SES, Race, and Patterns of Health Care Navigation of Parents of Pediatric Cancer

描述（由申请人提供）：虽然社会经济地位（SES）和健康结果之间的正相关性一直是健康相关研究的一致发现，但产生这种关联的途径仍然不完全清楚。一个途径，已被假设为一个人的SES和他们的健康结果之间的重要联系是他们的健康护理导航模式。虽然有一些关于成人医疗导航和健康结果的研究，但研究尚未研究这些过程如何影响儿科癌症患者。我们也不知道父母在严重的儿科诊断后的医疗导航模式如何因种族和社会经济地位而异。这项研究的目的是了解父母在孩子被诊断患有癌症后的医疗导航模式如何因种族和社会经济地位而异，并将这些发现转化为基于证据的干预计划。为了实现这一目标，拟议的研究有三个具体目标：1）进行深入访谈80名儿童癌症患者的父母，以记录他们的健康护理导航模式的不同特征; 2）收集和分析SES结构的多个维度的数据，以确定SES的哪些要素在理论上对关键结果变量是重要的;以及3）使用这些数据为制定基于证据的、对文化敏感的干预方案提供信息。本研究将采用混合方法，结合与癌症儿童的父母和护理人员的深入访谈以及社会人口变量和家庭功能量表的调查数据。这些方法将允许收集细微差别，丰富的数据，从而能够定义和理解儿童被诊断患有癌症后父母的医疗保健导航模式，以及这些模式如何因种族和SES而异。由于没有足够的现有数据来了解种族、SES、导航决策和儿科肿瘤患者家庭障碍之间的关系，因此我们无法进行假设驱动的研究。这项研究将建立基础数据，为未来的研究提供信息。这项研究的结果有可能为围绕儿科健康差异的学术和干预做出重大的理论和实践贡献。数据将用于定义医疗导航模式，以及父母制定的不同模式的身份签名元素。初步数据的基础上，结果将被用来开发一个理论框架，占的方式，种族和SES编织在一起，影响这些模式的医疗保健导航。从这些发现中得出的假设将在未来的定量纵向研究中进行测试，研究儿童癌症对患者及其家属的长期结局。研究结果还将用于制定文化敏感的干预计划，旨在减少癌症治疗对家庭成员健康的不良后果的风险。公共卫生相关性：以前的研究已经确定，社会经济和种族健康差异是美国持续存在的问题;然而，人们对个人种族，社会经济地位（SES）和健康之间产生这种联系的途径知之甚少。这项研究将探讨父母如何导航的医疗保健社区后，孩子被诊断患有癌症，并比较父母使用的策略分为四类：高SES非裔美国人，高SES白色，低SES非裔美国人，低SES白色。研究结果将有助于我们了解种族和社会经济地位如何影响医疗导航的关键组成部分，并将用于为以证据为基础的、对文化敏感的干预计划提供信息，这些计划旨在减少儿童癌症的负面结果。

DESCRIPTION (provided by applicant): While the positive association between socioeconomic status (SES) and health outcomes has been a consistent finding in health related research, the pathways that produce this association remain imperfectly understood. One pathway that has been hypothesized to be an important link between an individual's SES and their health outcomes are their patterns of health care navigation. While there has been some research on health care navigation and health outcomes in adults, research has not yet examined how these process impact pediatric cancer patients. We also do not know how parents' patterns of health care navigation after a serious pediatric diagnosis vary by race and SES. The goal of this study is to understand how parents' patterns of health care navigation after a child is diagnosed with cancer vary by race and SES, and to translate these findings into evidence based intervention programs. To accomplish this, the proposed study has three specific aims: 1) Conduct 80 in-depth interviews with parents of pediatric cancer patients to document the different characteristics of their patterns of health care navigation; 2) Collect and analyze data on the multiple dimensions of the SES construct to determine what elements of SES are theoretically important for key outcome variables; and 3) Use these data to inform the development of evidence-based, culturally sensitive intervention programs. This study will use a mixed methods approach, combining in-depth interviews with parents and care givers of children with cancer and survey data on socio-demographic variables and family functioning scales. These methods will allow for the collection of nuanced, rich data enabling the definition and understanding of parents' patterns of health care navigation after a child is diagnosed with cancer, and how these patterns vary by race and SES. Since there is not enough existing data to understand the relationship of race, SES, and navigational decisions and barriers of families of pediatric oncology patients, we are not able to do a hypothesis-driven study. This study will build foundational data to inform future research. Results from this study have the potential to make a significant theoretical and practical contribution to scholarship and intervention surrounding pediatric health disparities. Data will be used to define patterns of health care navigation, and identity signature elements of different patterns parents enact. Building upon preliminary data, results will be used to develop a theoretical framework that accounts for the ways that race and SES weave together to affect these patterns of health care navigation. Hypotheses derived from these findings will be tested in a future quantitative longitudinal study of the long term outcomes of pediatric cancer on patients and their families. Findings will also be used to inform the development of culturally sensitive intervention programs aimed to reduce the risks of adverse outcomes of cancer treatment on family members' well being. PUBLIC HEALTH RELEVANCE: Previous research has established that socioeconomic and racial health disparities are a continued problem in the United States; however, little is known about the pathways that produce this link between an individual's race, socioeconomic status (SES), and health. This research will examine how parents navigate the health care community after a child is diagnosed with cancer, and compare the strategies used by parents in four categories: high SES African American, high SES white, low SES African American, and low SES white. Results will add to our understanding of how race and SES affects key components of health care navigation, and will be used to inform evidence-based, culturally sensitive intervention programs aimed to reduce negative outcomes of pediatric cancer.