SES, RACE, AND PATTERNS OF HEALTH CARE NAVIGATION OF PARENTS OF PEDIATRIC CANCER
GAGE, ELIZABETH ANN Principal Investigator
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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.