Online Program

Key doorkeepers to health care access for children with special health care needs: Findings from a social network analysis

Tuesday, November 5, 2013

Rebecca Winitzer, MS, MSW, School of Social Service Administration, University of Chicago, Chicago, IL
Background: Navigating the U.S. health-care system poses challenges for many families, but particularly for caregivers of children with special health-care needs (CSHCN). Families often use both formal and informal relationships within their social networks to facilitate access to health-care services. This process is unstudied and potentially useful in further understanding the nuanced ways that families with CSHCN access health-care services.

Methods: From May-2009 to February-2010, 30 qualitative, open-ended interviews (60-90 minutes) were conducted in Illinois with caregivers of CSHCN. Respondents were recruited using purposive quota sampling techniques from a group of 102 respondents who had participated in a related telephone survey. Social network data was collected using the Hierarchical Mapping Technique. Data entered into Nvivo software and analyzed by thematic and matrix coding.

Results: 30 CSHCN caregivers reported having small (n=13), medium (n=9), or large (n=8) social networks made of informal (60%) and formal (40%) ties involved in their child's health care. They obtained key resources resulting in health-care access from five main sources: pediatricians (n=6), specialists (n=3), other health-care providers (n=3), informal friends and family (n=10), and via hospitalization (n=7). Matrix analysis demonstrates socio-demographic differences among these sources, including parent income, education, and illness acuity.

Conclusions: Social-network analysis reveals that the type of key doorkeepers to health-care access for families of CSHCN vary by the social determinants and point to different mechanisms by which families navigate health-care systems. These findings warrant further examination of the roles of formal and informal social networks in improving systems of care for CSHCN.

Learning Areas:

Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Demonstrate the use of social-network analysis as a way to explore how families access health-care services for CSHCN. Identify key persons in family networks of CSHCN that serve as doorkeepers to health-care access.

Keyword(s): Children With Special Needs, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral candidate at the University of Chicago and chief researcher on this dissertation study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.