Experience Of Hardship Research Articles

Oral Health Care Out-of-Pocket Costs and Financial Hardship: A Scoping Review.

The objective of this study is to characterize how financial hardship related to oral health care (OHC) out-of-pocket (OOP) spending has been conceptualized, defined, and measured in the literature and to identify evidence gaps in this area. This scoping review follows Arksey and O'Malley's framework and synthesizes financial hardship from OHC concepts, methodologies, and evidence gaps. We searched Ovid-Medline, Ovid-Embase, PubMed, Web of Science, Scopus, EconLit, Business Source Premier, and the Cochrane Library. Gray literature was sourced from institutional websites (World Health Organization, United Nations, World Bank Group, Organisation for Economic Co-operation and Development, and governmental health agencies) as well as ProQuest Dissertations and Thesis Global. We used defined inclusion and exclusion criteria to select studies published between 2000 and 2023. Of the 1,876 records, 65 met our criteria. The studies conceptualized financial hardship as catastrophic spending, impoverishment, negative coping strategies, bankruptcy, financial burden, food insecurity, and personal financial hardship experience. We found heterogeneity in defining OHC OOP payments and services. Also, financial hardship was frequently measured as catastrophic health expenditure using cross-sectional designs and national household spending surveys from high-income and to a lesser extent lower-middle-income countries. We identify and discuss challenges in terms of conceptualizing financial hardship, study designs, and measurement instruments in the OHC context. Some of the common evidence gaps identified include studying the causal relationship in financial hardship from OHC, assessing the financial hardship and unmet dental needs due to cost relationship, and distinguishing the effect between pain/discomfort and esthetic/cosmetic dental treatments on financial hardship. Financial hardship in OHC needs further exploration and the use of consistent definitions as well must distinguish between treatments alleviating pain/discomfort from esthetic/cosmetic treatments. Our study is relevant for policy makers and researchers aiming to monitor financial protection of OOP payments on OHC in the wake of universal health coverage for oral health.

The risk of energy hardship increases with extreme heat and cold in Australia

Climate change is shifting the experience of energy hardship. Here we examine the effect of the intensity, frequency, and duration of temperature extremes on energy hardship, and how this risk is shaped by individual, housing and neighbourhood resiliencies across Australia, using nationally representative data (269,500 observations) on energy hardship linked to temperature records between 2005 and 2021. Findings suggest that the risk of energy hardship increases with more intense extreme heat and cold, with greater risks for older individuals, lone-person or single-parent households, and rental tenants. These vulnerabilities can be offset by quality housing and renewable energy installations. Energy hardship risks under moderate and high emissions global warming scenarios are projected to increase by 0.1%−2.6% and 0.6%−3.3% respectively in the long run. Energy hardship will remain a concern despite raising temperatures, especially for colder regions less prepared for heat and populations with individual vulnerabilities and lacking housing and neighbourhood adaptations.

“The little I receive is not enough’’: A qualitative study of food insecurity in the South Bronx

ABSTRACT The objective of this study was to explore the lived experiences of food insecurity amongst Bronx residents. Applying a community-based participatory research approach, we conducted a qualitative study, entailing 38 interviews with food pantry recipients, 4 key informant interviews with social service administrators, and two focus groups with 12 food pantry staff and social service providers in New York City (NYC). Applying a precarity framework, we identified three themes: (1) unaffordability of living expenses in NYC; (2) financial hardships during the COVID-19 pandemic; and (3) institutional and technological barriers to food access. We identified the following subthemes under theme one: rising food costs and high cost of living. Under theme two, we identified four subthemes: (a) large household size driving poverty for Bronx families; (b) vulnerabilities to food insecurity among older adults; (c) budgeting for reduced incomes during the COVID-19 pandemic; and (d) managing unstable employment. Under the third theme, we identified three subthemes: (a) lack of access to healthy, culturally appropriate foods; (b) need for wider service availability; (c) and not having smartphones for telehealth. Study findings demonstrate how precarity impacts the lived experiences of food insecurity and financial hardship for residents of the South Bronx during the COVID-19 pandemic.

Late-Life Hardship at the Intersection of Age and Gender

ABSTRACT Late-life material hardship captures older adults’ inability to afford necessities. Using data from the Understanding America Study, this study shows that while older women experienced higher levels of hardship than older men, the prevalence of hardship decreased as age increased. Older women had more hardship at an earlier age (65–69), highlighting the intersectional disadvantage experienced by older women. The chance of any hardship for older women was higher than that for older men in 2021–2022, concurring with recent rises in inflation and cost-of-living. Policies and interventions to alleviate deprivation should pay greater attention to older women’s disproportionate experience of material hardship.

Financial Hardship: A Qualitative Study Exploring Perspectives of Seriously Ill Patients and Their Family

ContextSeriously ill patients, such as those who experience critical illness, and their families experience a variety of poor outcomes, including financial hardship. However, little is known about the ways in which these seriously ill patients and their families experience financial hardship. ObjectiveTo examine seriously ill patients’ and families’ experiences of financial hardship and perspectives on addressing these concerns during and after critical illness. MethodsWe conducted a thematic analysis of semi-structured interviews with seriously ill patients who recently experienced a critical care hospitalization (n=15) and family caregivers of these patients (n=18). ResultsOur analysis revealed three themes: 1) Prioritizing Survival and Recovery; 2) Living with Uncertainty—including experiences of prolonged uncertainty, navigating bureaucratic barriers, and long-term worries; and 3) Preferences for Financial Guidance. Our results suggest patients and families prioritize survival over financial hardship initially, and feelings of uncertainty about finances persist. However, patients and family caregivers are reluctant to have their physicians address financial hardship. ConclusionsOur findings suggest that the acute and time sensitive nature of treatment decisions in critical care settings provides a unique context for experiences of financial hardship. Additional research is needed to better understand these experiences and design context-sensitive interventions to mitigate financial hardship and associated poor patient- and family-centered outcomes.

Assessment and Empirical Treatment of Chronic Abdominal Pain from Suspected Helicobacter Pylori Infection In a Remote Setting

The prevalence of Helicobacter Pylori (H. Pylori) remains globally high, with an estimated 50% of the words population believed to be infected. Despite the continually high incident rates of infection 90% of those infected remain asymptomatic. H.Pylori is a gram-negative, microaerophilic bacteria, mostly found in stomach of affected individuals that causes inflammation and ulceration. Definitive routes of transmission and subsequent infection are still debated. The most likely mechanism of transmission is thought to be intrafamilliar, this encapsulates fecal-oral, gastric-oral, oral-oral and sexual vectors. Contaminated foods and water sources are also highly likely mechanisms of transmission. Therefore in developing countries with poor sanitation, potentially contaminated water sources and regions with social-economic hardship experience increased symptomatic cases of H.Pylori.

Economic hardship and the role of cost in childcare decisions: An exploratory study

The high cost of US childcare has become burdensome to most families with young children, yet little is known about how childcare costs shapes parental childcare decisions. This study addresses a critical gap in knowledge by examining how economic hardships shape parental childcare decisions, along with the individual and community characteristics associated with the influence of cost on childcare decisions. Guided by the accommodation model and family stress model, we used data from a statewide consumer survey in Iowa to conduct the first known study to examine associations between household constraints (i.e., economic hardships) and respondent reports that cost influenced their childcare decisions at least once in the previous year (i.e., systemic barriers to childcare). As hypothesized, each form of economic hardship was associated with increased odds of cost influencing childcare decisions. Our logistic regression demonstrated that every standard deviation increase in our financial stress scale resulted in a 110% increase in the odds of cost influence, while each additional experience of material hardship (out of 16) increased the odds of cost influence by 10%. Additionally, we identified demographic variations, with cost playing a more prominent role for people who were Hispanic/any race, unemployed, and were between the ages of 18- to 34-years old. Overall, findings demonstrate that economic hardships are constraints that, coupled with systemic barriers like cost, shape childcare decisions across demographic groups, communities, and income brackets. Findings also suggest the need for more public support to alleviate the costs of childcare among all families, such as expanding childcare subsidies or funding the provision of care, which may mitigate the risk of negative outcomes associated with economic hardship.

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study

BackgroundIndividuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centered approach to treating individuals with diabetes.MethodsSemi-structured interviews were conducted with staff (n = 15) and patients (n = 18). Clinical data were extracted from the electronic medical record of patients (n = 1,599) seen at a safety-net health system in Chicago, Illinois, United States. The mixed methods study was guided by implementation science and participatory research principles. Staff interviews were 60 min and covered patient care activities, work flow, perceived patient experience, and facilitators/barriers to care coordination. Patient interviews were 60 min and covered satisfaction, attitudes about diabetes management, quality of life, and technology. Patient interviews were co-analyzed by research staff and members of a patient advisory committee. Clinical data were collected at an index visit, two years prior and at one-year follow up (n = 1,599).ResultsFour themes emerged from the interviews: (1) patients perceived the TBC model to be patient centered and of high quality; (2) technology can be an innovative tool, but barriers exist; (3) diabetes management is a complex process; and (4) staff communication enhances care coordination, but misinterpreting roles reduces care coordination. From pre-enrollment to the follow-up period, we found a statistically significant increase in missed visits, decrease in hemoglobin A1c (HbA1c), decrease in body mass index, and decrease in the percent of patients with high blood pressure. We found that each medical visit during the follow-up period was associated with an HbA1c decrease of 0.26 points.ConclusionsA TBC model is a patient-centered approach to providing care to patients with complex health needs, such as diabetes, patients were satisfied with the care they were receiving, and the model was associated with an improvement in clinical outcomes.

Racial-Ethnic Gaps in Pandemic-Related Economic Hardship: Age Differences Among Older Adults.

Racial-ethnic disparities in experiences of economic hardship during the pandemic are well documented in the population overall and among older adults. Existing research shows that this economic hardship was much less common at older than younger ages. Little is known about the intersection of racial-ethnic and age disparities in pandemic-related hardship in later life. This research report investigated racial-ethnic gaps in economic hardship by age group among older adults. Data were from the 2018 and 2020 U.S. Health and Retirement Study (HRS) including the 2020 coronavirus disease 2019 module. We estimated Heckman-corrected linear probability models to examine differences in experiences of pandemic-related economic hardship in the 2020 HRS by race-ethnicity (non-Hispanic White, non-Hispanic Black, U.S.-born Hispanic, foreign-born Hispanic) across age groups (55-64, 65-74, 75+). In the multivariable analysis, we controlled for sociodemographic characteristics, participation in social programs, pre-existing health conditions and behaviors, and economic resources from the 2018 HRS. Experiences of economic hardship declined with age within each racial-ethnic group. Racial-ethnic gaps in hardship remained at older ages without any controls. However, when all controls were added, racial-ethnic gaps in economic hardship were eliminated for those ages 75+. Individual characteristics prior to the pandemic explained racial-ethnic differences in hardship for the oldest adults (75+) but did not explain gaps for those ages 55-74. Results point to structural factors generating new racial-ethnic gaps in pandemic-related economic hardship among those approaching retirement (ages 55-74) that did not affect the oldest adults (ages 75+).

Financial hardship experience in middle- and older-aged patients with advanced lung cancer

PurposeAdvancements in medical treatments have resulted in increased medical costs for cancer patients. More than half of the patients with advanced lung cancer reported unmet financial needs. The purpose of this study is to examine the differences in the prevalence and correlates of financial hardship between middle- and older-aged patients with advanced lung cancer, and its impact on multiple health-related outcomes.MethodsThis study presents a cross-sectional analysis involving 226 patients with advanced lung cancer, who were enrolled in a randomized controlled trial conducted between 2018 and 2020. Data collection was performed through self-reported questionnaires and electronic medical records. Multivariable logistic and linear regression models were adopted for analysis.Results58.0% reported experiencing financial hardships. Middle-aged participants who were single and had a lower education level were more likely to experience financial difficulties. However, males and higher performance status were associated with a lower likelihood of experiencing financial difficulties among older-aged participants. Financial hardship was significantly associated with anxiety (p < 0.001), depression (p < 0.001), sleep disturbances (p < 0.001), quality of life, global health status (p = 0.002), functional scale score (p < 0.001), symptom scale score (p < 0.001), and lung cancer-specific scale score (p < 0.001).ConclusionsMore than half of the patients with advanced lung cancer experienced financial hardships caused by cancer or its treatment, with a higher prevalence reported in middle-aged patients. Different sociodemographic and clinical variables correlated with financial hardship in middle- and older-aged participants, respectively. More attention should be paid to middle-aged patients with advanced lung cancer, particularly during routine assessments.

Longitudinal gambling risk transitions: evidence from a nationally representative Australian sample

Aims Problem gambling has downstream consequences on individuals, families and the community. While a strong research base now exists on predictors and outcomes of problem gambling risk and severity, few studies have examined the transitions in gambling risk status over time, and factors associated with these transitions. Methods The current study addresses this knowledge gap by examining gambling transitions using two waves of longitudinal, population-representative Australian data (N = 12,364) collected in 2015 and 2018. Focal to our approach is the assessment of predictors of gambling risk status including demographics, and key psychosocial factors that might attenuate the risk of transition into more severe gambling. Results The results show significant stability in gambling risk over time, particularly among individuals who reported no or low gambling risk. Gambling risk transitions were more likely to occur toward less severe than more severe levels of gambling. Furthermore, gambling problems tended to persist in more severe levels of gambling risk. Financial hardship, younger age, male gender, experience of hardship, lower levels of educational attainment, chronic health conditions, risky levels of alcohol consumption, living in low SES areas, and low sense of mastery were associated with transitions from low to more severe gambling over the three-year period. There were no significant predictors of transitions to lower levels of gambling risk in the current data. Conclusions Our findings can help inform public health interventions by better targeting individuals at elevated risk for more severe gambling over time, and we outline a method for analyzing transitions in longitudinal datasets that can be applied in future studies in addiction.

Digital comfort amidst precarity: New middle classes’ experience of well-being and hardship in pandemic times in Brazil

During the pandemic, digital platforms had a boom in revenue or subscriptions. Despite their increasing relevance, few studies explore how different social strata experience such access. Based on 31 in-depth interviews in Rio de Janeiro, Brazil, this article discusses the meanings and practices of digital consumption among the ‘new middle class.’ By focusing on three platforms—ride-sharing apps, food delivery apps, and audio-visual streaming—we interrogate how digital consumption has shaped experiences of well-being and hardship during pandemic times and how it relates to social mobility. We argue that digital platforms brought comfort amidst precarity as mechanisms for accessing relaxing and fun moments while responding to structural issues of Brazilian megacities. Our data also suggest these digital platforms enhance middle-class symbolic status related to individualised and private practices, though collectiveness is still present in participants’ liminal class experience.

“The spirit of a fighter”: Mixed‐status Latine immigrant families' experiences during COVID

AbstractObjectiveUsing a community‐based participatory research (CBPR) approach, this study documents Latine immigrant families' work, childcare, and education experiences during the COVID‐19 pandemic to inform policy and practice to support Latine families.BackgroundLatine immigrant communities, comprising undocumented and mixed‐status families, were among the hardest hit by the COVID‐19 pandemic. In addition to employment and housing challenges, children and families lost access to the important academic supports and social services built into childcare programs and schools.MethodFor this study, we collected in‐depth qualitative interview data from mothers who were immigrants from Central America and Mexico (N = 23) as part of an ongoing CBPR project. Using community coding techniques, data were analyzed in partnership with our Community Advisory Board, Amigas de la Comunidad.ResultsIn the context of illegality, participants and their families who already feared deportation and family separation, faced added burdens during the pandemic including job loss, school and childcare closures, and isolation. Parents worried about meeting their families' basic needs, getting sick, losing loved ones to COVID‐19, and being evicted from their housing.ConclusionWhile participants shared stories of resilience and resistance, they also reflected on stories loss and hardship—experiences that were exacerbated by anti‐immigrant laws and policies that made navigating the pandemic especially punishing for immigrant families.ImplicationsOn the basis of study findings, program and policy implications for serving Latine children and youth and their immigrant parents, especially those with mixed documentation status, are discussed.

Instrumental safety net configurations and changes over time among economically marginalized families.

Poverty, a social determinant of health, disproportionately affects families with children. Public and private safety nets, or support networks available in times of need, can help address poverty and its consequences. Independently, strong safety nets (public or private) promote health and well-being, yet little is known about how private and public safety nets combine and evolve over time. Using latent class and latent transition analyses, this study examined public and private safety net configurations of mothers with low-income, sociodemographic characteristics associated with these configurations, and safety net changes over time. Using data from the Future of Families and Child Wellbeing Study from child ages 1, 5, and 9 (N = 2,251), results indicated that mothers were sorted into four safety net configurations (public support only, private support only, all high, and all low) and 30%-53% of each class of mothers transitioned from one safety net configuration to another at the next neighboring wave, underscoring the importance of examining both public and private supports simultaneously and longitudinally. Membership in configurations with low private support (e.g., public only, all low) and sociodemographic disadvantage (e.g., more poverty, recent experience of hardship) predicted transitions, commonly leaving mothers without advantage in the riskiest safety nets. To promote a more responsive, equitable safety net, lengthening public safety net program certification periods and increasing outreach efforts (e.g., through schools, churches) to potentially eligible mothers could strengthen and stabilize safety nets to lessen poverty and its consequences for economically marginalized families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Gender Stereotypes and Coping with Adversities

Women’s subjective experience of life hardships may be connected with gender self-concept and misogynistic attitudes. This empirical study of external and internal misogyny as a gender stereotype consisted of two stages. The first stage relied on such quantitative methods as scale questionnaires to identify the coping strategies, self-attitudes, and misogynistic ideas. The second stage used two qualitative methods: the free associations method helped to define the concept of adversity in men and women while the thematic analysis identified the default coping strategies in the focus group. The study involved 312 women aged 18–45 y.o. from Tashkent, Uzbekistan. The research revealed a relationship between some parameters of self-attitude and the severity of misogynistic attitudes. For example, prominent self-confidence, self-acceptance, self-guidance, and openness in communication accompanied low scores for social vulnerability, personal inferiority, and a sense of danger. Internal conflicts and self-blame corresponded with strong misogynous attitudes. In general, the gender role remained a prevailing characteristic of adversity. The adversity concept demonstrated an inner contradiction: the core concentrated on sexual and physical family violence while the periphery was more about interpersonal family relations. The thematic analysis showed that the choice of coping strategy depended on the limitations caused by misogynistic attitudes. However, the relationship between the misogynistic gender stereotyping and the choice of coping strategy proved to be ambiguous.

“More Concerned About Mr. and Mrs. Denmark”: Coping with Pandemic Crisis at the Intersection of Homelessness and Drug Use

ABSTRACT This article builds on fieldwork conducted during lockdown in Denmark among users of services at the intersection of homelessness and drug use. The paper bridges two distinct approaches to understanding the relation between marginalization and crisis, with one focused on the impact of “big events” on marginalized populations, and another on everyday strategies employed to survive situations of homelessness and drug use. The paper shows how past experiences of hardship became relevant for coping with pandemic crisis. It further exploreshow, through critical engagement with dominant accounts of vulnerability, research participants carved out a space for negotiating their marginality in the Danish welfare state.

Economic Hardship Predicts Intimate Partner Violence Victimization During Pregnancy.

Intimate partner violence (IPV) during pregnancy is associated with negative physical and mental health consequences for both mothers and infants. Economic hardship is often exacerbated during pregnancy and is associated with increased rates of IPV in non-pregnant samples. However, temporal associations between economic hardship and IPV victimization have not been well characterized during pregnancy. The present study used data collected at the weekly level to examine the interindividual and intraindividual effects of economic hardship on IPV victimization during pregnancy and determine whether longitudinal changes in IPV across pregnancy vary based on level of economic hardship. Two hundred ninety-four women reported on weekly experiences of IPV and economic hardship (i.e., food insecurity and other money problems) during weeks 17-40 of pregnancy. Participants were oversampled for low income and IPV exposure. Binary logistic multilevel models were used to test study hypotheses. Greater economic hardship on average during pregnancy predicted increased odds of IPV victimization. Within-person increases in economic hardship also predicted increased odds of IPV victimization in the same week. Although IPV victimization tended to decrease on average over the course of pregnancy, there was a significant time by economic hardship interaction such that IPV decreased more gradually for women reporting high levels of economic hardship. The present study examined weekly patterns of IPV victimization across pregnancy in a low-income community sample. Results suggest that policies aimed at increasing families' economic security during the perinatal period may reduce the individual and societal burden of IPV.

Health inequity associated with financial hardship among patients with kidney failure.

Financial hardship is a common challenge among patients with kidney failure and may have negative health consequences. Therefore, financial status is regarded as an important determinant of health, and its impact needs to be investigated. This cross-sectional study aimed to identify the differences in patient-reported and clinical outcomes among kidney failure patients with different financial status. A total of 354 patients with kidney failure were recruited from March to June 2017 at two hospitals in Hong Kong. The Dialysis Symptoms Index and Kidney Disease Quality of Life-36 were used to evaluate patient-reported outcomes. Clinical outcomes were retrieved from medical records and assessed using the Karnofsky Performance Scale (functional status) and Charlson Comorbidity Index (comorbidity level). Patients were stratified using two dichotomised variables, employment status and income level, and their outcomes were compared using independent sample t-tests and Mann-Whitney U-tests. In this sample, the employment rate was 17.8% and the poverty rate was 61.2%. Compared with other patients, increased distress of specific symptoms and higher healthcare utilization, in terms of more emergency room visits and longer hospital stays, were found in patients with poorer financial status. Low-income patients reported a decreased mental quality of life. Financially underprivileged patients experienced health inequity in terms of impaired outcomes. Attention needs to be paid to these patients by providing financial assessments and interventions. Additional research is warranted to confirm these findings and understand the experience of financial hardship and health equity.

The Impact of Temporary Assistance for Needy Families Benefit Requirements and Sanctions on Maternal Material Hardship, Mental Health, and Parental Aggravation.

Temporary Assistance for Needy Families requirements can be stress-inducing, difficult for families to complete, and may be detrimental during early life. We assessed the impact of TANF requirements on primary caregiving mothers' experiences of material hardship, anxiety, depression, and parental aggravation in the first year of a child's life. Survey responses were selected from mothers in the Future of Families and Childhood Wellbeing Study, who received TANF in the first year of their child's life (N = 1085). Survey-weighted regression models showed associations between: presence of any requirements and increased material hardship, work requirements and increased material hardship, requirement to name the father of their child and increased depression, benefit cuts and increased parental aggravation, and benefit cuts and increased material hardship. Federal and state policies should revise requirement programs to increase program accessibility and support the mental health and financial stability of mothers applying for TANF to facilitate sustainable movement into employment.

Authoritarian leaders, economic hardship, and inequality

ABSTRACT Do political leaders influence the level of economic inequality in authoritarian countries? Building on previous studies on political leaders and authoritarian regimes, we argue that economic inequality is likely to decrease during the tenure of authoritarian leaders with personal experiences of economic hardship. Since authoritarian leaders have greater policy discretion than their democratic counterparts, their policy choices are less constrained by other political actors and institutions. As their material background makes authoritarian leaders more likely to favour introducing redistributive measures, they are expected to use such strategies for political survival, leading to a decrease in economic inequality. We created and analysed a new dataset on political leaders’ socioeconomic backgrounds in authoritarian regimes and found support for our arguments. In line with recent studies on political leaders and policy outcomes, our findings suggest that leaders’ personal experiences of economic hardship greatly affect their policy choices in authoritarian countries.