Health Access for Native Hawaiians and Pacific Islanders: Determinants of Health Service Utilization and Insurance Coverage

夏威夷原住民和太平洋岛民的健康获取：健康服务利用和保险覆盖范围的决定因素

• 批准号: 10682335
• 负责人: Steven Sasa Marsiglia
• 金额: $ 4.2万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-07 至 2024-04-06
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10682335
• 关键词: Accounting; Address; Adult; Analysis of Variance; Anxiety; Awareness; Cardiovascular Diseases; Characteristics; Communities; Computer software; Data; Data Collection; Data Set; Development; Diabetes Mellitus; Dimensions; Disparity; Disparity population; Electronic Mail; Ethnic Population; Geography; Goals; Health; Health Disparities Research; Health Insurance; Health Professional; Health Services; Health Services Accessibility; Health Status; Healthcare; Heart Diseases; Hypertension; Income; Individual; Influentials; Insurance Coverage; Internet; Intervention; Literature; Malignant Neoplasms; Measurement; Measures; Medical; Mental Depression; Methods; Modeling; National Health Interview Survey; National Institute on Minority Health and Health Disparities; Native Hawaiian; Native Hawaiian or Other Pacific Islander; Nature; Outcome; Participant; Personal Satisfaction; Population; Provider; Public Health; Public Policy; Regression Analysis; Religion; Reporting; Research; Samoan; Sample Size; Subgroup; Surveys; Testing; Underrepresented Populations; Uninsured; United States; United States National Center for Health Statistics; access disparities; aged; behavioral health; cultural competence; design; ethnic minority population; health care availability; health care service utilization; health data; health determinants; health service use; improved; innovation; insight; neglect; novel; perceived stress; preference; racial discrimination; racial minority population; racial population; recruit; service providers; social culture; social media; statistics; theories; underserved community

PROJECT SUMMARY/ABSTRACT Background: A high percentage of Native Hawaiian and other Pacific Islander (NHPI) adults (37.4%) aged 18 and older did not see a doctor in the past year. This is the highest percentage among all racial groups. Furthermore, approximately one in eight NHPI adults (12%) are uninsured, a rate that is markedly lower than Whites. Federal reports historically struggle to capture data that could explain these phenomena. Hence, NHPI are insufficiently and incompletely represented in health statistics, access health services at lower rates, and are insured at lower rates than other racial and ethnic minority groups. This has implications for perpetuating adverse health conditions and disparities that are prevalent in this community (e.g., cardiovascular disease, hypertension, diabetes, heart disease, cancer, etc.). Objective: The overarching goal of this research is to improve and broaden our understanding of novel multi-level health determinants causing (1) low health service utilization rates and (2) low health insurance coverage rates of NHPIs, which are presently understudied health access disparities for Native Hawaiians and other Pacific Islanders in the U.S. Design: A closed access, cross-sectional Internet survey will be used to collect data. Participants will be recruited with announcements distributed nationwide via email to NHPI organizations, associations, and networks across the United States and social media. The proposed sample size is 300 NHPI adults aged 18 and older. Analysis: Latent profile analysis (LPA) will be conducted using Mplus 8 statistical software to examine whether different conceptually meaningful profiles of NHPI Islanders emerge based on levels of hypothesized individual (Depression, Anxiety and Perceived Stress), interpersonal (Medical Mistrust and Racial Discrimination), community (Cultural Efficacy and Pacific Connectedness and Belonging) and societal-levels (Religious Centrality and Perceived Societal Wellbeing) health determinants while accounting for demographic covariates. We will then test whether the resulting profiles had differential healthcare access rates (health service utilization and insurance coverage). LPA fits the purpose of this study, which is to determine distinct configurations (i.e., profiles) of potential individual, interpersonal, community and societal-level health determinants of healthcare access and to examine whether profiles differed in their health service utilization rates and insurance coverage rates. Latent profile analysis allows for the estimation of measurement error to improve accuracy of estimates. Significance: Findings will inform public policy and healthcare professionals about this severely underrepresented population in health research to eliminate excessively low levels of healthcare utilization and low insurance coverage rates among NHPI. The results could contribute to the development of culturally competent interventions for this underrepresented and underserved community in health services and behavioral health research.

项目总结/摘要 背景：夏威夷原住民和其他太平洋岛民（NHPI）成年人（37.4%）年龄在18岁及以上， 过去一年没有看过医生。这是所有种族群体中比例最高的。此外，大约 八分之一的NHPI成年人（12%）没有保险，这一比例明显低于白人。联邦报告称 来获取可以解释这些现象的数据。因此，NHPI在卫生领域的代表性不足， 根据统计数据，少数民族以较低的费率获得医疗服务，其保险费率低于其他种族和族裔群体。 这意味着该社区普遍存在的不良健康状况和差距将长期存在（例如， 心血管疾病、高血压、糖尿病、心脏病、癌症等）。目的：本研究的总体目标 是提高和扩大我们对新的多层次健康决定因素的理解，这些因素导致（1）低卫生服务水平 利用率和（2）国家卫生保健机构的医疗保险覆盖率低，这是目前研究不足的健康获取 夏威夷原住民和其他太平洋岛民在美国的差异设计：一个封闭的访问，跨部门的互联网 调查将用于收集数据。参与者将通过电子邮件在全国范围内发布公告招募， NHPI组织，协会和美国各地的网络和社交媒体。建议样本量为300 18岁及以上的NHPI成人。分析：将使用Mplus 8统计软件进行潜伏特征分析（LPA） 研究是否出现不同的概念上有意义的档案的NHPI岛民的基础上的水平假设， 个人（抑郁、焦虑和感知压力），人际（医疗不信任和种族歧视）， 社区（文化效能和太平洋连通性和归属感）和社会层面（宗教中心地位和 社会幸福感）健康决定因素，同时考虑人口统计学协变量。然后我们将测试 由此产生的概况显示了不同的医疗保健获取率（医疗服务利用率和保险覆盖率）。LPA拟合 本研究的目的是确定不同的配置（即，个人的，人际的， 社区和社会层面的健康决定因素的医疗服务，并检查是否有不同的配置文件， 卫生服务利用率和保险覆盖率。潜在轮廓分析允许估计测量 误差，以提高估计的准确性。重要性：调查结果将告知公共政策和医疗保健专业人员， 这一严重代表性不足的人口在健康研究，以消除过低的医疗保健利用水平， NHPI的保险覆盖率低。研究结果可能有助于培养文化能力 在卫生服务和行为健康研究中为这一代表性不足和服务不足的社区采取干预措施。