Health conditions in rural low-income families

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Johnson, R. B., & Onwuegbuzie, A. J. (2004). Mixed methods research: A research paradigm whose time has come. Educational Researcher, 33(7), 14–26. doi: 10.3102/0013189X033007014
Retrieved from the Walden Library databases.

Collins, K. M., & O’Cathain, A. (2009). Introduction: Ten points about mixed methods research to be considered by the novice researcher. International Journal of Multiple Research Approaches, 3(1), 2–7.
Retrieved from the Walden Library databases.

Burkholder, G. J., Cox, K. A., & Crawford, L. M. (2016). The scholar-practitioner’s guide to research design. Baltimore, MD: Laureate Publishing.

Chapter 6, “Mixed Methods Designs and Approaches”

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Simmons LA, Huddleston-Casas CA, Morgan KA, Feldman D. Mixed methods study of management of health conditions in rural low-income families: implications for health care policy in the USA. Rural Remote Health. 2012;12:1879. Epub 2012 Apr 10.

INTRODUCTION: The purpose of this mixed methods study was to examine the health issues and health management strategies utilized by rural low-income women and their families to inform the design, implementation, and evaluation of health reform in rural areas of the USA.

METHODS; Quantitative data was analyzed from 271 rural, low-income women and their families and qualitative data from a sub-sample of 44. Specifically explored were the: (1) types and perceived severity of health conditions rural, low-income individuals report; (2) perceived value and utilization of a usual source of care; and (3) strategies these individuals employ to manage their health.

RESULTS: Rural American families manage multiple healthcare needs with limited resources; 42.1% reported 1 – 4 chronic conditions in the family, 31.4% reported 5 – 8 conditions, and 17.7% reported 9 or more conditions. The majority of participants (79.0%) reported having a doctor or other healthcare professional that they usually see; 61.3% reported their partners had a usual provider, and 91.7% reported their children had a usual provider. Analysis of the qualitative data revealed two main themes regarding management of health conditions: (1) lack of engagement in managing overall health; and (2) ineffective utilization of health care.

CONCLUSIONS: Rural low-income individuals in the US may benefit from new policies that promote patient-centered, personalized care. However, any policy change must be carefully designed to consider the ways in which rural American families manage their health in order to improve individual health status and reduce rural health disparities.

D’Avolio DA, Strumpf NE, Feldman J, Mitchell P, Rebholz CM. Barriers to Primary Care: Perceptions of Older Adults Utilizing the ED for Nonurgent Visits. Clin Nurs Res. 2013 Nov;22(4):416-31. doi: 10.1177/1054773813485597. Health conditions in rural low-income families

The purpose of this mixed methods study was to understand access to primary care among older adults who present to an inner city emergency department (ED) for nonurgent care. Questionnaires (N = 62) included demographic, illness characteristics, and health care utilization. Qualitative interviews (N = 20) were conducted. Data was analyzed using descriptive statistics, and qualitative methodology. More than half of the participants were female (60%), African American (57%) and pain was the presenting symptoms among 48% of the participants. Nearly all participants reported barriers to primary care; difficulty with phone systems and staff, and lack of available appointments resulting in an ED visit. Older adults face barriers accessing primary care and as a result, can turn to the ED for their primary care needs. Interventions to improve access for vulnerable older adults might have benefits not only for patient outcomes but also for health policy issues related to cost effective care and overcrowded EDs.

Nguyen BL, Tremblay D, Mathieu L, Groleau D. Mixed method exploration of the medical, service-related, and emotional reasons for emergency room visits of older cancer patients. Support Care Cancer. 2016 Jun;24(6):2549-56. doi: 10.1007/s00520-015-3058-1.

PURPOSE: When dealing with health issues, older cancer patients are likely to visit emergency rooms (ER), which are known to expose these patients to the risk of adverse outcomes. Little is known about the profile and reasons for such visits. The aim of this study is (1) to describe the profile of elderly cancer patients aged 70 years and older who visited the ER of a regional hospital in Québec, Canada, and (2) to explain the medical reasons and factors determining such visits from the patients’ perspective.

METHODS: A concurrent mixed method design was used. Descriptive analysis of administrative databases was conducted to describe the socio-demographic, clinical, and service utilization profile of 792 cancer patients aged 70 years and older. Content analysis of 11 semi-structured interviews of a sub-sample was subsequently performed to better understand the experience and meaning these patients attribute to this health behaviour.

RESULTS: The sample of 792 older cancer patients made a total of 1572 ER visits. Most visits occurred during the daytime. More than half (53 %) of the patients were discharged, and close to 40 % were hospitalized. The most frequent reasons for consulting were respiratory (15.8 %), digestive (13.4 %), neurological (8.3 %), fever or infection-related (8.3 %), and cardiovascular (8.2 %). Content analysis of the qualitative data suggested that patients made ER visits mostly when other cancer care services were unavailable or because of a serious life-threatening health condition. Health conditions in rural low-income families

CONCLUSIONS: The study suggests areas of improvement to prevent ER visits when health issues can be addressed by other care services. Health conditions in rural low-income families