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Socioeconomic status influences the toll paediatric hospitalisations take on families: a qualitative study
Andrew Finkel Beck1, Lauren G Solan2, Stephanie A Brunswick3
1Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Insights
Hospitalizations and transitions home present unique challenges for families, especially those with lower socioeconomic status (SES). Addressing these disparities in care is crucial for preventing adverse health outcomes and reducing post-discharge inequities.
Area of Science:
- Healthcare Disparities
- Pediatric Health Outcomes
- Socioeconomic Factors in Health
Background:
- Hospitalizations and transitions home can increase patient risk for adverse health outcomes.
- Disparities in healthcare experiences may arise from differences in family resources and support systems.
- These disparities can perpetuate inequities in post-discharge care.
Purpose of the Study:
- To qualitatively explore how hospitalization and transition experiences differ among families with varying socioeconomic status (SES).
Main Methods:
- Conducted focus groups and individual interviews with caregivers of recently discharged children.
- Stratified sessions based on SES, using census tract poverty rates (<15% or ≥15%).
- Employed an open-ended, semistructured question guide to assess family experiences.
Main Results:
- 61 caregivers participated; 56% were from low SES backgrounds (≥15% poverty rate).
- Identified interrelated logistical, emotional, and financial challenges.
- Themes related to hospitalization and transition experiences were described differently across SES strata.
Conclusions:
- Lower SES families face distinct challenges during hospitalizations and transitions.
- Tailored care delivery models and discharge planning are needed to mitigate adverse events and reduce post-discharge disparities.
Background:
Stress caused by hospitalisations and transition periods can place patients at a heightened risk for adverse health outcomes. Additionally, hospitalisations and transitions to home may be experienced in different ways by families with different resources and support systems. Such differences may perpetuate postdischarge disparities.
Objective:
We sought to determine, qualitatively, how the hospitalisation and transition experiences differed among families of varying socioeconomic status (SES).
Methods:
Focus groups and individual interviews were held with caregivers of children recently discharged from a children's hospital. Sessions were stratified based on SES, determined by the percentage of individuals living below the federal poverty level in the census tract or neighbourhood in which the family lived. An open-ended, semistructured question guide was developed to assess the family's experience. Responses were systematically compared across two SES strata (tract poverty rate of <15% or ≥15%).
Results:
A total of 61 caregivers who were 87% female and 46% non-white participated; 56% resided in census tracts with ≥15% of residents living in poverty (ie, low SES). Interrelated logistical (eg, disruption in-home life, ability to adhere to discharge instructions), emotional (eg, overwhelming and exhausting nature of the experience) and financial (eg, cost of transportation and meals, missed work) themes were identified. These themes, which were seen as key to the hospitalisation and transition experiences, were emphasised and described in qualitatively different ways across SES strata.
Conclusions:
Families of lower SES may experience challenges and stress from hospitalisations and transitions in different ways than those of higher SES. Care delivery models and discharge planning that account for such challenges could facilitate smoother transitions that prevent adverse events and reduce disparities in the postdischarge period.
Trial Registration Number:
NCT02081846; Pre-results.
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