Homework 7
Part 1:
1. Choose a paper describing the development or validation of a measure of relevance in health disparities research (please give the full citation and/or upload the paper if that's possible).
Dehlendorf C, Henderson JT, Vittinghoff E, et al. Development of a patient-reported measure of the interpersonal quality of family planning care. Contraception 2018; 97: 34-40.
2. What was the definition of the construct?
This study described the development and examined the evidence of the validity of a patient-reported scale (the Interpersonal Quality of Family Planning Care/IQFP). The IQFP measures the interpersonal quality of contraceptive counseling by patients rating their experiences with providers while receiving family planning services.
This study is relevant to health disparities research because it has the ability to enhance the emphasis on and delivery of high-quality, patient-centered care that women receive. Moreover, because previous studies have shown that patients who report high-quality family planning care are more likely to keep using their chosen birth control method and given the history of contraceptive coercion among women of lower SES and women of color, this study assessing the validity of a measure examining quality of care has the ability to mitigate some of the disparities that exist with regard to family planning care.
3. How did the authors provide evidence on the validity of the measure? Could you think of additional approaches to validating the measure?
The study approached providing evidence of the validity of the measure from multiple angles. Construct and convergent validity were examined using correlations with measures of satisfaction and observed patient-centered provider behaviors. Discriminant validity was examined via association between the time spent counseling and the interpersonal quality of the exchange. I believe the study undertook a thorough approach to assessing the validity of the measure.
4. How did the authors provide evidence on the reliability of the measure? Could you think of additional approaches to evaluating the reliability of the measure?
Evidence regarding the reliability of the measure was provided using Cronbach's alpha. Again, I believe the study undertook a thorough approach to assessing the reliability of the measure.
5. Describe the implications of a lack of measurement validity or reliability for future research applications.
The implication of a lack of measurement validity or reliability in any research study has the potential to hinder the accuracy of future research. Lack of these measurements can also lessen the amount of importance other researchers place on such measures. For example, not measuring the validity or reliability of the IQFP could lead to a reduction in the level of value placed on future research endeavors examining the quality of family planning services and counseling that women receive. Not examining the quality of family planning services and where we as providers fall short/ how we can improve would be doing a large disservice to our patients and could worsen outcomes and disparities experienced in the family planning setting.
Part 2:
1. Find a paper describing a health disparity (please give the full citation or, even better, upload the paper so everyone else can look at it too)
Heike T, Braughton M, Bradsberry M, et al. Racial and ethnic disparities in postpartum care and contraception in California’s Medicaid program. AJOG 2017; 47: e1-7.
2. Summarize the construct and measurement of the dimension of disparity (e.g., racial inequalities?, SES inequalities?) and the outcome measured (e.g., self-rated health).
This study examined differences in postpartum visit rates and receipt of postpartum contraception among women receiving publicly funded healthcare in California by race/ ethnicity, language preference, and residence in a primary care shortage area.
Measurement: healthcare/racial inequalities experienced by women
Outcome: postpartum healthcare visits and postpartum contraception
3. What is the evidence for the validity and reliability of the measures?
There is validity to this study’s measurements as it is a prospective cohort study that included the data from 199,860 Californian women. However, because the study utilized administrative claims and encounter data, the reliability of the measure is not as strong. For example, the use of claims data can lead to an underestimate of contraceptive method provision if correct claims were not submitted, if clients paid for contraceptives themselves, had already picked up prescription contraception prior to birth, or if they relied on their partner’s method.
4. What is the reference category used for the disparity measure (ie, who is the comparison group)? Why does this reference category make sense (or not) for this research question?
The reference category used for the disparity measure are white, english-speaking women who never lived in a primary care shortage area. This reference category makes sense given that the study was looking to identify differences in care by race/ethnicity. Moreover, because previous studies have shown that black women are more likely to experience short inter-pregnancy intervals and poor maternal and infant health outcomes when compared with white women, it is important to identify exactly where we are falling short between groups with regard to providing the best care and minimizing the disparity.
5. How is the disparity quantified or measured? Is this an absolute or relative measure or are both provided? Describe which type of measure you would prefer for this research area, or, if both, why.
The disparity in this study is quantified by both absolute and relative measures -- the overall number of women who attended a postpartum visit or received postpartum contraception was measured (absolute) and the adjusted odds ratio of white women compared with black, Latina, and Asian/Pacific Islander women who attended a postpartum visit or received postpartum contraception was reported (relative). Both absolute and relative measures should be reported in this research area because providing both facilitates a more detailed account of the exact nature of the disparities.