Access to Healthcare Among Asthmatic Children - Research Proposal Example

?Access to Healthcare among Asthmatic Children: Looking at Parental Role in the Culture Factor The study proposes to ascertain the beliefs and perceptions of parents of asthmatic children four years and younger with respect to their beliefs and perceptions about healthcare access, compliance with medical regimen and adherence to treatment interventions for the management of asthma. The research is being proposed to look at the role of parents within the cultural setting in their children’ access to healthcare as suggested by Wright and Newman-Giger (2010); and to formulate recommendations to enhance health outcomes among the children afflicted with asthma and improve their quality of life. The descriptive-quantitative research methodology will be adopted using the survey questionnaire as the primary data gathering instrument. Parent – respondents will be selected using purposive sampling and will involve a minimum of 200 respondents determined using post-hoc statistical power analysis. Both descriptive and inferential measures will be utilized in the statistical treatment of the data gathered. SPSS Version 17 will be used in the statistical analysis of data. Introduction Background of the Study The comprehensive health reform legislation known as the Patient Protection and Affordable Care Act (PPACA) of 2010 was signed into law to expand healthcare coverage and cost and enhance the delivery of health care in the United States. Reporting on the feedback from Spanish media, Nix and Adair (2010) articulated that President Barack Obama championed the law to reassure that minorities in the US can avail of access to health care services by way of between coverage options. The PPACA may well one improvement that Mensah and Glover (2007) believe to be possible in the American healthcare setting characterized with a history of pervasive disparities in health status and health care delivery for the last two centuries. Health disparities refer to “differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions” (National Institutes of Health, as cited in Mensah & Glover, 2007; Pamies & Nsiah-Kumi, 2009). The burden of asthma is an example of disparities in childhood in the US in a general sense (Akinbami & Schoendorf, 2002; Smith, Hatcher-Ross, Wertheimer & Khan, 2005; McDaniel, Paxson & Waldfogel, 2006). While Pamies and Nsiah-Kumi (2009) highlighted the disparities among children of color, Wright and Newman-Giger (2010) focused on Hispanics / Latinos. Of particular concern in this regard is the documented fact that children younger than four years are usually hospitalized because of asthma and that the largest increase in hospitalization trend was among children from 0 to 4 years old (Bigby, 2011; Brooker & Elward, 2010). In the case of children 4 years old and younger, access to healthcare is a matter of parental decision. Compliance and adherence to medication regimen is also largely a parental responsibility. Accordingly, as suggested in Wright and Newman-Giger (2010), there is a need to address how parents’ beliefs and perceptions regarding healthcare play a role in the enhancement of health outcomes of their children, especially those in the 0 to 4 age bracket. Problem Statement As revealed by the Institute of Health (2009), the culture factor in the asthma burden among Hispanic children had been examined from the angle of birth place and lifetime asthma diagnosis, family income and insurance status. Studies have also been undertaken to investigate access to healthcare among cultural minorities from a very general perspective (Edmunds & Coye, 1998; Wright & Newman-Giger, 2010). In the case of asthmatic children four years or younger, however, access to healthcare, as well as compliance and adherence to medical intervention are mediated by their parents or guardians who are mostly relatives. There is a paucity of research which ventured to explore this perspective of disparities in healthcare access in terms of parents’ beliefs and perceptions pertaining to relevant aspects of access grounded on their culture. These aspects include, among others visits to physicians, insurance coverage, continuity of care, seeking care outside the neighborhood, use of hospital-based facilities, need for healthcare, preventive interventions, etc (Edmunds & Coye, 1998). The research problem, therefore, delves on the significance of culture as an intervening factor in parental decisions regarding access to healthcare and compliance and adherence of children four year old and younger in their medication and treatment interventions. Theoretical Framework Figure 1 shows the theoretical framework from which the proposed study is tailored: the traditional linear input-process-output model as discussed in Helloso, Lorensen, Sorensen, Norman and Bang (2006). Figure 1. Theoretical Framework As depicted in Figure 1 input represents information which is processed in a systematic manner to achieve desired outcomes. In this study parental beliefs and perceptions of asthmatic children on healthcare access, compliance in prescribed medical regimen and adherence in treatment interventions comprise the input. Process denotes tasks or activities in which the input is exposed to effect observable or measurable changes. In this study, input data will be scientifically processed through statistical analysis and triangulation from existing knowledge in the research area with the end in view of formulating interventions for greater awareness of parents on their role in the management of their children’s asthma. Finally, output refers to the expected outcomes from the study. The desired output in this proposed study is enhanced health outcomes among children with asthma as a result of the interventions employed. General Problem This study will venture to address the prevailing conditions of the burden of asthma among children of cultural minorities who are four years old and younger by looking at parental beliefs and perceptions on healthcare access, compliance and adherence of their asthmatic children with respect to prescribed treatment and medication. The purpose of the study being proposed is, therefore, to formulate knowledge-based and awareness interventions for parents of asthmatic children in order to enhance the health outcomes of these children and eventually their quality of life. Specific Aims Aims The goal of this study is to scrutinize beliefs and perceptions of parents regarding healthcare access, as well as compliance with prescribed medication and adherence to the treatment intervention, among children four years old and under. Primarily, the influence of culture on parental beliefs and perceptions will be utilized as the take-off point from which knowledge and awareness interventions will be targeted. Specifically, the aims of the study are to: (1) describe the profile of the parents of children fours years and younger who are afflicted with asthma; (2) identify the beliefs and perception of the parents in terms of three categories: healthcare access, compliance and adherence to their childrens’ medication and treatment regimen; (3) evaluate whether culture and the other profile variables considered in this study affect the parents’ beliefs and perceptions; (4) recommend interventions to enhance health outcomes of children with asthma based on the findings of the study. Research Questions The following research questions will guide the conduct of the proposed study: 1. What is the profile of the parents of children with asthma with respect to the following: gender, age, ethnicity, socio-economic status, educational attainment, and healthcare insurance coverage? 2. What are the beliefs and perceptions of the parents of children with asthma in terms of healthcare access, compliance to prescribed medication regimen and adherence to treatment interventions? 3. Are there significant differences in the beliefs and perceptions of the parents of children with asthma in terms of the profile variables considered in this study? 4. What interventions can be formulated to increase the knowledge and awareness of the parents of children with asthma with respect to their role in the management of their children’s’ asthma towards enhanced health outcomes? Hypothesis The following hypotheses, stated in the null and alternative forms, will be evaluated using non-directional or two-tailed analysis and a 0.05 level of significance (? = 0.05): Null hypothesis. There are no significant differences in the beliefs and perceptions of the parents of children with asthma in terms of the profile variables gender, age, ethnicity, socio-economic status, educational attainment, and healthcare insurance coverage. Alternative hypothesis. There are significant differences in the beliefs and perceptions of the parents of children with asthma in terms of the profile variables gender, age, ethnicity, socio-economic status, educational attainment, and healthcare insurance coverage Significance of the Problem While various elements of the health care system may be instrumental in reducing childrens’ access to healthcare, it is still the parents’ decision which determines how their children four years old and under will access the best possible health care service. As indicated in Flores and Zambrana (2001), there are many barriers to access to healthcare, which includes the length of waiting time for consultation appointments, the availability of physicians on a 24 hour basis, transportation time, the time spent at the waiting room, as well as, consultation / treatment time. The proposed study is, therefore, significant, because a working knowledge of the beliefs and perceptions of the parents of children with asthma regarding healthcare access, compliance and adherence issues, will offer significant inputs in the design of interventions. Furthermore, results from the proposed study will contribute in its own little way to improve the American healthcare system. As cited in Carillo, Trevino, Betancourt, and Coustasse (2001), the healthcare system in the United States is the most expensive and yet arguably among the least cost effective in the developed world” (p. 55). Premised on Carillo, et al. (2001), the multiplicity of rules and emerging economic forces shape the structure and function of the healthcare system, and this indirectly and inevitably results in the woes of vulnerable populations. Even the comprehensive health reform law espoused by President Obama has not really improved the plight of the low-income families since healthcare costs continued to rise (Heyes, 2011) The study will also be significant for children of cultural minorities in the US, broadly categorized as Hispanics, non-Hispanics or blacks, whose parents will be targeted in the dissemination of interventions to increase knowledge and awareness of parents on their role in the management of asthma among young children. Review of Literature Davis, DiSantostefano and Peden (2011) evaluated paired responses from parents and children with asthma regarding asthma symptom prevalence, physical activity limitations, impact of exercise on asthma, asthma management, and medication use. Overall results of the evaluation revealed that majority of parents underestimate the burden of asthma being experienced by their children. Specifically, parents underestimated the avoidance tactics used by children to prevent the onset of symptoms in terms of exercise and physical activity. In addition, parents underreported asthma symptoms and medication use. The authors concluded that improved and regular communication between parent, child, and physician should be enforced to attain better management of asthma and overall health. Chini et al. (2011) examined the effects of an active partnership between schools, parents, and pediatricians in the improvement of asthma management and quality of life among children suffering from asthma. Results of the study shows a positive link between building a strong relationship between the family, physician, and schools, educational intervention, and extracurricular activities in alleviating respiratory and psychological conditions. The authors suggested a multi-action program for diagnosis, clinical follow-up, education, self-management, and quality-of-life control to help ease the socio-economic burden of asthma disease. Petsios et al. (2011) evaluated the level of agreement between child and parents on reporting of health-related quality of life (HRQol) assessments to determine which would be the better respondent for HRQol studies for children with asthma. Results of the study show a discrepancy on the level of agreement between parent and children assessment. In addition, families belonging to a higher income bracket show a higher level of agreement. However, fathers are observed to be better in reporting HRQol than mothers. The authors concluded that parents overestimate HRQol of their children. Moreover, it is suggested that HRQol approaches should consider taking to account both parent and child perspectives. Meah, Callery, Milnes and Rogers (2010) investigated the relationship between negotiation of responsibilities for asthma self-care and the meaning of responsibility between children with asthma and their parents. Results of the study revealed that children have the capability of avoiding asthma exacerbators and limiting its effects. However, children face several limitations in exercising such responsibilities. It was concluded that independent self-care by children is something that is beyond mere compliance to parental instructions. Therefore, the responsibility shared between parents and their children should be properly distributed to ensure independence later in life. Furthermore, parents are encouraged to seek assistance from health professionals in managing asthma self-care initiatives for their children. Butz et al. (2011) examined the link between second-hand smoke from caregivers, household smoking behavior, and morbidity among children suffering from asthma. Results of the longitudinal study show that mothers comprise the majority of primary smokers in the household. In addition, most children have uncontrolled asthma. Overall, it is shown that children with asthma residing in urban areas are more likely to be exposed to high levels of second-hand smoke from the primary household smoker. Al-Akour and Khader (2009) performed an assessment on quality of life among Jordanian children with asthma and their parents to determine how the disease impairs daily life on two aspects: (1) activity limitations; and (2) emotional function. Results of the assessment show that there was not significant difference between families in terms of activity limitations. However, a significant difference was identified among families in terms of emotional function. Also, higher quality of life was associated with: respondents living in rural areas; mothers of children with mild asthma; and parents caring for older children. Furthermore, majority of parents equate asthma medication to acquiring the best possible treatment for their children. Halterman et al. (2010) conducted a study to determine factors which drive smoking cessation efforts by parents of children with asthma. Parent motivation was measured through a 10-point scale, with 10 indicating highest motivation. Overall, the average level of motivation was 6.9, with 47% of parents scoring 8 and above on the scale. Parents who were aware that their children’s asthma is uncontrolled and those who believe that their children’s asthma symptoms will be reduced if they stop smoking had higher motivation levels. The authors concluded that a link exists between parents’ perception on the risk of smoking to their children’s asthma and motivation to quit smoking. It was suggested that awareness raising initiatives on the risk of smoking and smoking cessation should be conducted to improve motivation levels among parents. Martin, Beebe, Lopez, and Faux (2010) conducted a qualitative study on asthma self-management beliefs and practices among Puerto Rican families. Overall observations indicate that Puerto Rican children with asthma assume self-management responsibilities at an early age. However, adolescent subjects expressed their need for more assistance from their parents in terms of managing their asthma. Ungar, Cope, Kozyrskyi, and Paterson (2010) provided several observations regarding socio-economic factors, elimination of allergens, and children with asthma. Cross-sectional data analysis show that a significant relationship between a mother’s employment status and home environment quality. In addition, mothers who stay at home display better home practices compared to mothers who are fully or partially employed. Moreover, children whose mothers have received more than secondary education are more likely to be less exposed to environmental tobacco smoke. Overall, children whose mothers are better educated and stay at home are more likely to be less exposed to allergens which can trigger asthma. The study of Oreskovic et al. (2009) on the travel patterns to school of children with asthma revealed that only a small percentage actually prefer active commuting. Also, most parents choose a school close to home, had few concerns regarding pollution, and have limited interaction with physicians. Mansour, Lanphear and DeWitt (2000) conducted a study to determine barriers to effective treatment of asthma among urban, minority children as perceived by their parents. Demographic information collected shows that all parent respondents were of black racial backgrounds, with an average age of 36.8 years, 92% are female, 70% are non-married, and 38% had less than a high school education. Meanwhile, 45% of the children included in the study suffer from intermittent or mild asthma while the rest have moderate to severe asthma. The top barrier types identified were: (1) patient / family characteristics; (2) environmental; (3) health care provider; and (4) health care system. Meanwhile, the top parent concerns were: (1) use, safety, and long-time complications of asthma medications; and (2) impact of limited exercise on quality of life for both child and parent. These results run contrary to popular belief that issues regarding access to medical care, health insurance, and continuity of care are the most prevalent hindrances to effective asthma treatment. The authors suggested asthma education and management interventions which are custom-fit depending on the target audience such as minorities, individuals with limited education, etc. Conn, Halterman, Lynch and Cabana (2007) investigated parents’ perceived needs and concerns regarding their children’s asthma medications and the impact of positive and negative beliefs on parent-reported adherence through a cross-sectional survey on parents of children with asthma. Results of the analysis show that 72% of parents agree on the necessity of their children’s asthma medication. In addition, 30% of the parents show a high level of concern regarding the use of asthma medication. These results confirm the link between medication belief of parents and the adherence level of asthma treatments. Methods Design The proposed study will adopt a descriptive-quantitative methodology using a researcher constructed survey questionnaire as the main data-gathering instrument and purposive sampling in the selection of respondents. A descriptive study is deemed most appropriate because it answers the question, “what is” or prevailing conditions, which is exactly what the proposed study will inquire about – prevailing beliefs and perceptions of parents about access to healthcare, compliance and adherence to medication regimen of very young children with asthma. Furthermore, a quantitative study is required since only a quantitative study can handle hypothesis testing. Descriptive and inferential statistics will be utilized in the analysis of the data collected. All inferential statistics will be performed using two-tailed analysis and a level of confidence of 0.05. Sample A minimum sample size of 200 parent – respondents will be involved in the proposed study computed based on post-hoc statistical power analysis using the software G-Power (2009) and the following parameters: (1) effect size of 0.25 (medium); (2) ? error probability of 0.05; (3) number of groups (5). The sample size will yield a statistical power of 80%. Selection of respondents will be carried out using purposive sampling, where the basis of selection will be parent or legal guardian of children four years or younger who are suffering from asthma. Protection of Human Subjects Conduct of the study will be guided by all applicable provisions of Title 34 of the Code of Federal Regulations (Office of the Federal Register, 2010), particularly Title 97, pertaining to protection of human subjects. Informed consent will be secured for the study prior to data collection. Likewise, anonymity, confidentiality and privacy of the respondents will be protected with the adoption of sound ethical practices. Setting The research locale of this study will be the state of Georgia with a total population of close to 10 million residents. This figure is broken down approximately into 5.6 million whites, 2.9 million blacks, 0.9 million Hispanics and about 0.3 million non-Hispanics. About 700,000 children in Georgia are below 5 years old (US Census Bureau, 2010). Of this number, asthma related hospitalization among the 0 to 4 age group is 228 per 100,000 of the group population in one year (Georgia Department of Community Health, 2010). It may, therefore, be roughly estimated that children four years old and younger in Georgia contribute to 1500 asthma-related hospitalizations in a year. Instrument A researcher - constructed survey questionnaire will be the main data gathering instrument. It will consist of four parts, namely: respondent profile, beliefs and perceptions on healthcare access, compliance with medication regimen, and adherence to treatment interventions. To date, the questionnaire is being developed to contain 30 – 40 items which will answered using a multiple choice type responses in the first part and a five-point Likert scale in the second, third and fourth parts. The instrument will be piloted in order to verify internal consistency validity using Cronbach alpha. Likewise, the questionnaire will also be subjected to face and content validity. Data Analysis Data gathered for the first research problem pertaining to respondent profile will be statistically presented using frequency and percentage distributions, and when applicable, the mean and standard deviation will also be computed. The second research question pertaining to the belief and perception of the parents will be presented using frequency and percentage distributions, mean and standard deviation. For the third research problem, significant differences in the parent – respondents’ beliefs and perception when the respondents are grouped according to gender will be evaluated using independent samples t-test. Levene’s test for homogeneity of variances will be used as a supplementary test to check the assumptions of normality of data as prescribed for the use of independent samples t-test and analysis of variance (ANOVA). One-way analysis of variance will be used to determine whether significant differences are present in the responses for beliefs and perceptions of parents when they are grouped according to age, ethnicity, socio-economic status, educational attainment, and healthcare insurance coverage. All statistical computations will be carried out using the statistical software SPSS (2008) Version 17. 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