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83rd Annual Meeting of the Eastern Sociological Society, Boston, MA

March 22, 2013, Boston, MA

NERI’s Center for Qualitative Research presented results from an in-depth case study about how a working poor family manages chronic illness and disability. This qualitative work was a sub-study of the Boston Area Community Health Survey. The presentation was part of a Health Disparities roundtable at the Eastern Sociological Society Annual Meeting in Boston, MA.


Everyday Consequences of Healthcare Disparities: Illustrating the Potential of Qualitative Research
Lisa C. Welch and John B. McKinlay
Disparities in comprehensive healthcare for low socio-economic status families are well documented statistically, but less clear is how to target health policy to reduce the consequences. The objective of this presentation is to elucidate the story of one low-income family as it seeks to manage a mid-life disability in order to identify policy-relevant barriers to regaining wellbeing. We conducted a qualitative case study using a series of in-depth interviews over a 4-month period with one family in the Boston area. Eligibility criteria included household income below 200% of poverty, at least one household member engaged in paid work, at least one adult household member with a disability, and at least one child in the household. Interviews were audio-recorded and transcribed verbatim to facilitate accurate analysis. Results reveal the everyday consequences of disparities in access to care. Through early occupational therapy, the disabled family member regained some activities of daily living. However, when coverage for further rehabilitation ended, the family could not afford continued therapy or a gym membership to continue the work needed to regain sufficient strength and mobility for re-entering the workforce. The disabled family member was unable to regain independence, creating long-term financial dependence and insecurity as well as cumulative stress on family relationships. Results have broad implications. For public health, this family’s story underscores the critical role of safety-net health policies to support low-income families in regaining independence and maintaining family wellbeing when faced with a disability. Within the field of medical sociology, results illuminate how one family experiences the intersection of social class, health, and health care in the U.S. The qualitative approach reveals nuances and trade-offs that can complement statistical results, providing important context for targeting policy decisions.

Marceau, L., McKinlay, J. B., Shackelton, R., & Link, C. (Epub ahead of print). The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus. Journal of Evaluation in Clinical Practice.

Siegrist, J., Shackelton, R., Link, C., Marceau, L., von dem Knesebeck, O., McKinlay, J. (2010). Work stress of primary care physicians in the US, UK and German health care system. Social Science and Medicine, 71(2), 298-304.

Von dem Knesebeck, O., Bonte, M., Siegrist, J., Marceau, L., Link, C., & McKinlay, J. (2010). Diagnosis and therapy of depression in the elderly--influence of patient and physician characteristics. Psychother Psychosom Med Psychol, 60(3-4), 98-103.

Konrad, T. R., Link, C. L., Shackelton, R. J., Marceau, L. D., von dem Knesebeck, O., Siegrist, J., et al. (2010). It's about time: Physicians' perceptions of time constraints in primary care medical practice in three national healthcare systems. Medical Care, 48(2), 95-100.

Von dem Knesebeck, O., Gerstenberger, E., Link, C., Marceau, L., Roland, M., Campbell, S., et al. (2010). Differences in the diagnosis and management of type 2 diabetes in 3 countries (US, UK, and Germany): Results from a factorial experiment. Medical Care, 48(4), 321-326.

Grant, R. W., Lutfey, K. E., Gerstenberger, E., Link, C. L., Marceau, L. D., & McKinlay, J. B. (2009). The decision to intensify therapy in patients with type 2 diabetes: results from an experiment using a clinical case vignette. The Journal of the American Board of Family Medicine, 22(5), 513-520.

Maserejian, N. N., Lutfey, K. E., & McKinlay, J. B. (2009). Do physicians attend to base rates? Prevalence data and statistical discrimination in the diagnosis of coronary heart disease. Health Services Research, 44(6), 1933-1949.

Shackelton, R. J., Marceau, L. D., Link, C. L., & McKinlay, J. B. (2009). The intended and unintended consequences of clinical guidelines. Journal of Evaluation in Clinical Practice, 15(6), 1035-1042.

Shackelton, R., Link, C., Marceau, L., & McKinlay, J. (2009). Does the culture of a medical practice affect the clinical management of diabetes by primary care providers? Journal of Health Services Research and Policy, 14(2), 96-103.

Jackson, C.B., Botelho, E.M., Welch, L.C., Joseph J., & Tennstedt, S.L. (2012). Talking With Others About Stigmatized Health Conditions: Implications for Managing Symptoms. Qualitative Health Research, Epub ahead of print.

Link, C.L., Stern, T.A., Piccolo, R.S., Marceau, L.D., Arber, S., Adams, A., Siegrist, J., von dem Knesebeck, O., McKinlay, J.B. (2011). Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment. The Primary Care Companion for CNS Disorders, 13(5), e1-e7.

Lutfey, K.E., Campbell, S.M., Marceau, L.D., Roland, M.O., McKinlay, J.B. (2012). Influences of organizational features of healthcare settings on clinical decision making: Qualitative results from a cross-national factorial experiment. Health, 16(1), 40-56.

Marceau L, McKinlay J, Shackelton, R, Link C. (2011). The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus. Journal of Evaluation in Clinical Practice, 17(6),1122-8.

McKinlay, J.B., Marceau, L.D., Piccolo, R.J. (2012). Do doctors contribute to the social patterning of disease? The case of race/ethnic disparities in diabetes mellitus. Medical Care Research and Review, 69(2),176-93.

McKinlay J.B., & Marceau, L.D. (2011). New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent? International Journal of Health Services, 41(2), 301-35.

Oka, M., Link, C.L., Kawachi, I. (2011). Disparities in the prevalence of obesity in Boston: results from the Boston Area Community Health (BACH) survey. Public Health Reports, 126(5), 700-7.

Shackelton-Piccolo, R., McKinlay, J.B., Marceau, L.D., Goroll, A.H., Link, C.L. (2011). Differences between internists and family practitioners in the diagnosis and management of the same patient with coronary heart disease. Medical Care Research and Review, 68(6), 650-66.

Welch, L.C., Lutfey, K.E., Gerstenberger, E., Grace, M. (2012). Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms". Journal of Health and Social Behavior, 53(3), 313-28.

Welch, L.C., Botelho, E.M., Joseph, J.J., Tennstedt, S.L. (2012). A qualitative inquiry of patient-reported outcomes: the case of lower urinary tract symptoms. Nursing Research, 61(4), 283-90.

Welch, L.C., Botelho, E.M., Tennstedt, S.L. (2011). Race and ethnic differences in health beliefs about lower urinary tract symptoms. Nursing Research, 60(3), 165-72.

McKinlay, J.B. & Marceau, L.D. (2012). From cottage industry to a dominant mode of primary care: stages in the diffusion of a health care innovation (retail clinics). Social Science & Medicine, 75(6), 1134-41.

Heretic's Corner
10/4/2011 - Posted by NERI Upstream
For example, how useful is it to encourage households in poverty (experiencing food insecurity) to consume more costly “healthful” diets (lean meats, whole grains and fresh vegetables and fruit). The examples are endless............