Perceptions Of Access To Care Research Articles

Childcare Instability and Maternal Depressive Symptoms: Exploring New Avenues for Supporting Maternal Mental Health

ObjectiveWe investigated links between childcare experiences—specifically, care instability and mothers' perceptions of care access—and maternal depressive symptoms in an effort to illuminate policy-amenable mechanisms through which childcare experiences can support maternal mental health. MethodsData were taken from the nationally representative Early Childhood Longitudinal Study–Birth Cohort. We used regression models with lagged dependent variables to estimate associations between aspects of childcare instability and perceptions of care availability and maternal depressive symptoms. We did so on the full sample and then on subgroups of mothers for whom childcare instability may be especially distressing: mothers who are low income, working, single, or non-native speakers of English. ResultsChildcare instability—length in months in the longest arrangement and number of arrangements—was not associated with maternal depressive symptoms. However, mothers’ perceptions of having good choices for care were associated with a reduced likelihood of clinical depressive symptoms, even after controlling for prior depressive symptoms and concurrent parenting stress; this latter association was observed both in the full sample (adjusted odds ratio [AOR] = 0.77; 95% confidence interval [CI] = 0.63–0.96) and among subgroups of employed mothers (AOR = 0.71; CI = 0.57–0.87) and single mothers (AOR = 0.72; CI = 0.52–0.99). ConclusionsAlthough dimensions of care instability did not associate with maternal depressive symptoms, mothers’ perceptions of available care options did. If replicated, findings would highlight a previously unconsidered avenue—increasing care accessibility and awareness of available options—for promoting maternal mental health in a population likely to experience depression but unlikely to be treated.

Do Access Experiences Affect Parents’ Decisions to Enroll Their Children in Medicaid and SCHIP? Findings from Focus Groups with Parents

The Covering Kids and Families (CKF) program seeks to expand health insurance coverage for children by supporting community-based outreach and enrollment. For the evaluation of CKF, researchers conducted focus groups to explore parents' experiences accessing health care for their children, and to assess whether these experiences affected decisions to enroll their children in Medicaid or the State Children's Health Insurance Program (SCHIP). In May and June 2003, 13 focus groups were conducted in 5 cities--Everett, MA; Denver, CO; Los Angeles, CA; Mena, AR; and San Antonio, TX. In each community, groups were conducted with parents of children insured under Medicaid or SCHIP and parents of uninsured children. Three groups were conducted with Spanish-speaking parents in two communities--Denver and Los Angeles. Access to primary care was considered good by most parents with children in Medicaid and SCHIP. Among parents of uninsured children, there was more variation in perceptions of access to care. For parents of both uninsured and insured children, access to dentists and specialists was more problematic. Spanish-speaking families reported numerous barriers to care due to language differences and perceived discrimination. All focus group participants said that they placed great value on health insurance. Even when parents encountered problems accessing care, very few indicated that this discouraged them from enrolling their children into Medicaid or SCHIP, or from renewing their children's public coverage.

Perceptions of care access: the experience of rural and urban women following brain injury

To examine care access among women with brain injuries, a qualitative, phenomenological study was conducted. Twenty one women with acquired brain injuries were recruited for the inquiry, representing rural and urban regions of Colorado. The phenomenological approach allowed the investigators to examine the shared experiences of women with brain injuries as they sought rehabilitative supports and services, and attempted to re enter their lives and communities. Each woman was interviewed one or two times, the interviews were transcribed and then coded and analysed by both authors separately. Thematic analysis of the data revealed two major emergent themes: issues surrounding diagnosis and barriers to accessing care. A total of 10 women interviewed experienced difficulty obtaining a diagnosis of brain injury and experienced serious personal and professional consequences as a result. All the women experienced barriers to accessing care, including problems with service providers and service systems, financial challenges, travelling for services, lack of information or services in their area, lack of care coordination and funnelling. Some of the barriers cannot be changed secondary to cost, efficiency and logistics. Other barriers, could be changed through education, training and policy making.