Choosing Healthful Interventions
Condition: Socioeconomic Factors; Low-Income Population; Health Status
Study type: Observational

Summary: 
      This study will identify what programs, along with traditional healthcare, low-income urban
      residents would choose to improve their health. The information is intended as a step toward
      designing public policies aimed at improving the health of low-income populations in the
      United States.

      Residents of Washington, D.C., who are between 18 and 64 years of age and are in a specified
      income bracket may be eligible for this study.

      Participants take part in audio-taped group discussions led by a trained facilitator. During
      a 3 hour session, participants engage in 4 cycles of choosing benefits. Participants select
      benefits as follows:

        -  For themselves individually.

        -  For their neighborhood.

        -  For an entire city.

        -  Once again individually.
    

Detailed description: 
      BACKGROUND:

      There is a growing recognition that health status is only partially a function of health
      care. Socio-economic determinants of health, particularly income status and education, have
      significant effects on health status and outcomes. In light of these socio-economic
      determinants, several governments in the Organization for Economic Cooperation and
      Development (OECD) are adopting evidence-based policy recommendations for improving the
      health of their populations. Britain has conducted research that has been path breaking in
      identifying these determinants of health and in planning to address them. Canada has similar
      plans.

      OBJECTIVE:

      The goal of this project is to explore the possibility of designing public policies aimed at
      improving the health of urban low-income populations in the US. Toward this end, this project
      will engage health policy experts and low-income residents in an exploratory exercise aimed
      at designing an affordable, evidence-based intervention program targeted at addressing
      socio-economic factors and reducing health disparities among low income residents of
      Washington, DC. A three step process will be carried out:

        1. Identification of candidate interventions that have been shown to ameliorate the
           socio-economic determinants of health, through literature review and consultation with
           experts;

        2. Consideration of a reasonable per capita expenditure for the purpose;

        3. Engagement of low-income residents to ascertain their priorities for publicly funding
           the proposed interventions within the assigned budget.

      Several hundred low-income adults recruited from clinical and community settings will
      participate in this engagement process through small group exercises in which a facilitated
      discussion will take place using a previously tested group decision tool, REACH (Reaching
      Economic Alternatives that Contribute to Health). Data pertaining to participants'
      socio-demographic characteristics, attitudes toward health, and preferences for possible
      interventions will be collected anonymously. Group discussions will be audio-taped. Data will
      be analyzed quantitatively and qualitatively to determine preferences for various
      interventions and their association with socio-demographic characteristics. Participants will
      be financially compensated with $75 for their participation.

      RISKS AND BENEFITS:

      Given the anonymous nature of the data collection, we anticipate no risks other than those
      entailed in discussion of poor health outcomes associated with lack of insurance and low
      income. Participants may benefit from learning about factors that improve health status.

      OUTCOME AND MEANING TO THE FIELD:

      Study results will yield information about benefits that are of utmost priority to low income
      urban residents. This is unique information that may contribute to efforts to find affordable
      strategies for ameliorating the socio-economic determinants of health for low-income urban
      population in the US.
    

Time perspective: Prospective
Keywords: Socioeconomic Determinants; Health Status; Low-income; Priority-setting; Group Discussion