which over the years hasn’t been incorporated into the healthcare system. Disparities in health outcomes and experiences can be related to varying exposure to negative social and environmental variables based on race/ethnicity and socioeconomic position, which contributes to Adverse Childhood Experiences (ACEs) (Kim et al., 2020). The impact of ACEs on health can differ based on race/ethnicity, gender, and socioeconomic level, culture (Jou et al., 2019). The effects of ACEs are felt differently depending on how many socioeconomic statuses overlap, such as being a well-educated Black/African woman, white lady, a low-income Asian, and more (Hendricks, 2020).

African/black women are more likely to suffer stigma and prejudice while seeking health care and may be less inclined to seek assistance for their ACEs owing to fear of discrimination or a lack of faith in medical experts (Greeson & Lewis-Fernández, 2015).While working with African/black women, it is critical for health care practitioners to be culturally competent in order for them to receive the care and support they require to cope with their ACEs. Furthermore, studies have shown that knowing cultural and racial distinctions might help in devising treatments that are targeted to the needs of African/black women (Nash & Johnson, 2017).

To address these two issues, a mix method will be used to explore the relationship between cultural competence and ACEs. Using a cross sectional study may be utilized to compare ACE scores between African/black women and white women in the United States to test for the first research question. The ACE scores of both groups may be compared using data sources such as the National Survey of Child and Adolescent Well-being. A qualitative technique will also be used to test the second question by giving out questionnaires to African/black women and white women to explore their experiences with health disparities which will be adapted from the ACE study questionnaire, to establish if culture/cultural competency plays a part in their ACE scores. The interviews might probe into the participants' histories, experiences, and perceptions of how culture/cultural competence affects their ACE scores. Focus groups can also be employed to better investigate this topic and gain insight into the experiences of others.

Survey using a validated questionnaire assessing cultural sensitivity, health outcomes, and socio-demographic characteristics. The questionnaire shared will have dichotomous items (yes/no) that ask individuals if they had any of the 5 ACE before 18 years. If they viewed some things as normal/cultural yes or no, to the following questions: If they see it as harmful? Do you see yelling, belittling or made fun of as emotional abuse? Do you see not having enough food, clothing lack of money, as physical neglect? Do you view divorce, death, incarceration etc; (stressful life event)? Do you see emotional neglect as (not enough love, attention, or support)? Did you experience racism at any point in your life?

Data will be gathered from the mixed methods, also secondary data will be reviewed to compare outcome: Summary of questionnaires outcome, including the cross-sectional study result and if there are recommendations for further research on the topic.

Strength: For Cross-sectional technique has the advantage of providing useful insight into the interactions between diverse factors. It can also be used to compare and distinguish between distinct groupings of people. For Questionnaire it provides a huge volume of data that can be used to investigate correlations between different variables and maybe identify causal linkages.

Limitations: The cross-sectional approach does not allow for causation to be established. It merely provides a snapshot of the data at a single point in time, making it impossible to draw inferences about the cause and impact of many variables. Furthermore, because the data may not be representative of the entire population, the conclusions may not be generalizable. For Questionnaire approach it cannot demonstrate causation with precision because they examine the correlation between two variables rather than the cause-and-effect relationship. In other words, surveys cannot absolutely establish that one variable cause another, simply that the two are related.

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