R1 Barriers and Strategies Validation Study
Principal Investigator: Gloria Krahn, PhD, MPH
The purpose of this study is to create a brief listing of common and important barriers to routine health care access and potential strategies to overcome them for people with disabilities based on published reports. This list will then be reviewed by a group of adults with disabilities in order to validate its completeness. The results of this study will be used in study R3.
Hypothesis: Adults with disabilities will confirm the barriers
and strategies to health care access identified by literature review.
Study Design: Literature review with validation through member-checking
to result in a brief listing of common and important barriers to
routine health care access and potential strategies to overcome
them for use by outpatient clinic staff and persons with disabilities.
Samples: (1) All articles on barriers to health care and strategies
to overcome them identified by a literature search with the following
parameters: peer-reviewed articles addressing health care barriers
and access for people with disabilities or other vulnerable populations,
published in the preceding 5 years (to assure currency), and relevant
to the US health care system. (2) Disability commenters for the
member-check phase will include at least 5 disability advocates
regarded as experts in health, and at least 50 people who experience
disabilities. Participants will be drawn from disability networks
across the country.
Data Collection and Measurement: Articles to
be included in the literature review will be collected through
search of current databases including MEDLINE, PsychInfo, PubMed,
Web of Science, and EBSCO. Strategic key words and subject headings
will be used to retrieve articles related to health care accessibility
for people with disabilities and other vulnerable populations.
Data Analysis: Research articles will be reviewed
for both barriers and strategies to address the barriers. Once
the sample of literature has been identified, content analysis
techniques will be used to distill the information. Content analysis
is an empirical approach to the methodological study of texts within
their context. It follows content analytical rules and has clearly
defined procedures (Mayring, 2000). Specifically, emergent coding
will be used to code and collect data from the literature (see
Stemler, 2001). Two reviewers will independently review the literature
and create a checklist of barrier categories described in the text.
The ICF (WHO, 2001) and Kaplan & Litvak (2002) frameworks will
serve as a beginning point for the barrier categories, with the
expectation that the barriers list should be meaningful to disability
advocates and health care providers. The reviewers will compare
their lists and reconcile any differences. The final categories
will be mutually exclusive (non-overlapping) and exhaustive (i.e.,
all data will fit into at least one category). The developed list
will then be used to code all of the articles. Inter-rater reliability
of coding will be calculated on 20% of the sample using Cohen’s
kappa. If the reviewers fail to meet the reliability criterion
(.80), they will repeat the previous steps until they reach the
standard. Advanced level graduate or postdoctoral students will
conduct the category development and coding of all articles in
the sample. Validation and potential addition to the barriers and
strategies checklist will occur through member-checking (Creswell,
Members will include at least 50 people with disabilities and staff
from at least two health clinics who will respond to the general
listing of barriers and strategies and prioritize those items to
include on a checklist.
Anticipated Findings: A list of barriers and
strategies to overcoming barriers to accessing primary health care
has been validated by adults with disabilities. The validated
list will be summarized in a journal article, as a checklist,
and will be used in R3 to inform health care providers and administrators
as potential intervention areas.