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.

项目摘要/摘要 背景：夏威夷人和其他太平洋岛民（NHPI）成年人（37.4％）年龄在18岁及以上的成年人的比例很高 过去一年没有看医生。这是所有种族群体中最高的百分比。此外，大约 八分之一的NHPI成年人（12％）没有保险，这一比率明显低于白人。联邦报告历史挣扎 捕获可以解释这些现象的数据。因此，NHPI在健康方面不足和不完全代表 统计数据，以较低的速度访问卫生服务，并以低于其他种族和少数民族群体的速度保险。 这对在这个社区中普遍存在的不良健康状况和差异具有永久性（例如， 心血管疾病，高血压，糖尿病，心脏病，癌症等）。目的：这项研究的总体目标 是为了改善和扩大我们对新型多层次健康决定因素的理解（1）低健康服务 利用率和（2）NHPI的健康保险范围较低，目前对健康访问进行了研究 美国设计中夏威夷原住民和其他太平洋岛民的差异：封闭式访问，横断面的互联网 调查将用于收集数据。参与者将通过电子邮件通过电子邮件招募全国发行的公告 美国和社交媒体的NHPI组织，协会和网络。建议的样本量为300 NHPI成年人18岁及以上。分析：潜在剖面分析（LPA）将使用MPLU 8统计软件进行 检查NHPI岛民的不同概念上有意义的概况是否基于假设的水平 个人（抑郁，焦虑和感知压力），人际交往（医学不信任和种族歧视）， 社区（文化有效性和太平洋的联系和归属感）和社会层面（宗教中心和 在考虑人口协变量的同时，感知的社会健康决定因素。然后我们将测试是否 由此产生的概况具有不同的医疗保健访问率（Health Service使用和保险范围）。 LPA适合 这项研究的目的，即确定潜在个体，人际关系的不同配置（即配置文件） 社区和社会级别的医疗保健访问的决定因素，并检查概况是否有所不同 卫生服务利用率和保险率。潜在轮廓分析允许估计测量 错误以提高估计的准确性。意义：调查结果将为公共政策和医疗保健专业人员提供信息 这种在健康研究中的人群严重不足，以消除过度较低的医疗保健利用和 NHPI的保险率低。结果可能有助于文化胜任的发展 在卫生服务和行为健康研究中，这种代表性不足和服务不足的社区的干预措施。