The Influence of Financial Strain on Health Decision-Making.
The Influence of Financial Strain on Health Decision-Making.
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财务压力对健康决策的影响。
DOI：
10.1007/s11606-017-4296-3
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发表时间：
2018
影响因子：
5.7
通讯作者：
Lee,SimonCraddock
中科院分区：
文献类型：
--
作者：
Nguyen,OanhKieu;Higashi,RobinT;Makam,AnilN;Mijares,JuanC;Lee,SimonCraddock
方法我们进行了12个焦点小组在英语和西班牙语中的55名成年人寻求援助的十字路口社区服务在市中心达拉斯，得克萨斯州，从2016年7月至11月。十字路口是最大的非营利性食品再分配组织，隶属于北德克萨斯州食品银行。参与者是有目的地从十字路口等候区招募的。焦点小组使用半结构化指南私下进行，并进行数字记录，转录和翻译。我们使用持续比较法对成绩单进行了主题分析。数据收集和分析是同时进行的，以便分析性见解能够为征聘和持续的数据收集提供信息。分歧通过协商一致解决。我们在达到主题饱和时停止了招聘。这项研究得到了UT西南机构审查委员会的批准。大多数参与者年龄在40多岁和50多岁; 67%是女性; 5%是白色，38%是黑人，56%是西班牙裔。与会者反复提出的一个共同主题是，财政紧张而不是具体需求是影响卫生决策的唯一最重要因素。财务压力导致每天权衡每一项支出决策，而不仅仅是与健康相关的决策（表1）。虽然参与者重视并优先遵守医生推荐的治疗方法，但当资源缺乏时，他们采用替代和/或自我处方治疗。
METHODSWe conducted 12 focus groups in English and Spanish among 55 adults seeking assistance at Crossroads Community Services in downtown Dallas, Texas, from July to November 2016. Crossroads is the largest non-profit food redistribution organization affiliated with the North Texas Food Bank. Participants were purposively recruited from the Crossroads waiting area. Focus groups were conducted in private using a semi-structured guide and were digitally recorded, transcribed, and translated. We conducted thematic analysis of transcripts using the constant comparative method. Data collection and analysis were conducted concurrently so that analytical insights could inform recruitment and ongoing data collection. Disagreements were resolved by negotiated consensus. We ceased recruitment upon reaching thematic saturation. The study was approved by the UT Southwestern institutional review board.RESULTSMost participants were in their 40s and 50s; 67% were women; 5% were white, 38% black, and 56% Hispanic. The one recurrent and unifying theme among participants was that financial strain, rather than a specific need, was the single most important factor influencing health decision-making. Financial strain resulted in daily weighing of trade-offs with every spending decision, not only health-related ones (Table 1). Although participants valued and prioritized adherence to physician-recommended therapies when possible, they employed alternative and/or self-prescribed treatments when resources were lacking.