Children With Special Needs: Dissatisfaction With Care
Children With Special Needs: Dissatisfaction With Care
To better understand if reported delayed/forgone care and dissatisfaction with care for children with special health care needs (CSHCN) are associated with the parent's perception of health care providers' cultural competency. National survey. Fifty United States and the District of Columbia yielding 750 families per state and District of Columbia with CSHCN ≤ 18 years participated in the 2005–06 National Survey of CSHCN. Outcome measures were delayed/forgone care in the past 12 months (yes or no) and dissatisfaction (very dissatisfied to very satisfied). Demographic/clinical characteristics and the parent's perception of health care providers' cultural competency were examined. Perception of cultural competency was defined by questions related to time spent with child, respect for family values, listening to the family, sense of partnership, and information provided. Delayed/forgone care and dissatisfaction with care were associated with perceived health care provider cultural competency. Parents whose children were older, whose children's condition affected their ability to do things, whose interviews were not conducted in English, and were from certain racial and ethnic groups reported more delayed or forgone care and were more dissatisfied with their children's health care. Delayed/forgone care and dissatisfaction with care were associated with perceived cultural competency of health care providers. This did not appear to differ consistently by racial or ethnic group. Further research using more refined instruments and longitudinal designs is needed to assess the effects of health care providers' cultural competency and other cultural factors on the delayed/forgone care for CSHCN and on the dissatisfaction with care of parents with CSHCN.
Due to the large number of racial/ethnic health disparities in the United States' health care system and the diversity of the country, the government has placed identification and resolution of health disparities on the national agenda. A primary goal of the Healthy People 2010 program is the elimination of health disparities by the year 2010.
Differences in parent's satisfaction with and children's access to health care persist across race, ethnicity, and socioeconomic status in the U.S.. Access to health care services is vital for the well-being of all children; however those with chronic health conditions may be more vulnerable to poor health outcomes. For example, Silver and Stein found that children with chronic conditions were less likely to receive the full range of needed health services than healthy children despite higher levels of insurance coverage and greater access to regular providers of medical care.
Using the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN) Van Dyck and colleagues estimated that 12.8% of children needed special health care, with the highest prevalence among boys, school-aged children, and children in lower income families. Racial/ethnic differences have been associated with a variety of outcomes for CSHCN including unmet needs, delayed/forgone care, ease of using care, and satisfaction with care.
Zuvekas and Taliaferro found that factors such as insurance, socioeconomic status, and health care system capacity could not explain all the differences between Hispanic and White children in several measures of access. They recommended that researchers move beyond simply documenting differences in satisfaction and disparities in access to health care and examine why these disparities exist.
Beyond race/ethnicity and language, little research has been conducted to examine the potential influence of cultural factors, including cultural competency of health care providers. An effort has been made to introduce culturally competent strategies to providers; however there is very little research demonstrating effectiveness of culturally competent health care services. Cultural competency can be defined as "a set of congruent behaviors and attitudes, and policies that come together in a system, agency or among professionals, and enables that system, agency, or those professionals to work effectively in cross-cultural situations". In order to address health care disparities among different racial/ethnic groups, it has been recommended that the cultural competency of health care delivery systems and providers be improved.
Cultural competency is a construct that is comprised of multiple factors which can be challenging to include in one study. One method of assessing perceptions of cultural competency of health care providers comes from the common ground between family-centered care and cultural competency. There are a number of shared core features that are central to each construct, including time spent with a child, respect of family values, and quality of listening. In addition, these features can include the extent to which a family feels a sense of partnership in their health care and is provided with appropriate educational materials and information.
The 2005 National Survey of Children with Special Health Care Needs (NS-CSHCN) is the first population-based survey to include questions related to these shared features of family-centered and culturally-competent care. The NS-CSHCN was sponsored by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, and the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention. The survey results provide an opportunity to begin the exploration of the relationship between families' perceptions of providers' cultural competency and their relationship with dissatisfaction with care and delayed/forgone care for CSHCN.
The purpose of this study was to examine the association between parents' reported delayed/forgone care and dissatisfaction with care for their CSHCN with the parent's perception of cultural competency of their children's health care providers. Understanding this relationship may ultimately lead to the development of appropriate interventions to increase satisfaction and maximize care for all families and their CSHCN.
Abstract and Introduction
Abstract
To better understand if reported delayed/forgone care and dissatisfaction with care for children with special health care needs (CSHCN) are associated with the parent's perception of health care providers' cultural competency. National survey. Fifty United States and the District of Columbia yielding 750 families per state and District of Columbia with CSHCN ≤ 18 years participated in the 2005–06 National Survey of CSHCN. Outcome measures were delayed/forgone care in the past 12 months (yes or no) and dissatisfaction (very dissatisfied to very satisfied). Demographic/clinical characteristics and the parent's perception of health care providers' cultural competency were examined. Perception of cultural competency was defined by questions related to time spent with child, respect for family values, listening to the family, sense of partnership, and information provided. Delayed/forgone care and dissatisfaction with care were associated with perceived health care provider cultural competency. Parents whose children were older, whose children's condition affected their ability to do things, whose interviews were not conducted in English, and were from certain racial and ethnic groups reported more delayed or forgone care and were more dissatisfied with their children's health care. Delayed/forgone care and dissatisfaction with care were associated with perceived cultural competency of health care providers. This did not appear to differ consistently by racial or ethnic group. Further research using more refined instruments and longitudinal designs is needed to assess the effects of health care providers' cultural competency and other cultural factors on the delayed/forgone care for CSHCN and on the dissatisfaction with care of parents with CSHCN.
Introduction
Due to the large number of racial/ethnic health disparities in the United States' health care system and the diversity of the country, the government has placed identification and resolution of health disparities on the national agenda. A primary goal of the Healthy People 2010 program is the elimination of health disparities by the year 2010.
Differences in parent's satisfaction with and children's access to health care persist across race, ethnicity, and socioeconomic status in the U.S.. Access to health care services is vital for the well-being of all children; however those with chronic health conditions may be more vulnerable to poor health outcomes. For example, Silver and Stein found that children with chronic conditions were less likely to receive the full range of needed health services than healthy children despite higher levels of insurance coverage and greater access to regular providers of medical care.
Using the 2001 National Survey of Children with Special Health Care Needs (NS-CSHCN) Van Dyck and colleagues estimated that 12.8% of children needed special health care, with the highest prevalence among boys, school-aged children, and children in lower income families. Racial/ethnic differences have been associated with a variety of outcomes for CSHCN including unmet needs, delayed/forgone care, ease of using care, and satisfaction with care.
Zuvekas and Taliaferro found that factors such as insurance, socioeconomic status, and health care system capacity could not explain all the differences between Hispanic and White children in several measures of access. They recommended that researchers move beyond simply documenting differences in satisfaction and disparities in access to health care and examine why these disparities exist.
Beyond race/ethnicity and language, little research has been conducted to examine the potential influence of cultural factors, including cultural competency of health care providers. An effort has been made to introduce culturally competent strategies to providers; however there is very little research demonstrating effectiveness of culturally competent health care services. Cultural competency can be defined as "a set of congruent behaviors and attitudes, and policies that come together in a system, agency or among professionals, and enables that system, agency, or those professionals to work effectively in cross-cultural situations". In order to address health care disparities among different racial/ethnic groups, it has been recommended that the cultural competency of health care delivery systems and providers be improved.
Cultural competency is a construct that is comprised of multiple factors which can be challenging to include in one study. One method of assessing perceptions of cultural competency of health care providers comes from the common ground between family-centered care and cultural competency. There are a number of shared core features that are central to each construct, including time spent with a child, respect of family values, and quality of listening. In addition, these features can include the extent to which a family feels a sense of partnership in their health care and is provided with appropriate educational materials and information.
The 2005 National Survey of Children with Special Health Care Needs (NS-CSHCN) is the first population-based survey to include questions related to these shared features of family-centered and culturally-competent care. The NS-CSHCN was sponsored by the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, and the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention. The survey results provide an opportunity to begin the exploration of the relationship between families' perceptions of providers' cultural competency and their relationship with dissatisfaction with care and delayed/forgone care for CSHCN.
The purpose of this study was to examine the association between parents' reported delayed/forgone care and dissatisfaction with care for their CSHCN with the parent's perception of cultural competency of their children's health care providers. Understanding this relationship may ultimately lead to the development of appropriate interventions to increase satisfaction and maximize care for all families and their CSHCN.
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