A Reaction Paper

Varshney: https://doi.org/10.1353/hpu.2022.0026 … Journal of Health Care for the Poor and Underserved, Volume 33, Number 1, February 2022, pp. 356-361 (Article) by Karan Varshney.

Description of the Article

Theory:
The theory used in the provided article is anchored in the proximity analysis model, which explores the connection between child poverty and access to healthcare. Specifically, the theory emphasizes the contribution of federally qualified health centers (FQHCs) in lowering health inequities by giving care to impoverished children (Varshney, 2022). It postulates that regions with an increased rate of poor children often encounter challenges in accessing adequate and quality healthcare, resulting in deteriorated health outcomes among these children. Moreover, the theoretical framework stresses the perspective that poverty substantially impacts health outcomes, leading to inequalities in accessing healthcare. By managing these inequities through expanding the number of FQHCs, the model asserts that it is feasible to enhance healthcare access for the impoverished population and lower existing inequalities. Therefore, the research offers pragmatic evidence backing the theoretical framework that expanding healthcare services to the deprived regions can solve the health needs of impoverished children and encourage health equity and positive outcomes.

Population:
The focus population in the article is impoverished children in Detroit. The rate of child poverty in the area is significantly higher compared to the national averages, hence the need for urgent healthcare interventions (Varshney, 2022). Understanding various health challenges puzzling children is vital for formulating strategies that can go a long way in managing the identified health disparities and enhancing equitable access. The study recognizes the exceptional needs and existing vulnerabilities faced by impoverished children for an urgent reversal of the negative trend and to promote their well-being.

Methods/Analysis:
The research employed a proximity analysis approach to analyze the accessibility of FQHCs by poor children in Detroit, Michigan. A base map of Detroit, demographics data, poverty rates information, and FQHCs across Detroit were obtained for analysis. Buffers were established around FGHCs at different distances to define regions of proximity. The assessment included establishing the percentage of poor children living in various buffer distances from existing FQHCs and computing the ratios for comparison purposes. ArcGIS version 10.3 was adopted for mapping and performing proximity evaluations, allowing quantitative analysis of access to healthcare based on proximity (Varshney, 2022). The spatial analysis techniques aimed to identify healthcare resource distribution and map the areas with scarce coverage. This can then inform approaches for enhancing healthcare access to impoverished children in Detroit.

Results:
The proximity evaluation shows that whereas the current 24 FQHCs in Detroit are appropriately distributed, many impoverished children reside far away from existing FQHCs. Specifically, 32.8 percent of children live closer to the available FQHCs, while 67.2 percent reside in underserved areas (Varshney, 2022). The analysis shows that some regions of Detroit need more healthcare access due to inadequate distribution of FQHCs in the region. The findings emphasize the urgent need to increase the number of FQHCs to facilitate adequate healthcare for poor children in Detroit.

Limitations
The study reports various limitations, including using census centroids as proxies for the demographic locations, which might not accurately represent definite residential settings. In addition, apart from distance, other factors such as unavailable bus service, low walkability in localities, unsafe streets, and provider preference can make a person not select a healthcare facility nearer to them (Varshney, 2022). Consequently, these factors should be factored in when expanding FQHC in Detroit.

Reaction to the Article

Is the article theory/framework sound?
A comprehensive analysis of the study's theoretical frameworks shows a well-argued research model that adequately addresses the challenge of healthcare access and child poverty viewed through the lens of FQHCs in mitigating existing disparities. The framework describes in detail the connection between child poverty and healthcare outcomes, highlighting the role poverty plays in Detroit's access to adequate healthcare. The theory forms the compelling basis and justification for exploring the need to expand FQHCs to address child poverty and healthcare access.

Whereas the existing theory is detailed and relevant, it can be improved by contextualizing the issue from the social determinants of health perspective to complement the presented socioeconomic perspective. The paper has shown that poverty is a significant issue in accessing healthcare among impoverished children in Detroit. However, integrating social determinants such as food insecurity, transportation, and housing would go a long way in addressing existing healthcare inequalities and formulating a robust strategy for improved access and outcomes (Williams, 2020). Moreover, Williams, in her efforts to assess the efficacy of addressing social determinants in healthcare access in Detroit, discussed insightful contributions. Fixing social determinants of health in Detroit through interventions that enhance health outcomes goes a long way toward attaining health equity.

Are there better/different methods that could be used to answer the research question better?
The proximity analysis method employed in the paper has provided valuable perspectives on the connection between the distance of the available FQHCs and their accessibility by poor children in Detroit. It is a good starting point that enables individuals to understand the significance of healthcare resource distribution and corresponding access by impoverished children. However, a complementary approach can be deployed to provide a detailed comprehension of various factors that hinder healthcare access beyond the proximity perspective. This is because proximity has largely emphasized distance as the primary aspect of accessing healthcare. This approach overlooks other elements impacting utilization and healthcare access among this vulnerable population. Factors such as cultural preference, socioeconomic challenges, and transportation also hinder healthcare access. Therefore, the paper could have complimented the proximity analysis method with qualitative approaches such as interviews and focused group discussions with the identified community to establish more views on non-distant factors that impact healthcare access among impoverished children (St. George et al., 2023). The qualitative approaches could allow community members to mention many other factors that hinder them from accessing healthcare.

In addition, the research implemented buffer rings to establish the percentage of poor children residing within a given distance from the existing FQHCs. However, it needs to mention the service portfolio and the capacity of the facilities to handle the various healthcare needs of impoverished children. Therefore, the methodology could have integrated various healthcare aspects such as service range, lead times, and cultural competence of existing FQHCs to present a detailed understanding of access to healthcare in Detroit among impoverished children.

How would you address the limitations based on your knowledge?
The research presents limitations, such as deploying census centroids as proxies for establishing the children's locations, which could be inaccurate. Other limitations include the absence of bus services, reduced walkability in localities, insecure streets, or provider preference. The study could have used community outreach initiatives or access electronic health data following a collaboration with local agencies or healthcare providers to address the challenge of using census centroids as a proxy for getting a child's location. This approach not only gathers geocoded specific addresses but also contributes to the overall accuracy of the study.

Moreover, challenges related to non-distance matters, such as bus services, unsafe streets, or provider preferences, can be addressed using qualitative methods. These encompass study interviews with community members and stakeholders such as healthcare providers and the Department of Health to get more insights into the issues to complement the proximity analysis approach for a comprehensive strategy formulation (St. George et al., 2023). Techniques such as spatial clustering methods could also be used to identify various clusters of unmet healthcare requirements among poor children and design specific interventions to address such challenges.

What are the next steps of the research that you would pursue?
The following research step would address the limitations beyond proximity that hinder poor children in Detroit from accessing required healthcare. Since the quantitative research outcomes obtained from the proximity analysis method are clear, investigating non-distance aspects would be appropriate. Therefore, interviews with community members, health departments, and healthcare providers would be pursued to identify specific challenges that contributed to reduced uptake of healthcare among the study demographics (St. George et al., 2023). This will complement the proximal analysis aspect and give a clearer picture of the matter for practical analysis.

In addition, the research would also seek to address uses such as unsafe streets, lack of bus service, and reduced walkability in localities by lobbying policymakers and collaborating with healthcare providers to develop specific interventions. This will help address the identified issues and enable poor children in Detroit to access healthcare in FQHCs. Interventions such as petitioning the local health department to channel specific community outreach programs to the underserved areas could provide a short-term solution as the situation is addressed.


References
_St. George, S. M., Harkness, A. R., Rodriguez-Diaz, C. E., Weinstein, E. R., Pavia, V., & Hamilton, A. B. (2023). Applying rapid qualitative analysis for health equity: Lessons learned using “EARS” with Latino communities. International Journal of Qualitative Methods, 22(1), 1-12. https://doi.org/10.1177/16094069231164938
_Varshney, K. (2022). Are federally qualified health centers accessible to pediatric populations in most need throughout Detroit? A visualization using proximity analysis. Journal of Health Care for the Poor and Underserved, 33(1), 356-361. https://doi.org/10.1353/hpu.2022.0026
_Williams, E. (2020, January 06). Addressing the social determinants of health in Detroit. Michigan State University. https://publichealth.msu.edu/news-items/alumni-at-work/206-addressing-the-social...