PDF(Pubmed)
Abstract：
BACKGROUND: There is limited understanding of how social determinants of health (SDOH) impact family decision-making when seeking surgical care for children. Our objectives of this study are to identify key family experiences that contribute to decision-making when accessing surgical care for children, to confirm if family experiences impact delays in care, and to describe differences in family experiences across populations (race, ethnicity, socioeconomic status, rurality).
METHODS: We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children\'s Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations.
CONCLUSIONS: We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.
METHODS: We will use a prospective, cross-sectional, mixed methods design to examine family experiences during access to care for children with appendicitis. Participants will include 242 parents of consecutive children (0-17 years) with acute appendicitis over a 15-month period at two academic health systems in North Carolina and Virginia. We will collect demographic and clinical data. Parents will be administered the Adult Responses to Children\'s Symptoms survey (ARCS), the child and parental forms of the Adverse Childhood Experiences (ACE) survey, the Accountable Health Communities Health-Related Social Needs Screening Tool, and Single Item Literacy Screener. Parallel ARCS data will be collected from child participants (8-17 years). We will use nested concurrent, purposive sampling to select a subset of families for semi-structured interviews. Qualitative data will be analyzed using thematic analysis and integrated with quantitative data to identify emerging themes that inform a conceptual model of family-level decision-making during access to surgical care. Multivariate linear regression will be used to determine association between the appendicitis perforation rate and ARCS responses (primary outcome). Secondary outcomes include comparison of health literacy, ACEs, and SDOH, clinical outcomes, and family experiences across populations.
CONCLUSIONS: We expect to identify key family experiences when accessing care for appendicitis which may impact outcomes and differ across populations. Increased understanding of how SDOH and family experiences influence family decision-making may inform novel strategies to mitigate surgical disparities in children.
摘要：
背景：在为儿童寻求手术治疗时，对于健康的社会决定因素（SDOH）如何影响家庭决策的理解有限。我们这项研究的目的是确定关键的家庭经验，有助于在接受儿童外科护理时做出决策。为了确认家庭是否会受到护理延误的影响，并描述不同人群家庭经历的差异(种族，种族,社会经济地位,rurality).
方法：我们将使用前瞻性，横截面,混合方法设计，以检查阑尾炎儿童在获得护理期间的家庭经历。参与者将包括在北卡罗来纳州和弗吉尼亚州的两个学术卫生系统中，在15个月内患有急性阑尾炎的242名连续儿童（0-17岁）的父母。我们将收集人口统计学和临床数据。家长将接受成人对儿童症状调查(ARCS)的回应，不良童年经历(ACE)调查的儿童和父母形式，负责的健康社区与健康相关的社会需求筛查工具，和单项素养筛选器。并行ARCS数据将从儿童参与者（8-17岁）收集。我们将使用嵌套并发，有目的的抽样选择家庭的子集进行半结构化访谈。将使用主题分析对定性数据进行分析，并将其与定量数据相结合，以确定新兴主题，从而在获得外科护理期间为家庭级决策的概念模型提供信息。多元线性回归将用于确定阑尾炎穿孔率与ARCS反应（主要结果）之间的关联。次要结果包括健康素养的比较，ACE,和SDOH,临床结果，和不同人群的家庭经历。
结论：我们希望在获得阑尾炎治疗时确定关键的家庭经历，这些经历可能会影响结果，并且在人群中有所不同。对SDOH和家庭经历如何影响家庭决策的更多了解可能会为减轻儿童手术差异的新策略提供信息。
方法：我们将使用前瞻性，横截面,混合方法设计，以检查阑尾炎儿童在获得护理期间的家庭经历。参与者将包括在北卡罗来纳州和弗吉尼亚州的两个学术卫生系统中，在15个月内患有急性阑尾炎的242名连续儿童（0-17岁）的父母。我们将收集人口统计学和临床数据。家长将接受成人对儿童症状调查(ARCS)的回应，不良童年经历(ACE)调查的儿童和父母形式，负责的健康社区与健康相关的社会需求筛查工具，和单项素养筛选器。并行ARCS数据将从儿童参与者（8-17岁）收集。我们将使用嵌套并发，有目的的抽样选择家庭的子集进行半结构化访谈。将使用主题分析对定性数据进行分析，并将其与定量数据相结合，以确定新兴主题，从而在获得外科护理期间为家庭级决策的概念模型提供信息。多元线性回归将用于确定阑尾炎穿孔率与ARCS反应（主要结果）之间的关联。次要结果包括健康素养的比较，ACE,和SDOH,临床结果，和不同人群的家庭经历。
结论：我们希望在获得阑尾炎治疗时确定关键的家庭经历，这些经历可能会影响结果，并且在人群中有所不同。对SDOH和家庭经历如何影响家庭决策的更多了解可能会为减轻儿童手术差异的新策略提供信息。
