A serious shortage of Latino health care providers in rural areas of the United States exists, resulting in greater health disparities for rural residents (Burrows, Suh, & Hamann, 2012). This is particularly troubling because demographic shifts are occurring at rapid rates in rural areas, which are seeing increasing rates of Latino immigration. In rural mid-western states, Latino immigrants are often heavily recruited to replace the aging European American labor force working in agribusinesses and the meat packing industry (Carr, Lichter, & Kefalas, 2012). Yet, Latino immigrants often do not have adequate access to medical care in these areas in part because of the serious shortage of medical personnel. Compounding this problem is the lack of Latino medical providers who are culturally and linguistically similar to immigrants living in rural areas (Cristancho, Garces, Peters, & Mueller, 2008). Although Latinos make up approximately 50% of the population in some rural midwestern areas, they constitute less than 1% of the health care workforce (Yehieli, Grey, Vander Werff, Grey, & Whitaker, 2005). Thus, there is a critical national need to increase the diversity of the rural health care workforce (Ortega, Rodriguez, &: Vargas Bustamante, 2015).
Increasing the diversity of the health care workforce has become a major priority for the medical community and health care workforce researchers (Ortega et al., 2015; Saha & Shipman, 2006). These entities acknowledge that the shortage of Latinos in health care is directly related to academic pipeline issues, whereby Latino students are unable to pursue health science careers because of a lack of academic preparation and resources (Olivares-Urueta, 2012; Sullivan, 2004). Remedying this situation requires a concerted effort to actively encourage and support the career development of rural Latino students early in their academic trajectories (Sullivan, 2004) and requires university-community partnerships (Murray-Garcia &: Garcia, 2002), especially in rural schools.
One crucial aspect of pursuing a health science career is math/science preparation. Career interventions that stress the importance of math/ science in health science careers may be an important step in helping rural Latino students to plan for a health science career (Murray-Garcia & Garcia, 2002). Career development researchers are well positioned to partner with rural school districts and other health care professionals to develop and implement programming that helps Latino students connect math/science to health care careers. Many career development researchers have noted the need and importance of using career development theory and research in developing the STEM (science, technology, engineering, and math) and health science workforce (Byars-Winston, Gutierrez, Topp, & Carnes, 2011). Several of these researchers used social cognitive career theory (SCCT; Lent, Brown, & Hackett, 1994) to understand the STEM career development of Latino students and suggested that this research has promise for developing interventions to increase Latino students' pursuit of STEM careers (e.g. Navarro, Elores, & Worthington, 2007). Therefore, we conducted two exploratory quasi-experimental studies to evaluate the effectiveness of an SCCT-guided career education program designed to help students in rural middle schools explore health science career opportunities with an explicit emphasis on the link between math/science subjects and health science career opportunities.
SCCT and Math/Science Careers
SCCT (Lent et al., 1994; Lent, Brown, & Hackett, 2000) posits that career development is influenced by the interaction of person variables (e.g., affective states, cognitions, physical attributes), environmental factors, and overt behaviors. Two of the central mechanisms of SCCT are self-efficacy and outcome expectations. Self-efficacy refers to beliefs that individuals have about their ability to perform a specific task. Outcome expectations refer to what individuals believe will happen when they perform a specific behavior. SCCT also considers contextual factors that influence the development of self-efficacy beliefs and outcome expectations that lead to the development of career interests and actions. The contextual nature of SCCT is appropriate and useful for application with diverse populations. In particular, studies have focused on the use of SCCT in explaining the socioeognitive mechanisms associated with underrepresented K-12 students' math and science performance. Given that most health science careers require a solid background in math and science, research that applies SCCT to math and science career interest and achievement is particularly relevant to the current studies.
Math/Science and Health Science Career Research
Research investigating math and science career development in middle school has been limited, though it has yielded important insights. For example, Navarro et al. (2007) examined the development of math/ science career interests of Mexican American middle school students and found that the SCCT model was a good fit. They found that perceived parental support predicted math/science self-efficacy, which, in turn, predicted math/science outcome expectations, interests, and goals. Additionally, social class predicted performance in math and science achievement. Although Navarro et al. provided important insight into math/science achievements for Mexican American middle school students, very little career development research has focused on math/ science career interventions.
Although many STEM and health science career interventions exist, the effectiveness of these interventions has largely been unexamined with a few notable exceptions. One such study reported that the year-long math/science career intervention was associated with an increase in students' knowledge of math and science careers and the type of math courses (e.g., algebra, geometry) that the students took in high school (Fouad, 1995). A qualitative study of urban high school students found that a career intervention was associated with an increase in knowledge and exploration of STEM-related fields (Blustein et al., 2013).
The nursing field has also begun to implement and evaluate health care pipeline programming. Matutina (2008) conducted a literature review to describe the research on school-based nursing career pipeline programs from 1989 to 2006 that focused on middle school students 9 to 13 years of age. Matutina described interventions, such as nursing camps, recruitment videos, presentations, and handouts, and reported that data analyses for these studies indicated statistically significant increases in students' consideration of nursing as a career choice after participating in the interventions. However, the interventions described in this review neither had a basis in specific career development theory or research, nor incorporated research and literature that suggest best practices for career interventions. For example, these studies did not include discussion of the five critical ingredients that Brown and Ryan Krane (2000) found to be associated with effective career interventions. These five critical ingredients include: (a) written exercises, (b) individualized interpretation and feedback of career inventories, (c) information on the world of work, (d) modeling, and (e) attention to building support. More school-based career intervention research is needed that incorporates these best practices for career interventions.
Although school-based career interventions can be more difficult to implement and control than laboratory settings, the study of interventions can provide career counselors with important information about what works with specific groups of people. As Whiston (2011) argued, career researchers and counselors need to consider the context of clients and learn which interventions work for them under which conditions, particularly in terms of diverse clients. Therefore, we conducted two studies to assess the effectiveness of Project HOPE by measuring changes in math and science interests, outcome expectations, intentions, health science career interests, and self-efficacy beliefs in relation to students' ethnic backgrounds. The two studies were conducted in different rural middle schools where more than 50% of the student population identified as Latino.
Study 1 involved the initial development, implementation, and evaluation of Project HOPE. The research questions of interest in this study were: Do students participating in the intervention report a positive change in math/science self-efficacy beliefs and interests, and vocational skills self-efficacy beliefs, from baseline to follow-up? Do the changes observed differ between Latino and European American students such that one group showed larger gains in math/science self-efficacy beliefs and interest and vocational skills self-efficacy beliefs?
Participants. Participants were 73 eighth-grade students in a Midwest rural community, enrolled in one of four sections of a career planning course. Of the participants, 49.4% identified as female adolescents and 50.6% identified as male adolescents. The participants in this study ranged in age from 13 to 14 years with a mean age of 13.33 years (SD = 0.47). Most participants identified their...