Factors Affecting the Use of Health Services by Americans - Research Proposal Example

Research Critique/Review      RESEARCH CRITIQUE/REVIEW What research question did the set out to answer? The research study does not explicitly state the research question, but this can be inferred from the conceptualization of the research. A research question denotes the unknown element or phenomenon that a research bid endeavors to reveal or answer. An analytical exploration of the purpose of the study and the identified research problems facilitate an understanding of the research question behind the study. Firstly, the study identifies an already known problem before identifying how that leads to the current study. The researchers note that ensuring sufficient care for a population does not necessarily reflect quality care and equity in utilization (Song et al., 2010). A case that is true among minorities because of cultural, language and financial barriers. The research thus sets out to seek the quality indicators required beyond access so as to guarantee quality in care with a specific focus on Korean American minorities. The study identifies a gap in knowledge in understanding utilization of healthcare among minority groups and the factors that influence actual utilization levels (Song et al., 2010). After identifying the lack of a systematic review on ethnic minorities’ utilization of healthcare, the researchers define the purpose of the study. According to the researchers the purpose of the study was to determine the predictive ability of a model of care utilization, which explains the effect different variables have on care utilization among minorities. The researchers note that utilization of care among immigrant minorities is often affected by the interplay of three categories of factors including need, enabling and predisposing factors (Song et al., 2010). In a nutshell, the study identifies the lack of adequate utilization of healthcare among Korean minorities. The researchers note that this affects effective management and prevention of chronic conditions. However, there is no sufficient research into the factors affecting utilization. This research therefore works towards identifying whether a generally proposed theoretical model on utilization of care has better predictive ability to reveal the influence of various factors on utilization (Song et al., 2010). The research questions would therefore be explicitly stated as follows: 1. Does the Anderson behavioural model have predictive ability to show how need, enabling and predisposing factors influence utilization of healthcare services among Korean Americans? 2. If there is significant predictive ability in the model, then, what is the relative influence of different factors on utilization levels among Korean Americans? What research hypothesis/hypotheses was/were tested in this study? The development of the research hypotheses for this study relied on three major assumptions identified within the study. The first assumption was that the use of healthcare services among individuals is influenced by three main factors, which are need, enabling and predisposing factors (Song et al., 2010). This assumption was derived from the Anderson model. The second assumption was that the utilization patterns among immigrant minorities should undergo interpretation in a migration context as viewed from an ecological perspective. The third assumption was that income and insurance cover, which are classified as enabling factors, have significance in predicting utilization levels (Song et al., 2010). The hypotheses of the study were developed with the consideration of the above-mentioned assumptions, and the identified hypotheses are as follows: 1. Need-related factors in the Anderson model such as medical history, clinical symptoms and high blood pressure directly influence healthcare utilization (Song et al., 2010). 2. Predisposing factors, which include life priorities and years of residence in the United States influences utilization of healthcare services indirectly and directly through other factors (need and enabling factors) (Song et al., 2010). Which study design was employed in the study? What (if any) type of bias is inherent to this design? The researchers adopted a prospective cohort study, which can be classified under survey-study designs because data was collected through questionnaires (Song et al., 2010). The presence of a baseline in data collection and the fact that the designated sample was followed through time before more data collection implies that this was a prospective study (Martyn, 2009). The cohort element emerges from the fact that the designated sample had similar characteristics (Immigrants, Koreans, Americans, members of a high blood pressure program etc,). Prospective cohort studies generally entail the following of group of similar participants over time (Martyn, 2009). These studies are aimed at finding a relation between a variable/s (utilization) and characteristics shared by the cohort. The use of questionnaires offers the accords the design an element of being classified as a survey design. Prospective cohort studies have inherent bias, which may significantly affect the study’s findings. For example, differential loss in the following process may introduce bias (LaMorte, 2012). Additionally, there is the possibility of having selection bias, which reduces representativeness. Poor representativeness of the sample affects validity and generalization (LaMorte, 2012). For example, the fact that the American Koreans in one health program were selected from one locality implies that the results from the study have limited applicability to American Koreans in other regions and health programs. Finally, there is a possible exposure misclassification that can cause measurement bias. This commonly happens when some members of the followed cohort change exposure status (Anonymous (2003). These changes should be accounted for so as to avoid bias, and therefore, periodic assessments of cohorts are necessary (Anonymous (2003). Summarize the univariate findings displayed in Table 1. The univariate analysis revealed that 93% of the participants were married and 89.2% of the cohort was well educated with at least high school level education (Song et al., 2010). The number of women and men was almost even (525 versus 48% respectively). The mean age of the cohort was 52 years and more than two thirds of the participants came to the United States within the last two decades. The participants in the cohort had stayed in the United States for an average of 16 years. Less than half of the participants (35.7%) felt that their income was sufficient to sustain them. 39.1% of the participants perceived the income to be fair; whereas 25.2% stated that their income levels were uncomfortably low. Most of the participants were employed during the study period, but only half (41.9%) had health cover. Privately covered participants were a majority (97.3%) within the insured lot (Song et al., 2010). The total percentage of the uninsured stood at 78% within the cohort. A significant percentage of participants without a cover cited high premium levels as the main reason, whereas 14% cited the reason as lack of a provision from the employer. Out of the whole cohort only 59.8% rated high blood pressure (HBP) management and health as a top five priority in their list of important issues. The participants’ rates of HBP related medical conditions were 13.1% and 13.9% for diabetes and kidney problems (Song et al., 2010). Summarize the bi-variate findings reported in Table 2. Bivariate analyses are meant to determine the relationship that exists between two non-independent variables. The findings established that marital status, possession of health cover, years of residence and medical history were related to healthcare utilization levels at levels of significance above P> 0.05 (Song et al., 2010). Therefore, individuals that were married and had been in the US for longer and had HBP related conditions were highly likely to highly utilize healthcare. There were also significant relations between the various need, enabling and predisposing factors. The number of years spent in the US, was found to be positively related to health cover and perceived levels of income. There also was a strong relation between perceived income, life priorities and years of residence. Participants that had incomes perceived as sufficient and had spent more years in the US and highly prioritized HBP care and health were likely to be covered (Song et al., 2010). What limitations were noted with regard to the study’s findings and conclusions? The researchers explicitly identify a weakness in generalization or applicability of the research findings to a wider population and different regions. Therefore, the researchers warn that caution should be exercised in interpretation because the sampled cohort was from a single ethnic group within one locality and in one health program. This limits applicability because of the inherent low representativeness. Inferences that can be drawn from the study are, therefore, limited (Song et al., 2010). Additionally, there is noted exclusion of some variables that could be significant in determining the study’s outcome. Variables such as level of language barrier and acculturation stress are not incorporated yet they are noted as being significant factors. The inclusion of these variables in the future should offer better interpretation of utilization determinants in an immigrant-related context (Song et al., 2010). References Anonymous (2003). Advantages and Disadvantages of Cohort Studies, http://gwxy.gzsums.edu.cn/lxbx/english/epidemiologic%20knowledge/Prospective%20and%20Retrospective%20Cohort%20Studies/Advantage.html LaMorte, W. W. (2012). Advantages & Disadvantages of Cohort Studies. Retrieved from http://sph.bu.edu/otlt/lamorte/EP713/Web_Pages/EP713_CohortStudies/EP713_CohortStudies5.html Martyn, S. (2009). Cohort Study. Retrieved from http://explorable.com/cohort-study.html Song, H., Han, H., Lee, J., Kim, J, Kim, K.B., Ryu, J.P., & Kim, M. (2010). Does access to care still affect health care utilization by immigrants? Testing of an empirical explanatory model of health care utilization by Korean American immigrants with high blood pressure. Journal of Immigrant Minority Health, 12, 513-519. Read More