scholarly journals Identifying Positive Adaptive Pathways in Low-Income Families in Singapore: Protocol for Sequential, Longitudinal Mixed-Methods Design

10.2196/11629 ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. e11629
Author(s):  
Esther Chor Leng Goh ◽  
Wan Har Chong ◽  
Jayashree Mohanty ◽  
Evelyn Chung Ning Law ◽  
Chin-Ying Stephen Hsu ◽  
...  
2018 ◽  
Author(s):  
Esther Chor Leng Goh ◽  
Wan Har Chong ◽  
Jayashree Mohanty ◽  
Evelyn Chung Ning Law ◽  
Chin-Ying Stephen Hsu ◽  
...  

BACKGROUND This study aims to examine the adaptive process of children and mothers from multistressed low-income families in Singapore. It aims to bridge the knowledge gap left by existing poverty studies, which are predominately risk focused. Through a sequential longitudinal mixed-methods design, we will differentiate children and mothers who demonstrate varied social, developmental, and mental health trajectories of outcomes. Through utilizing the Latent Growth Curve Model (LGCM), we aim to detect the development and changes of the positive Family Agency and adaptive capacities of these families over time. The construct of Family Agency is underpinned by the theoretical guidance from the Social Relational Theory, which examines child agency, parent agency, relational agency, and the interactions among these members. It is hypothesized that positive Family Agency within low-income families may lead to better outcomes. The key research questions include whether the extent of positive Family Agency mediates the relationship among financial stress, resource utilization, home environment, and parental stress. OBJECTIVE The study elucidates the Family Agency construct through interviews with mother-child dyads. It also aims to understand how financial stress and resources are differentially related to home environment, parent stress, and parent and child outcomes. METHODS In phase 1, 60 mother-child dyads from families receiving government financial assistance and with children aged between 7 and 12 years will be recruited. In-depth interviews will be conducted separately with mothers and children. On the basis of 120 interviews, a measurement for the construct of Family Agency will be developed and will be pilot tested. In phase 2a, a longitudinal survey will be conducted over 3 time points from 800 mother-child dyads. The 3 waves of survey results will be analyzed by LGCM to identify the trajectories of adaptation pathways of these low-income families. In addition, 10 focus groups with up to 15 participants in each will be conducted to validate the LGCM results. RESULTS This project is funded by the Social Science Research Thematic Grant (Singapore). The recruitment of 60 mother-child dyads has been achieved. Data collection will commence once the amendment to the protocol has been approved by the Institutional Review Board. Analysis of phase 1 data will be completed by the end of the first quarter of 2019, and the first set of results is expected to be submitted for publication by the second quarter of 2019. Phase 2 implementation will commence in the second quarter of 2019, and the project end date is in May 2021. CONCLUSIONS Findings from this study can potentially inform social policy and programs as it refines the understanding of low-income families by distinguishing trajectories of adaptive capacities so that policies and interventions can be targeted in enhancing the adaptive pathways of low-income families with children. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/11629


Author(s):  
Jennifer A Garner ◽  
Stephanie B Jilcott Pitts ◽  
Karla L Hanson ◽  
Alice S Ammerman ◽  
Jane Kolodinsky ◽  
...  

Abstract A randomized trial of Farm Fresh Foods for Healthy Kids (F3HK) was initiated across 4 states and 12 farms to test whether cost-offset community-supported agriculture (CO-CSA) could improve diet quality among children in low-income families. Intervention households purchased a 50% subsidized share of local produce and were invited to nine complimentary nutrition classes. The purpose of this study was to assess F3HK reach, dose, and fidelity via a mixed methods process evaluation. Screening and enrollment records indicated reach; study records and postlesson educator surveys tracked dose delivered; CSA pickup logs, lesson sign-in sheets, postseason participant surveys, and postlesson caregiver surveys assessed dose received; and coordinator audits and educator surveys tracked fidelity. Educator interviews contextualized findings. The results of this study were as follows. Reach: enrolled caregivers (n = 305) were older (p = .005) than eligible nonenrollees (n = 243) and more likely to be female (p < .001). Dose: mean CSA season was 21 weeks (interquartile range [IQR]: 19–23). Median CSA pickup was 88% of the weeks (IQR: 40–100). All sites offered each class at least once. Most adults (77%) and children (54%) attended at least one class; few attended all. Eighty-two percent of caregivers indicated that their household consumed most or all produce. Median lesson activity ratings were 5/5 (“very useful”). Fidelity: CSA locations functioned with integrity to project standards. Educators taught 92% of activities but frequently modified lesson order. This study demonstrates the feasibility of pairing a CO-CSA intervention with nutrition education across geographically dispersed sites. Greater integration of intervention elements and clearer allowance for site-level modifications, particularly for educational elements, may improve intervention dose and, ultimately, impact.


2021 ◽  
pp. 000283122199383
Author(s):  
Susan B. Neuman ◽  
Donna Celano ◽  
Maya Portillo

Recognizing the academic benefits of access to print for young children, book distribution programs abound in the United States. Designed to promote book ownership for low-income families, programs have unique delivery systems, leading to a largely fragmented policy. This article describes an urban city’s effort to build a coordinated book distribution program. Phase 1 examines the extent of book distributions, integrating data from 74 organizations and their branches (297). Using geographic information systems, we determined the spatialized patterns of scarcity and/or opportunity and the alignment between the intended and actual audience. In Phase 2, we conducted nine focus groups from neighborhoods receiving these book distributions. Results highlight the complexities of a well-intentioned policy and how multiple methods might inform policymaking in the future.


2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.


Pflege ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 93-107 ◽  
Author(s):  
Michael Kleinknecht-Dolf ◽  
Elisabeth Spichiger ◽  
Irena Anna Frei ◽  
Marianne Müller ◽  
Jacqueline S. Martin ◽  
...  

Hintergrund: Mit der Einführung der DRG-basierten Finanzierung erhalten Spitäler einen kleineren finanziellen Spielraum, was Prozessoptimierungen notwendig macht. Internationale Erfahrungen zeigen, dass solche Restrukturierungen Einfluss auf für die Pflege notwendige Kontextfaktoren haben können. Dadurch können auch Pflegequalität und Patientensicherheit beeinträchtigt werden. Ziel: Ziel der «DRG Begleitforschung Pflege» ist, ein Monitoringmodell samt dazugehörenden Instrumenten zur kontinuierlichen Überwachung des Einflusses der DRG-Finanzierung auf zentrale Pflegekontextfaktoren zu entwickeln. Methode: Die vorliegenden deskriptiven quantitativen Resultate wurden im Rahmen der in einem Mixed-Methods-Design durchgeführten Untersuchung mittels einer Online-Befragung erhoben, an der sich Pflegefachpersonen aus fünf Spitälern beteiligten. Ergebnisse: Die Resultate zeigen, dass die untersuchten Pflegekontextfaktoren «Komplexität der Pflege», «Arbeitsumgebungsqualität», «Führungsverhalten», «Moralischer Stress» und «Zufriedenheit mit der Arbeitsstelle» in allen Fachbereichen hinsichtlich der Arbeitsumgebung und Leistungserbringung der Pflege relevant sind. Es lassen sich Muster erkennen, die im Einklang mit der Literatur stehen, und die Hinweise auf die im Modell angenommenen Beziehungen zwischen diesen Kontextfaktoren geben. Schlussfolgerungen: Die Studie hat einerseits für die beteiligten Betriebe nützliche Daten geliefert, auf deren Basis sie Maßnahmen zur Sicherung der Qualität und Entwicklung der Pflege diskutieren können, andererseits konnten wichtige Informationen zur Weiterentwicklung des Modells und zu den eingesetzten Instrumenten gesammelt werden.


Pflege ◽  
2017 ◽  
Vol 30 (2) ◽  
pp. 53-63 ◽  
Author(s):  
Marianne Schärli ◽  
Rita Müller ◽  
Jacqueline S. Martin ◽  
Elisabeth Spichiger ◽  
Rebecca Spirig

Zusammenfassung. Hintergrund: Im klinischen Alltag stellt die interprofessionelle Zusammenarbeit zwischen Pflegefachpersonen und Ärzt(inn)en immer wieder eine Herausforderung dar. Quantitative oder qualitative Studien haben das Ziel, Erkenntnisse zu einer verbesserten Zusammenarbeit aufzuzeigen. Diese Erkenntnisse sind jedoch aus methodischen Gründen oft begrenzt. Ziel: Mittels Triangulation quantitativer und qualitativer Daten beschreibt diese Studie die interprofessionelle Zusammenarbeit aus Sicht der Pflegefachpersonen. Methode: Die Datenerhebung erfolgte in einem Mixed Methods-Design im Rahmen der interprofessionellen Sinergia DRG-Begleitforschung. Zunächst erfolgte eine separate Analyse der quantitativen und qualitativen Daten. Durch die Triangulation entstand in vier Schritten eine „Meta-Matrix“. Ergebnisse: Die „Meta-Matrix“ bildet alle relevanten quantitativen und qualitativen Ergebnisse sowie ihre Zusammenhänge modellähnlich auf einer Seite ab. Die Relevanz, die Einflussfaktoren sowie die Folgen der interprofessionellen Zusammenarbeit für Mitarbeitende, Patient(inn)en, Angehörige und Systeme werden deutlich. Schlussfolgerung: Die interprofessionelle Zusammenarbeit aus Sicht der Pflegefachpersonen in fünf Spitälern wird erstmals umfassend in einer „Meta-Matrix“ aufgezeigt. Die Folgen ungenügender Zusammenarbeit zwischen Pflegefachpersonen und Ärzt(inn)en sind beträchtlich, weshalb in interprofessionelle Konzepte investiert werden muss. Aus der „Meta-Matrix“ ist ersichtlich, welche Faktoren für die interprofessionelle Zusammenarbeit hinderlich bzw. förderlich sind.


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