Abstract
BackgroundThe incidence of hip fractures in older adults in India is likely to increase dramatically in the coming decades as a result of an aging population and increasing life expectancy. Currently, more than 600,000 adults over 60 years of age suffer a hip fracture annually in India. This paper outlines a protocol for a qualitative study investigating the care seeking behavior of older adults with hip fractures: to determine the processes in decision making, identify causes for delay in obtaining care, and identify potential barriers and facilitators to seeking appropriate care in time.Methods and designThe planned study will consider Odisha, an eastern state in India with limited health care facility, as a suitable case study. It is proposed to conduct 30 in-depth interviews in two administrative districts of Odisha. The participants will be patient and their carers in seven health facilities- four public hospitals, two private hospitals and one traditional bone-setting facility. The study relies on a purposive sampling strategy. Ethics permission will be sought from each participating institution and participants. The participants will be adults aged 50 years or older of both sexes arriving at the recruiting centers with a history of fall or injury, pain in the hip region and inability to walk and X-ray confirmed diagnosis of proximal femoral fracture and their primary carer. Trained qualitative research team will conduct these interviews. A thematic framework approach will be used to analyze the data using NVivo 9 software.The data collected from the interviews will be analysed to explore the cause of the hip fracture, events following the injury, the experiences of patients from the time of sustaining the injury, pain relief measures, decision to seek care, understanding of the urgency for treatment, causes for delay in receiving treatment, funding sources, cost liabilities for the family, financing mechanisms for out of pocket expenditure and the burden for caring.DiscussionThe findings of this study will provide an increased understanding of the care seeking behaviors of older adults with hip fracture, and inform contextually appropriate changes in healthcare program and policy aimed at improving health outcomes.
Highlights
The incidence of hip fractures in older adults in India is likely to increase dramatically in the coming decades as a result of an aging population and increasing life expectancy
The findings of this study will provide an increased understanding of the care seeking behaviors of older adults with hip fracture, and inform contextually appropriate changes in healthcare program and policy aimed at improving health outcomes
Hip fractures in older adults are common injuries in high-income countries and 30 % of them die within 1 year of hip fracture injury
Summary
Study design This is an exploratory study using qualitative methods. Qualitative research takes a detailed approach to the phenomena under the study in order to understand it more thoroughly. To identify factors influencing decisions to seek treatment with traditional osteopaths, hip fracture patients seeking care with the regional osteopath at Kalupada will be included in the study. Participants will be provided with verbal and written information in local language on the aims and methods of the study and consent will be obtained from the participants prior to the interview They will be informed that all data collected will be stored safely and only used by researchers, maintaining confidentiality. Possible outcome of the analysis The data collected from the interviews will be analyzed to identify factors influencing decision making in the family to seek care for older adults with hip fracture, the choice of care facility, influence of equity and gender in receiving appropriate care in time. Socio-cultural factors: Belief in a particular discipline of treatment, preference for the treatment and patient satisfaction
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