Researchstudies are guided by research questions. The current study is noexception. Although the article does not explicitly state the studyquestions, several of them can be deducted from the text. Firstquestion is does access to healthcare services often implyutilization of these services? In this question, the study sought tofind out how a sample of hypertensive Korean American Immigrants(KAI) failed to fully utilize healthcare services available to themas a result of several factors. The main assumption here was thatthere is adequate access to quality healthcare services in the US asa whole and to the particular minority group. The second questionis what are the factors that influence utilization of healthcareservices by vulnerable minority groups? The authors were interestedin knowing the factors that promote or hinder utilization ofhealthcare services. They recognized that access to healthcareservices does not amount to utilization. The third question is, howare the factors that influence utilization of healthcare servicesinterrelate? The authors utilized the Anderson model to identifyconceptual factors that influence utilization of healthcare servicesand on top of it employed the path analysis to show directeddependencies among the factors.
Researcherstry to answer such questions before embarking on research ashypotheses. The study hypothesized that need factors, such asHBP-relevant medical history and self-reported clinical symptomsdirectly influenced healthcare utilization. Also, years of residencein the US and perceived income level were predicted to directlyaffect health care utilization. Predisposing factors such ascompeting life priorities explained in terms of household income andyears of residence in the US explained by language and culturalcompetence were hypothesized to influence healthcare utilization bothdirectly and indirectly. The study is thus designed to answerresearch questions and also test the hypotheses.
Theresearchers used retrospective cohort approach based on anobservational study design. This involved a studying a targeted groupof people with shared characteristics, in this case hypertensive KAIpatients from Baltimore–Washington area enrolled in the Self-HelpIntervention Program for HBP Care (SHIP-HBP), and analyzing eventsthat have already happened, in this case their past experiences inutilization of healthcare services. This qualifies the study as aretrospective cohort study as it relies on recall (Song & Chung2010). This study design is prone to bias on different levels. First,the design relies on self report on various variables assessed whichis susceptible to recall bias or the accuracy of the self report asguided by the questionnaires as is the case in this particular study.Recall bias occurs because the respondents are supposed to report inevents that have already occurred (Gallin & Ognibene 2012). Forinstance, one question was “During the last 6 months, have you everpostponed HBP-related care due to medical expenses?’’ (Song etal.,2010 p. 515). Some respondents may not clearly recall events of thepast six months. Additionally, other respondents may not be willingto divulge some sensitive information such as the perceived level ofcomfort in their lives. Where interviews are used in a similardesign, interviewer bias may be included.
Univariatedata analysis was used first to analyze the data. The average age ofthe sample used in the study was 51.9 with a standard deviation ofjust 5.7 to correspond with the 40-64 age-group. This age group isalso one that faces a considerable higher risk of developing HBP andrelated illnesses such kidney problems and diabetes. The number ofyears residing in the US also varied from 4-39 and averaging 16.2meaning that most of the participants had experienced a significantdegree of acculturation a key determinant in healthcare serviceutilization. The priority of health or HBP case was ranked top byjust 59.8% which is also reflected by relative low uptake of healthinsurance cover. However, for the uninsured, price and lack ofprovision of cover by employers was cited as a key reason as opposedas low ranking of healthcare services. On the level of perceivedcomfort, 35.7% perceived their lives as comfortable, 39.1% as fairand 25.2% as unfair. The authors identified the potential problems inusing this measure by noting that not all participants werecomfortable in discussing money or earnings related issues in theirlives as a cultural taboo. Clinical symptoms were observed to havebeen present in an average of 8.3 years with a range of 0-33 years.This however, does not explain the period or their residence at thetime the first HBP related symptoms were observed. It would beinteresting to learn how accessibility or utilization of healthcareservices in the US or Korea influenced late or early diagnosis ofHBP.
Furtheranalysis was conducted using bivariate correlation analysis. The pathanalysis was also used to determine the correlation between thevarious factors on healthcare utilization. From the bivariatecorrelation, HBP-relevant medical history and health insurance coverhad the greatest influence on healthcare utilization at o.28 and 0.27respectively. This confirms one of the study’s hypothesis thatHBP-relevant medical history have one of the greatest influence onhealthcare service utilization. On the other hand, the hypothesizedinfluence of HBP-relevant medical symptom was not evident. Maritalstatus with a path coefficient of 0.06 also influence healthcareutilization. Married people were more likely to have insurance coverand utilize healthcare services more. A new consideration is theavailability of health insurance covers. This was related to theyears of residence in the US with the higher the number the years thehigher the likelihood of taking up insurance covers. Again, uptake ofinsurance cover was influenced by earnings and in turn, insurancecover promoted utilization of healthcare services.
Thestudy faced several limitations as with regard to the findings andconclusions. One is the shallow sample. The authors note that whilestudy’s sample involved KAI who have been in the US for more than 4years, recent immigrants may face more hurdles in healthcareutilization. Another study limitation the authors note is on theAnderson model used. They acknowledge that the model oversimplifiesthe issue of race and ethnicity and its role in determining accessand utilization of healthcare services. From this limitation, theauthors also used a single minority group of KIA in the knowledgethat cultural differences amongst minority groups in a more inclusivesample would not be captured. As aforementioned, more recentimmigrants in the US, who have retained much of their native cultureare more likely to face a different set of difficulties than thesample analyzed here.
Althoughnot highlighted, one limitation of the research which can beattributed to scope and the study design is that there is no controlsample to identify whether the factors influencing healthcareutilization are the same for other minority groups or for thoseliving with other illnesses. The authors acknowledge that minoritygroups face higher prevalence rates of chronic diseases such diabetesand HBP compared to the majority whites in the US.
Gallin,J. & Ognibene, F. (2012). Principles and Practice of ClinicalResearch. New York.
Song,H., Han, H., Lee, J., Kim, J, Kim, K.B., Ryu, J.P., & Kim, M.(2010). Does access to care
stillaffect health care utilization by immigrants? Testing of an empiricalexplanatory model of health care utilization by Korean Americanimmigrants with high blood pressure. Journalof Immigrant Minority Health,12, 513-519.
Song,J. & Chung, K. (2010). Observational studies: cohort andcase-control studies. Plast