According to (Kilbourne, Switzer & Fine, (2006), Health disparities are significant differences that are needed and viewed clinically and statistically in health care and health outcomes. These differences between groups of people can affect how often an illness(disease) have group affects, the number of people who have gotten sick and how many times do this particular disease or problem ends up with death occurring. There are a number of populations that can be affected by health disparities. ( Felton, (2013).
Some of these differences are:
Ethnic and racial minorities
Rural area residents
The elderly, children and women
People with disabilities. (Medline Plus.com., (2013).
Health disparity can also be defined as differences of populations in health care access, environmental exposures, health status, quality or utilization and outcomes involving your health. Health disparities are related generally to social issues and healthcare systems. The worldwide web coming in existence in the mid – 1990’s also can lead to health disparities since some ethnic groups would not be able to afford the internet. One of the objectives of Healthy People 2010 was to provide more internet services to the home. (Gibbons, (2005).
Since this study will be a quantitative study it will focus on the total number of uninsured or underinsured Americans who didn’t have health insurance by the end of 2012. Another focus of this study will be coming up with possible solutions to this growing trend in healthcare. In this study we will also seek to discover how the uninsured or underinsured individuals or families are being effected positively and negatively by gaining feedback from these individuals. There are several ways to obtain this feedback for this study in which we will be conducting surveys and questionnaires to get the answers we need.
These ways are: the reasons why they do not have insurance to determine how this may affect their access to care, to determine whether the cost of care is directly affecting the reason why these individuals may not be insured and in this study we need to try to find the problems, come up with solutions and look for ways to get rid of any barriers to persons so that they can find affordable health care policies. Since the Affordable Care Act of 2010 is in effect we need to study how the introduction of a new healthcare law to totally replace the healthcare system that has been in place for years will effect uninsured and underinsured Americans.
According to the article by (parkdatabase.org.,(2012). For the surveys we will be conducting our survey samples will be coming from males and females who are American citizens, all races or ethnic groups, 200 participants will be equally divided by gender. In order to cover a wide variety of people that are being effected by health disparities in quantitative research usually will require a large sample size in order to quantify the research. (Felton, 2013).
Background of the Study
There are several factors that join together populations to influence someone’s health and health status which results into health disparity. According to the Healthcare Fairness Act of 2000 House Resolution #3250, populations that have health disparities suffer from numbers that are significant as it relates to the total rate of incidence of disease, mortality, survival and morbidity when compared to the population in general. The most contributing factor to health disparities most often mentioned when watched in the United States population is Socioeconomic status (SES). Other factors related to health disparities include: physical and cultural environment, lifestyle, working and living conditions, and community and social networks. Socioeconomic status can be defined as how persons, households, families, and aggregates and census contracts as it relates to the size to consume or create goods that our society values. (Shavers, (2007).
The quality of healthcare experienced by our patients may be related to issues of disparity, socio-environmental determinants of health, practice variation, and substandard of care as scientific evidence seemed to show by the late 1990’s. (Gibbons,(2005). Since Disparities in the United States can be caused by rather a mixture that is complex, historic injury intertwined with problems with access along with systematic quality. Health disparities have many sides which include ethnicity, status, geography and race.
For policymakers it is critically important to give meaning to the problem in the correct way to make sure any solutions that are goal-related will be able to address the solutions reached. The goal is to provide health security for everyone no matter what your socio-economic characters are. Even though the United States goal is to completely get rid health disparities there will be efforts to become a part of a broader effort to change health care and by doing so, there must be focus on improving the quality of care delivered to patients individually first and foremost. (Frist, (2005).
We can now ask the question, Why the study of health disparity should be pursued and for whom is the study important to? The study of health disparity should be pursued because if nothing else but to determine if the research into health disparity will show any differences in organizational features that are specific. Furthermore the idea that organizational factors may play a significant role in health disparity has brought about more of a deep research on the role of organizational processes that are mutable when you look across the treatment setting. (Kilbourne, Switzer & Fine, (2006),
Purpose of the Statement
The purpose of this study will be to test the framework that is conceptual that will cover health disparities in 3 phases.
Reducing and/or Eliminating
The survey will include 200 male and female divided equally on uninsured Americans adults 18 years and older to gain feedback on why they do not have health insurance. (Felton, 2013).
Viable Research Questions and Hypotheses
What role if any how access to care directly affected your health status because you don’t have health insurance?
How has the cost of healthcare affected you individually, your families health status because of no health insurance?
How do you think your health status would change if you could afford health insurance?
Do you think the new health care law will positively or negatively affect your ability to purchase health insurance?
What factors do you believe are directly associated with the uninsured status as it relates to health insurance access? (Felton, (2013).
Having no health insurance is directly impacting my access to care.
Also the cost of care while having no health insurance is directly affecting my general health of me as well as my family.
Also, if I had no cost for health insurance or low cost this would positively affect my health status as well as my family.
With the Affordable Care Act of 2010 partially enforced, how do you believe this law will be directly associated with your uninsured status when it comes to access to health insurance. (Felton, 2013).
Nature of the Study
The strengths of Experimental Designs research according to the textbook, (Frankfort-Nachmias, & Nachmias, (2008), designs begins with the understanding of the 4 components of research design which are: _comparison(correlation of two variables), manipulation(control over), control, (removal of other factors(, and generalization(different settings, larger populations can be use)._ (Frankfort-Nachmias, & Nachmias, (2008). The strengths of experimental designs is it will help a researcher understand the logic behind all other research designs, another strength is that an experiment lets the researcher observe and draw inferences that are casual with less difficulty no matter what type of variable is used and it allows researchers to be able to understand other design limitations. (Felton, (2013).
According to the author,( Bhattacherjee, (2012). The limitations of Experimental Design research can be in the world of experimentation, the situation in the real world may not always relate, in situations where you have to randomly assign the persons to groups this may be impossible and unethical and another limitation would be getting rid of variables that are extraneous may not even be possible. (Felton, 2013).
According to textbook by, (Frankfort-Nachmias, & Nachmias, (2008). When I consider the quantitative research plan I am developing and my research questions, hypotheses, and variables, I would recommend the classic experimental design for research. The reason is my research plan involves, “Health Disparities,” which is a topic that can touch on several specific groups whether it be based on race, gender, insured, uninsured. In the classic experimental research design as the researcher you do have more control over the intrinsic and extrinsic variables for your research which is an advantage for me. Also in experimental design it allows the researcher to have control to introduce the variable that independent to help determine which direction the causation is being led to.
Since Health Disparities will need to cover several areas in order to be effective I feel that experimental research design offers me the best chance of reaching the goal of my research which are three phases: 1. Detection, 2. Understanding of the problem and 3. getting rid of or eliminating health disparities all together. ( Felton, 2013).
Since there are so many issues that are affecting “Health Disparities in our world today, I feel I need to choose a research design plan that offers flexibility to the researchers which allows them to properly research the issue, look at all sides to the issues to help come up with valid and ethical conclusions. Also, since I want to focus on uninsured Americans, just like me, and a hot topic in our world today, I will need an research design that will aid in my success to properly research this issue fully.
iii. Instrumentation and materials
According to the authors, (Keppel, Pamuk, Lynch, Carter-Pokras, Kim, Mays, Pearcy, Schoenbach, & Weisman, (2005). S The levels of measurement that will be important for my study in Health Disparities can involve at the nominal level, ordinal level and ratio level. Health disparities can be measured according to six issues that are between populations and groups:
1. a reference point will need to be selected in order to measure disparity.
2. Disparity need to be measured in either relative or absolute terms.
3. Measurements for health disparities need to be in terms of adverse or favorable events.
4. Health disparity needs to be measured in summary fashion or pair-wise.
5. In health disparity you need to choose whether to weigh groups according to the size of the group.
6. In health disparity there needs to be a decision whether to order the groups in a inherent way. (Felton, (2013).
According to the textbook, (Frankfort-Nachmias, (2008). The nominal level will be important to my study on health disparity because at this level you can measure a different symbol that will represent each symbol. For example: ethnicity, gender, nationality, martial status, religion, and where you live.
According to Messer, (2008). The ratio level is also another level of measurement that can be used in my research study on Health disparities because variables at this level have fixed natural zero points and absolute because these variable can be based on length, time, weight and area. Frankfort-Nachmias, (2008). Ratio measurement are the most common level of measurement used in disparity due to the scale of measurement. At the ratio level when measuring disparity it can be used in both as an absolute measure as well as a level of ratio. (Felton, (2013).
Validity in research is concerned with whether you are measuring what you really need to or intend to measure for your research. There are three kinds validity in research: content, empirical and construct validity.
I will ensure content validity, empirical validity, and construct validity for my study in health disparity in uninsured Americans by first understanding what each of the three types of validity mean:
1. Content validity is when your measurements are actually covering all areas you are intending to measure. In other words, nothing is left out. According to the textbook authors (Frankfort-Nachmias, (2008). Under content validity we have what is called face validity or the researcher’s evaluation that is subjective in their research. Another content validity is called sampling validity which is concerned about whether the population given in the research is sampled adequately. (Frankfort-Nachmias, (2008). Since health disparity covers a large area to be sampled, as a researcher I will have to find one area to focus on such as “uninsured Americans, covering persons 18 years and older, male and females, all ethnic groups will all be a part of the sample. (Felton, 2013).
According to authors (Hidalgo & Goodman, (2012). Empirical validity refers to the relationship that is between an instrument that needs to be measured and the outcomes of the measurements. Construct validity relates the issues you are measuring to theoretical framework that is general. In disparities research it will be important to assess the standard criteria needed for the research to do what it is intended to do, especially if you are using different populations. In some cases, questionnaires may be needed to create validity in the study, but not in all studies. If in your disparities research for uninsured Americans, where things like racism, race, ethnic groups which are considered constructs that are social can be hard to measure. (Felton, 2013)
According to the article from (Active Campaign, (2009). In order to ensure validity in my research using content research which will be requiring all areas in my research I want to cover as it relates to health disparities for the uninsured American I would need to use a subjective form of measurement.(Felton, 2013). In the textbook, (Frankfort-Nachmias, (2008). The strengths and limitations in the reliability and validity I chose Construct validity strengths are based on how many dimensions and measures construct validity has, construct validity can be operated in a number of ways. (Felton, 2013).
In order to ensure reliability for the measurement in my study, first I need to understand as a researcher the importance in the degree of reliability. Reliability is when your measuring instrument contain variable errors or mistakes that appear not all the time between your observation of your research for one time only or every time a variable is measured. So measurements contain two components which are called error component and true component. To further explain reliability which is measured on a ratio between true-score variance and variance in the total score measured. To ensure that my research study on health disparities is reliable for the measurement I will need to be able to distinguish that the results of the research may not be the exact same each time it is done. (Felton, (2013).
The strengths and limitations when it comes to health disparities in the terms of reliability and validity can be linked to the fact that there are several components by which health disparities can be measured. Empirical validity and reliability are part of the research that deals with health disparities. One strength of empirical validity is relationships between prediction and results.
According to the authors, (Ogden and Lo, (2011). The scale that is most appropriate to use for researching health disparities in uninsured America Likert scale (tests attitudes) since it requires the researcher build a list of items that needs to be scaled, random research, then total of results. In using Likert scales there will be some limitations in the research involving health disparities. Some limitations are due to the debate on the role of comparisons socially and the impact it would bring on how the scales are completed and the results of the data being researched. ( Felton, 2013).
According to authors Lobo and Mateus, (2013). Since in health disparities there are so many areas that need to be measured even access to health care and scales for measurement can help to achieve the needed results for the researcher if you take into account the aspects of the scale that you can enhance and you will continue to need to validate scales in your other populations. (Felton, (2013).
According to ( Nowjack-Raymer, (2013), the test that is appropriate for my health disparities research plan would probably looking to better understand inequalities as well as health disparities, another test could involve developing testing with interventions that would be targeting people living in poverty, and we could also consider testing implementation and dissemination approaches for exploration to findings that would be effective in order to assure translation that is fast that could be put into practice, bring about some policies with action within communities. (Felton, (2013).
The populations used for the scale and test as it relates to health disparities according to the NIDCR authors (Nowjack-Raymer, (2013), will involve research that will be focused on the vulnerable and disadvantaged population in subgroups. The testing population could include:
All ethnic and racial populations that are considered to be under health disparities, this will include Hispanic(Mexican, Puerto Rican, South and Central America, Cuban, and all Spanish speaking nations), African Americans, Native Americans, Pacific Islander, and Alaskan
Rural low income persons, urban dwellers, including Appalachians
Persons who are unable leave their homes due to disabilities and persons who are in institutions the special needs populations that includes persons living with AIDS, developmental or acquired intellectual or physical disabilities. (Nowjack-Raymer, (2013)
Data analysis plan:
Since in program research there a number that is limited in the efforts to evaluate and create health disparities involving new strategies with the health care system. Here are some of these program that are being supported by the AHRQ – Agency for Healthcare Research and Quality for example:
(EXCEED) or Excellence Centers to Eliminate Ethnic/Racial Disparities, this is a grant program that looks for ways to eliminate health disparities. (Gillian, (2004).
According to website (HHS.gov.,(2013), For my Quantitative Research Plan on Health Disparities using ratio measurement because it is the most common level used to measure disparity. The population (units of analysis that are relevant) for this research will include all uninsured African Americans in the United States today. Statistically according to the new Health Care Law or the Affordable Care Act there are 6.8 million African Americans eligible for benefits under the ACA. (Felton, 2013).
The population for my study includes all uninsured African Americans in the United States according to the ACA. Population: 6.8 million – African Americans (including male and female), almost half of this number of young adults. This population need to be defined on the basis of: A. Content, B. Extent, and C. Time. Size: 6.8 million. (HHS.gov.,(2013). I have made a change in my population for research which will be first finding a reference point which is critical when doing research on disparity.
According to the authors, (Keppel, Pamuk, Lynch, Careter-Pokras, Kim, Mays, Pearcy, Schoenbach, and Weissman,(2005). I will also need to measure disparity in relative or absolution terms. Disparity is very obvious when you realize that disparity occurs when the amount that separates a group from a reference point that is specified on a measure that is particular to health that is expressed in the terms of percentage, rate, means or some other measure that is quantitative. (Felton, 2013).
. According to authors, (Keppel, et al, (2005) Sampling: an individual within the Population such as for example the young adult population size of 3.2 million or 47% don’ t have health insurance from the ages 18 to 35 years of age. Type of Sampling used: Probability sampling. A sample need to be able to represent the population it will be used for. When you want to measure a sample and your objective is to work from individual groups in a certain domain then use comparisons that are pair-wise. When you summarize the measures used in your disparity this will quantify all the groups in opposition and any conclusions based on your summary results should be joined and interpreted using all groups. (Felton, 2013)
How the sample will be drawn?
When disparities are measured, first the reference point need to be identified, next if any two groups need to be compared the reference point with the favorable group need to be used(lowest rates). When using disparities samples it should be measured in both relative and absolute terms and when you are measuring disparities over various of health indicators it should be shown in terms of events that are adverse.
Why did you choose this sample size and why it was chosen in relation to the size of your population?
I initially chose this sample size since I had 3 populations to choose from for the uninsured African American population which were male, female, or young adults and I chose the young adult population since I had a solid statistical number of how many of young adults between the ages of 18 to 35 who are uninsured. I am not totally convinced that choosing a sample size representing millions of people will be the correct course for me to take and I had a terrible time trying to create a graph or chart to show my numbers and I could not get the graph to show.
Since the number of uninsured Americans is very high even with the Affordable Care Act being in place, I may have to consider working in another area in health disparity. I was attempting to doing a basic line graph chart showing the age of young adults with no health insurance. Since health disparities covers such a wide range of issues I will have to reconsider what area under health disparity I want to cover and research.
Health Disparities research has emerging advances which include comparative effectiveness studies and controlled trials that are often conducted at academic sites and multiple communities. The institutional review boards (IRBs) has presented a impediment that is major to the effective and timely conduct of health disparity research. When the research involved the underserved communities and minority along with institutional requirements, ethical standards interpretation may be different. These differences can cause complications in the research protocol and informed consent process and may have a negative effect on how the participants will respect this type of research and the quality of the trials.
Also the IRB or institutional review board, can also lead to delays that are unnecessary, jeopardizing the capacity to perform collaborative projects and funding. The Research Centers in Minority Institutions (RCMI), Translational Research Network (TRN) have created a community-partnered approach to run side by side with the IRB review directly across the 18 RCMI institutions grantees that make sure compliance while making it better quality of health disparity research. (Hammatt,. and Nishitani, Junko and Heslin, Kevin and Perry and Szetela, and Jones, and Williams, and Antoine-LaVigne, and Forge, and Norris, Keith C, (2011).
Even though Americans are living longer and are healthier, health disparities still exist. However, policymakers are making a response to the health disparity issue by putting together and introducing legislation that are geared toward getting rid of health disparities. (ncsl.org., (2014).
The Uninsured Americans as a health disparity
There is about 44 million Americans total without health insurance and another 38 million Americans who do not have enough health insurance to meet their healthcare needs. If persons do not have health insurance it will usually mean putting also necessary care such as:
no Primary care doctor
no access or limited access to prescription drugs
being hospitalized for a condition that otherwise would not have led to a hospital stay that could have been avoided if you had health insurance
Because of fear of medical bills you may choose to delay care which will usually lead to more cost to you, especially if you have to go to the emergency room.
We must also understand that when the uninsured persons face a health crisis because they can’t pay the burden of the cost will be to the insured population. (Glied, (2014).
Active Campaign, ( 2009). Validity in Research Design. Retrieved from website http://www.activecampaign.com/blog/validity-in-research-design/
Bhattacherjee, A.,(2012). SOCIAL SCIENCE RESEARCH: PRINCIPLES, METHODS, AND PRACTICES. Retrieved from website http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=1002&context=oa_textbooks
Felton. (2013). _An analysis of personality theory._ Unpublished
manuscript, Walden University.
Frankfort-Nachmias, C., & Nachmias, D. (2008). Research Methods in the Social Sciences 7th Ed. New York: Worth
Frist, W., (2005). Overcoming Disparities in U. S. Healthcare. _Health Affairs. Retrieved from website http://content.healthaffairs.org/content/24/2/445.short._
Gibbons, M., (2005). A Historical Overview of Health Disparities and the Potential of eHealth Solutions. _Journal of Medical Internet Research. Retrieved from website http://www.jmir.org/2005/5/e50/_
Gillian, S., (2004). Addressing Unequal Treatment: Disparities in Healthcare. _The Common Fund. Retrieved from website http://www.commonwealthfund.org/usr_doc/SteelFisher_unequaltreatment_cong2004_70 9.pdf?section=4039_
Glied, S., (2014). The Uninsured. Retrieved from the website http://www.pbs.org/healthcarecrisis/uninsured.html
HHS.gov(Health care.,. The Affordable Care Act and the African Americans. Retrieved from website
(HAMMATT,. AND NISHITANI, JUNKO AND HESLIN, KEVIN AND PERRY AND SZETELA, AND JONES, AND WILLIAMS, AND ANTOINE-LAVIGNE, AND FORGE, AND NORRIS, KEITH C, (2011). PARTNERING TO HARMONIZE IRBS FOR COMMUNITY-ENGAGED RESEARCH TO REDUCE HEALTH DISPARITIES. PUBMED.GOV. RETRIEVED FROM WEBSITE HTTP://WWW.NCBI.NLM.NIH.GOV/PUBMED/22102302
(Hidalgo & Goodman, (2012). Validation of Self-Reported Measures in Health Disparities Research. _Journal of Biometrics and Biostatistics. Retrieved from website_ http://www.omicsonline.org/validation-of-self-reported-measures-in-health-disparities- research-2155-6180.1000e114.pdf
(Keppel, Pamuk, Lynch, Carter-Pokras, Kim, Mays, Pearcy, Schoenbach, & Weisman, (2005). Methodological Issues in Measuring Health Disparities. Retrieved from website http://www.cdc.gov/nchs/data/series/sr_02/sr02_141.pdf
Kilbourne, A., Switzer, G., Hyman, K., Crowley-Matoka, M., & Fine, M., (2006). Advancing Health Disparities Research within The Health Care System: A Conceptual Framework. Retrieved from website http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1698151/
LOBO, A., & MATEUS, S., (2013). VALIDITY AND RELIABILITY OF AN EQUITY IN HEALTH CARE SCALE. _SAGE JOURNALS. RETRIEVED FROM WEBSITE_ HTTP://SGO.SAGEPUB.COM/CONTENT/3/4/2158244013506716
Messer, L., (2008). Invited Commentary: Measuring Social Disparities in Health-What Was the Question Again? _American Journal of Epiderminology._ Retrieved from website http://aje.oxfordjournals.org/content/167/8/900.full.pdf
ncsl.org., (2014). 2014 Health Disparity Legislation. Retrieved from website http://www.ncsl.org/research/health/2014-health-disparities-legislation.aspx
nlm.nih.gov., Medline Plus., (2013). Health Disparities. Retrieved from website http://www.nlm.nih.gov/medlineplus/healthdisparities.html
Nowjack-Raymer, (2013). Health Disparities Research Programs. Retrieved from website http://www.nidcr.nih.gov/Research/DER/ClinicalResearch/HealthDispar.htm
Ogden, J., & Lo, J.,(2011). How meaningful is data from Likert Scales? An evaluation of how ratings are made and the role of the response shift in the socially disadvantaged. Journal of Health Psychology. Retrieved from website http://hpq.sagepub.com/content/early/2011/08/06/1359105311417192,
Parkdatabase.org.,(2012). Qualitative and Quantitative Research Techniques for Humanitarian Needs Assessment. _An Introductory Brief._ Retrieved from website http://reliefweb.int/report/world/qualitative-and-quantitative-research-techniques- humanitarian-needs-assessment.
Shavers, V., (2007). Measurement of Socio-economic Status in Health Disparity Research. _Journal of National Medical Association. Retrieved from website_