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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 a systematic 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, 2003). 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 that 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.


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