Date of Award

2018-04-16

Degree Name

PhD Nursing

Dissertation Committee

Eileen Fry-Bowers, PhD, JD, RN, CPNP, Chairperson; Mary Barger, PhD, MPH, RN, CNM, FACNM, Committee Member; Jane M. Georges, PhD, RN Committee Member

Keywords

social capital, pediatric primary care, health care services, family, well child care, family social capital

Abstract

Background: Passage of the Affordable Health Care Act of 2010 increased insurance coverage for children, however possession of health care insurance doesn’t always equate to effective use of health care services. Misuse and underutilization of health care homes is associated with higher costs, fragmentation of health care, and poor health outcomes across the lifespan. Along with reliance upon the health care system, child health and well-being are dependent upon social factors such as interactions with caregivers and communities. Family social capital (FSC) addresses the interrelated nature of child health and family interaction while also promoting family cohesion as currency to stimulate wellness. While high levels of social capital correlate with improved health outcomes including physical health, longer life expectancy, and psychosocial well-being; little is known about the impact of family social capital upon child health care utilization.

Purpose:The purpose of this study is to examine the relationship between family social capital and utilization of preventative well-child health care services within a sample of cases of healthy children aged 0-5 years old from the California data within the National Survey of Children’s Health (NSCH) 2016.

Specific Aims:

1. Define and analyze the concept of social capital and the extent of the literature surrounding this topic via an evolutionary concept analysis.

2. Describe demographic characteristics including age of child, child designation as male or female, child ethnicity, who lives at home, highest level of education of primary care giver, parent marital status, involvement in organized religion, and type of health insurance; levels of family social capital, and utilization of well-child preventative health care services (defined as frequency of well-child preventative health visits over the past year as gleaned from the survey) in all cases the meet the inclusion criteria within the California subset of the 2016 NSCH.

3A. Analyze the associations between demographic characteristics, family social capital, and utilization of well-child preventative health care visits.

3B. Analyze the associations between family social capital; specified culture variables; and utilization of well-child preventative health care visits.

4. Examine the relationship of family social capital upon child preventive health care utilization while controlling for statistically significant demographic characteristics.

Methods:The investigator conducted a secondary analysis of data selected from the California subset of data from the 2016 NSCH to examine the relationships between family social capital, utilization of preventative child health care services, and the selected sociodemographic characteristics (N=257)

Results: Bivariate associations were investigated between sociodemographic characteristics with utilization of preventative health care services, family social capital variables, and family social capital variables with utilization of preventative health care services. Statistically significant associations were identified between preventative health care utilization and child age (chi-square = 61.9, p < 0.005, Cramer’s V = .364) and child race/ethnicity (fisher’s exact probability= 15.8, p= 0.024, Cramer’s V = 0.0.053), however no correlations were identified between the family social capital variables and utilization of child preventative health care services. Ordinal regression was not conducted due to a lack of significance between the dependent and independent variables.

Implications:While the of this study are inconclusive due to a lack of statistical significance, limitations within the research demonstrate the need for further investigation of the concept of family social capital and its’ influence on utilization of health care services. A social capital approach may foster a future of interventions that decrease the costs of health care, promote family empowerment, and enhance health and wellbeing across the life span.

Document Type

Dissertation: Open Access

Department

Nursing

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