There is growing recognition of disparities in access to appropriate and timely care for children. Children are the most diverse stratum of the US population and represent a vulnerable priority population. Improving access to health care and quality of primary care for vulnerable children is of enormous importance for the health of the future US population. Although considerable research has documented the relationship between vulnerability factors and health care processes and outcomes, our knowledge of the mechanisms underlying these disparities is less robust. Using an existing conceptual model, this project will apply qualitative methods to gain insight into the experiences of vulnerable children's families. Specifically, how they define their children's health needs, their decision making regarding where and when to seek care, and their expeniences with care received. Their voices, when heard, can help to define ways that the health care system could become more responsive to the needs of the most vulnerable segments of society. The project's objective is to provide qualitative information about managing the health care needs of vulnerable children in San Diego. The data will be gathered using in depth semi-structured interviews. Twenty five families will be selected from a subsample of the most vulnerable children (n=147) participating in a larger study """"""""Measurmig quality of care for vulnerable children"""""""" (HSI 03 17). The interviews will focus on health needs, health care services use (when, where, what type), problems in using care, and proposals for health care services improvement. Quality and credibility of the data will be addressed by carefully defining eligible cases, collecting evidence in support of nival explanations, disciplined field-note taking, searching for negative cases, triangulation in data collection (simultaneously collecting data from multiple sources), distinguishing evidence from interpretation, triangulating analysis (with independent analyses by multiple researchers and subject review), and having thought through and defined the types of data to be collected. Data will be analyzed using the rapid ethnographic assessment approach to generate theories. The results will be used (a) to generate hypotheses for further quantitative research and (b) to inform the design of effective interventions to improve health care delivery to vulnerable children.
