Virginia Tech Carilion School of Medicine, Roanoke, VA, United States of America.
Duke Global Health Institute, Durham, NC, United States of America.
PLoS One. 2024 Jun 24;19(6):e0304165. doi: 10.1371/journal.pone.0304165. eCollection 2024.
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).
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.
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.
对于社会决定因素（SDOH）如何影响家庭在为儿童寻求手术护理时的决策，人们的理解有限。本研究的目的是确定关键的家庭体验，这些体验有助于为儿童获得手术护理做出决策，确认家庭体验是否会影响护理的延迟，并描述不同人群（种族、族裔、社会经济地位、农村）的家庭体验差异。
我们将采用前瞻性、横断面、混合方法设计，研究儿童阑尾炎就诊过程中的家庭体验。参与者将包括在北卡罗来纳州和弗吉尼亚州的两个学术医疗系统中，在 15 个月的时间内连续 242 名患有急性阑尾炎的儿童（0-17 岁）的父母。我们将收集人口统计学和临床数据。父母将接受成人对儿童症状的反应调查（ARCS）、儿童和父母形式的不良童年经历（ACE）调查、负责任的社区健康相关社会需求筛查工具和单项识字筛查。将从儿童参与者（8-17 岁）中收集并行的 ARCS 数据。我们将使用嵌套的同期、有针对性的抽样方法，从家庭中选择一部分进行半结构访谈。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，以确定告知手术护理就诊过程中家庭层面决策的概念模型的新兴主题。将使用多元线性回归来确定阑尾穿孔率与 ARCS 反应之间的关联（主要结果）。次要结果包括比较不同人群的健康素养、ACE 和 SDOH、临床结局和家庭体验。
我们预计将确定在阑尾炎就诊时影响结局并在不同人群中存在差异的关键家庭体验。深入了解 SDOH 和家庭体验如何影响家庭决策，可能为缓解儿童手术差异提供新的策略。
