The development a new Multidimensional and Multilevel Measure of Institutional and Economic Barriers for English and Spanish speaking populations

University Of Maryland Baltimore, Baltimore MD

Investigators

Abstract

Advancing the health of all Americans starts by collecting valid and reliable data on barriers to health care access and optimal health outcomes. Institutional and economic barriers contribute to the gaps, inconsistencies, and inefficiencies in health care that result in excess medical costs, staffing shortages, lost productivity, and economic losses due to chronic diseases and early mortality. Current measures of institutional and economic barriers have multiple limitations: First, our preliminary data revealed a measurement bias based on a lack of measurement invariance (or equivalence), with different population groups interpreting indicators collected at the individual level differently for reasons other than those intended by the measure. Second, existing measures are overly focused on a single population (Blacks). This is a missed opportunity, because the Hispanic/Latino population is expected to be 21% of the U.S. population by 2030. Third, current indices lack economic indicators that are indispensable for measuring institutional barriers. According to epidemiologist, Dr. Nancy Krieger, variance in health outcomes is tied to variance in economic circumstances. Yet, current indices include indicators from the education sector (e.g., graduation rates) and housing sector (e.g., residential distribution), but no indicators from the economic sector (e.g., business ownership) To improve the health of all Americans, we must identify and remedy the root causes of poor health and early mortality in high incidence areas and communities. Our objective is to develop a new measure that is multilevel and multidimensional, incorporates economic indicators, evaluates institutional and economic barriers, has measurement invariance, and is valid for Blacks, Hispanics/Latinos, and Whites. Our approach is theory driven and we will use modern psychometric techniques to ensure the measure is valid and salient for different populations. Our specific aims are to: 1) Incorporate novel data sources that comprise economic indicators to assess ecological-level determinants of disproportionate health outcomes; 2) Create an item bank from existing measures of asymmetric treatment and items of economic disadvantage with measurement invariance across Blacks, Hispanics/Latinos, and Whites; and 3) Test the validity of the new instrument with an expanded, more representative sample of the American population. At the completion of the proposed research, the expected outcome will be a theory-driven, psychometrically sound, and culturally relevant measure. The overall positive impact of the tool will be its availability to the public and its use in research settings to find effective interventions to reduce the wealth and health gap and improve the health of all Americans.