Analysis Blog #2

The goal of this analysis is to recognize factors suspected of influencing patients’ perceptions of the quality of healthcare received. Physician-patient interaction is an important factor that influences health outcomes and it is expected that if interactions with healthcare providers are perceived by the patient as being positive, then patients will seek routine medical attention, potentially leading to healthier life outcomes. This analysis attempts to determine what factors affect the belief of Americans that they receive quality healthcare from their healthcare professionals.

Patient perception of quality of healthcare has many implications for treatment and recovery. Many factors are associated with perceptions of quality of care received, including ethnicity, levels of trust & satisfaction with healthcare providers, feelings that patients’ concerns are heard, validated and addressed and a general sense that healthcare providers care about the individual needs of the patients. Levels of trust between patient and healthcare providers have been correlated with improved outcomes. Patients feeling satisfied with the provider-patient interactions and trusting in their healthcare providers are more likely to participate in their healthcare and follow treatment instructions.

Differences in the physician-patient relationship exist between ethnic groups. In analyzing satisfaction and trust of physician style, researchers found significantly lower levels of trust among minority groups as compared to whites. Levels of participation in their own healthcare among ethnic groups vary as well. African Americans are less likely to participate as compared to whites. Feelings of assertiveness during interactions with healthcare providers are lower among certain cultures.

I anticipated that patients who perceive the interactions with their healthcare professionals will also perceive the quality of care received as high. The following research hypothesis was proposed:

H1: Patients reporting receiving positive medical experiences will rate with quality of healthcare received higher than those patients reporting less than positive medical experiences.

Using data from the 2012 Health Information National Trends Survey (HINTS), this project uses as the dependent variable respondent ratings on the quality of health care received in the past 12 months. Using SPSS, independent variable responses were compared to ratings of quality of healthcare received. Ratings are scored on either a 4-point or 5-point Likert scale, where 1 indicates the highest rating and either 4 or 5 indicates the lowest rating. The findings of this analysis are presented below. Independent variables, considered to be factors in patient perceptions of receiving quality healthcare, were selected based on prior research discussed above.

In general, how would you say your health is?

In general, how much do you trust information about health or medical topics from a doctor?
In the past 12 months, how often did you feel that you could rely on your doctors, nurses, or other health care professionals to take care of your health care needs?
In the past 12 months, how often did your health professional give you the chance to ask all the health-related questions you had?
In the past 12 months, how often did your health professional give the attention you needed to your feelings and emotions?
In the past 12 months, how often did your health professional involve you in decisions about your health care as much as you wanted?
In the past 12 months, how often did your health professional make sure you understood the things you needed to do to take care of your health?

As predicted, when patients perceived that interactions with healthcare professionals were positive, patients indicated that they received quality healthcare. Patients that were given opportunity to ask all their health related questions, had their feelings and emotions attended to, felt their needs were being addressed, were included in their health care planning, and understood the things they needed to do to take care of their health reported receiving quality care at higher rates. In contrast, a weaker relationship was found between trust in the information received from the doctor and quality of healthcare received in the last 12 months. Likewise, patient’s perceptions of their general health was not highly correlated with the quality of healthcare received in the last 12 months

I unexpectedly  discovered there were no real disparities in perceptions of the quality of healthcare received between gender and race/ethnicity groups as well education levels.

Future research should perform deeper analysis of the effect that bedside manner of healthcare professionals has on health outcomes. It is important research to take on because if healthcare professionals can identify what factors influence patients’ perceptions of interactions with their providers, it is possible that patient outcomes can be improved.

Reflective Blog

I was a bit nervous to take this giant, scary STATS class; its been so many years since i have a math course let a lone statistics, but I have actually enjoyed the learning that has taken place and the feeling of accomplishing something that once made me feel a little anxious. SOCY 508 has introduce me to so many statistical pieces relevant to research, pieces I once struggled with (even in my first few semesters in the program), especially methodology and data analysis sections in reach articles. While reading these sections in , I was always a bit confused  as to what tests were being performed, and what method of sampling.  But having taken this course, I felt more confident and competent in my other course this semester- I had a better understanding  that helped out while writing my research proposal.

All of the course assignments really helped to reinforce my understanding of statistics. I found the recorded lectures and slides to be extremely helpful in reinforcing the content from the book. I love to work in SPSS so that was my favorite as far as assignments go, but the chapter & literature exercises were beneficial as a method of applying the material. The blogs were another great feature- I think I found these helpful because they allowed me to surf the web looking for examples while causing me to serendipitously stumble upon other relevant pieces information.  I do not think there were any features that did not enhance my learning.

As I stated in my course intro blog, I use SPSS a lot in my current job, data collection and analysis it is actually my favorite aspect or my job, so I fell even more familiar with it and its functions. I was quite excited to learn how to build charts and graphs at time of analysis rather than taking an extra step to create something in Excel. I am least familiar with the techniques for analyzing correlation (i.e, in which situations to use them), I know the basics and I know this will come with further use and experience so I am not worried.

While I had considered doing a group analysis project, I did not know the best way to carry this out with many folks being off campus and working. I think it is possible to do group work using tele/videoconferencing if schedules work out but I do think real-time communication would need to take place at some point during collaborations.

I really do not know what could be changed as far as improving the learning process for future students. I think all aspects of the course were clearly designed to present us with content, allowed us opportunity to apply & synthesize the content, and assess our knowledge. Pretty sure you effectively hit all objectives on Bloom’s Taxonomy of Education Objectives. Great Job!

 

David Harvey “The Right to the City”

citiizensIn addition to utilizing spaces within the city, David Harvey reiterates the notion that residents also have the right to make changes to already existing spaces. This fundamental “right to the city” allows residents to reimagine what society could be and possibly its inhabitants. Building from Robert Park’s notion that in building cities to their likeness, man has redesigned himself, Harvey states “the right to remake ourselves by creating a qualitatively different kind of urban sociality is one of the most precious of all human rights”. The notion that we change ourselves in creating our world, Harvey argues is the dialectical relationship guiding human labor.

thrachThe paradox lies and weather what we have built is creative or destructive. Harvey asks whose rights and whose city? Does the city serve all or is it reserved for a select group? Is it socially just or are the rights of one group more important than the rights of another? Although he gives a nod toward Utopian planning and justice ideals, he prefaced it with Thrasymachus’ argument that justice is simply what ever the ruling class wants it to be.  I think Harvey is trying to say that we must strive for a socially just society, but the minority must sometimes fight to attain these rights.

 

Christopher Mele “Casinos, Prisons, Incinerators, and Other Fragments of Neoliberal Urban Development”

chesterPrivatization of government offices is not new to the 21st Century. Neoliberalism became very popular in early 20th century in order to counter act the negative economic impact experienced  in major US cities at the height of  industrialization and suburban flight. Christopher Mele divides this neoliberal form of government into two phases; the “rolling back” phase when local governments relaxed regulations in order to attract city development; and subsequently the “rolling out” phase when governments partnered with private industry to develop large venues such as casinos and sports stadiums, to enhance economic profit within the city. Mele presents the case of Chester, Pennsylvania, a small, industrial city in the southeastern part of the state, as an example of the two phases neoliberalism.

Chester, PA is a poor city with high rates of crime and gang activity, as well as poor quality schools. Similar to other major cities in the US at that time, the city of Chester experienced industrial decline and suburbanization, leaving the city poor and desolate. Following poor city planning and redevelopment initiatives, the city has become fragmented with each piece having its own specific functions and demographics with little interaction between them. These disjointed enclaves are a result of the first wave of “chasing the smokestacks”, a local version of “rolling back”, which is characterized as actively rolling back urban land use policies while the government prepares to promote private sector development. Following the rollback period of the 1980s, the “rolling out” phase of neoliberalism began in Chester in the 1990s, as the government incentivized private industry capital to invest in their cities. Specifically targeted were sports and entertainment industries.

chester_refin_crop

These public-private partnerships did not take into account concerns of citizens as evidenced by the noise and air pollution emanating from the waste management zone along the waterfront, causing citizens to become concerned with their health and well being. Instead of accommodating private development, private partnerships have come to define how public spaces are used, and these practices further disenfranchise already marginalized groups from the public atmosphere.

 

 

 

 

Setha Low “The Erosion of Public Space and the Public Realm”

zucotti

What Does public mean? Who do public spaces (streets, sidewalks, parks, etc.) belong to? Who defines their use? Seath Low argues that the control and use of public space is determined by homeowners, power elites, corporations, local government and city planners. These “public” spaces have become privatized, excluding certain groups from utilizing them. Preventing disenfranchised groups from entering and utilizing public spaces further alienates these marginalized groups, removing from the public eye altogether.

Discouraging use of public space by all groups removes the chances for social interaction and exchange of ideas. No longer will diverse groups interact and learn from each other. Setha Low states that through the privatization of public space, Americans are losing valuable public space within our cities that serve as hubs for political and social action. Privatization occurs when private groups acquire public space, forcefully limit access and utilization thorough extraneous rules, such as limiting the number of shopping bags and sitting on landscaped seating walls (both are clearly geared toward homeless) and heavily surveil those that do enter.

sonyLow presents specific instances of privatization of New York City’s public spaces including the World Trade Center Memorial, which was turned in to another “cemetery” according to battery Park City residents. Through interviews, residents had expressed their preference to have greater economic vitality by encouraging more businesses and visitors. Concerns of the residents were not taken into consideration when the memorial was eventually constructed.

Low and colleagues performed ethnographic studies at parks, historic sites, and beaches and from that research, developed principles that encourage cultural diversity in urban parks and historical sites, especially as they relate to retain the history of culturally diverse groups. Creating space to encourage diverse interactions is important in retaining positive characteristics of the urban life.

S. E. Merry “Spatial Governmentality and the New Urban Social Order: Controlling Gender Violence through Law”

panhandleMany cities define spatial areas that are off limits to certain social groups in order to control types of undesirable behavior. These forms of control are not always obvious. Obvious regulatory methods include surveillance technologies and zoning laws, such as drug free zones, gun free zones, and panhandler free zones, which are developed to regulate certain behaviors from occurring. Other, less obvious methods of social control were implemented in specific areas of cities to regulate the space in which the behaviors happen. Examples of spacial regulation include deterring socially unacceptable behaviors in certain areas but allowing them and others, such as prostitution and gambling, and gated communities preventing entrance of “undesirables” to specific areas.

The regulation of public space governs the whole population, and actually serves as an anticipatory mechanism developed to prevent behavior that may happen instead of punishing offenders after they have acted. Merry considers this form of social control “governance through risk management” rather than “preventing transgressions”. As governments shift more to risk management practices, the operation of police forces have also shifted. Law enforcement subsequently attempts to secure spaces by keeping out criminals altogether, rather than preventing and/or punishing criminal activity in those spaces.

jails_webMerry provides three distinct forms of governance: punishment, in which offenders are punished; discipline, focuses on reforming offenders using training in therapy; and security, where the goal is to prevent the offenders from sharing space with potential victims through spatial segregation. The author describes how each is used in approaches to prevent gender-based violence. The first form of government, punishment, was the preferred form of action for offenders from about 1970 to 1990. Punishment for gender violence included mandatory arrest, no drop prosecution and mandatory incarceration. In the 1990s, the preferred method for governing batterers was disciplinary action, which were levied against the person, rather than the offense. This method incorporates therapy and group support systems. The third form of governance, security, involves securing the general population form potential threats from offenders. These methods attempt to mitigate dangers by predicting who may engage in gender violence and then preventing the offense from happening. An example of this is restraining orders that prevent offenders from engaging with their victims.

The examples of governance described above will have negative effects for some sections of society but the author argues that they have proven beneficial for poor women and encourages governments to reconfigure practices that are more conducive to a postmodern, globalized world.

 

Karin Aguilar-San Juan “Staying Vietnamese: Community and Place in Orange County and Boston

Neighborhoods take on the cultural characteristics as their inhabitants. Place-making activities influence and shape the characteristics of neighborhoods. Karin Aguilar-San Juan focuses on these activities in two Vietnamese neighborhoods, one in Orange County California, the other in Fields Corner in Boston Massachusetts. The major difference between the two is that in Orange County there is a clear delineated location called Little Saigon representing the Vietnamese ethnic community, while in Fields Corner, the Vietnamese community overlaps with other enclave communities. Although the two communities appear to be very similar, Aguilar-San Juan presents marked differences, specifically population size, geographic distribution, and institutional completeness. The Orange County Vietnamese community has approximately seven times the population as Fields Corner, with the majority (75%) living in five adjacent cities, while the Vietnamese community in the Boston were scattered throughout the area among four non-adjacent neighborhoods.

Orange County, California historically has been an area indicative of suburban white privilege, that was developed deliberately as an area catering to for-profit enterprises, however, by the 1970s the demographics were changing as a result of an influx of Vietnamese refugees. Vietnamese shops, groceries and restaurants began to sprout roots in these areas. Through symbolization and territorialization, Little Saigon was formed. This area provides vigorous activity for the Vietnamese community so much so that Vietnamese living hundreds of miles away travel here for shopping and community.

The Vietnamese community in Fields Corner Boston began to form in 1975 when the Vietnamese refugees settled in the Chinatown Area of Boston. Eventually, high rent Forced Vietnamese into Fields Corner where their place-making activities made them the most powerful, albeit the smallest, immigrant group in the community. There the Vietnamese developed long term support systems, including affordable housing, jobs and child care services, that would ensure the survival snd success of the community. Their plans to develop a culturally-centric community have not proved successful as in Little Saigon, some initiatives that are thriving in Orange County, such as community centers and Vietnamese Soldier memorials, were not supported in Boston, preventing strong symbolization and territorialization of the Fields Corner Vietnamese community.

Regardless of the differences in their place-making activities, both communities have found a way to develop and grow among the American cities and “stay Vietnamese” in the process.

Edward LiPuma and Thomas Koelble “Cultures of Circulation and the Urban Imginary: Miami as Example and Exemplar

Miami’s proximity to  countries such as Cuba, Colombia, Haiti and Venezuela lends credence to the notion of LiPuma and Koelble that Miami is a post modern global city critical for the circulation of goods, people, services, and capital. The amount of people and goods that flow in and out of Miami is impressive. In any given month, about 3 million people, half of whom are classified as international travelers, enter and exit Miami. About 8 million tons of goods flow through the Port of Miami annually, making Miami a multiethnic, multicultural world city.

LiPuma and Koelble argue that a multi-cultural multi-ethnic city with international networks such as Miami has only become this exemplar city through urban imaginary, a narrative of the city’s contemporary and historical “story” that presents it as cohesive infrastructure. Miami politicians and the chamber of commerce would have one believe that Miami is a social totality, a stable, concrete city, rather than pluralities of multi-centric circulations. This imaginary identity has allowed Miami to grow as post modern global city.

Miami, an example of the postmodern city, is  pivotal for circulation of cultures via immigration, tourism, business travel, as well as vacationers and temporary residents. The authors state “Miami seems to function as an infrastructural platform for the flow of cultural forms through superimposed spatial planes that have literally no beginning or end.” In other words, Miami functions as a city of shifting identities with no definite governmental scale but rather scales defined more by the city’s interaction with multiple countries, primarily Latin and Caribbean countries. Miami is a web of unincorporated cities whereby each area functions in plurality rather than in totality. The authors argue that reasons for this are rather than shedding their home culture, immigrants and new residents retain their cultural identities and create a composite city made up of heterogeneous parts. Connectivity between each part of Miami is absent. Miami as a global city is more connected to external relationships with international cities, such as Mexico City, Havana and Bogota.

Richard Florida “Cities and the Creative Class”

Florida posits the idea of a creative capital thesis in which he believes creative and talented residents are key to contemporary urban growth and development. Florida argues that the cultural aspects of the city is a key factor in attracting a highly desirable creative workforce and that some cities attract larger proportions of the “creative class” than do others and he set out to find out why.

In contrast to Robert Putnam’s social capital theory, Florida found that contemporary communities tend to focus less on building strong community ties and residents were actually more content with weaker ties as these ties proved to be less invasive connections. These weaker ties allowed residents to maintain “quasi anonymity”.  A more contemporary theory,  the human capital theory of regional development, posits that the economic importance of a locale determines rate of growth, and you become economically important with highly educated and productive people working.  Florida asks why then are these highly educated productive people concentrated in certain places. Florida wants to know how do people decide where to locate. He produced the creative capital perspective.

In his research, Florida found that creative people do not just simply follow the jobs instead lifestyle considerations as well as economic considerations mattered in their decisions. The creative class prefers places that are innovative, diverse, and tolerant. He concludes that creative people are key to economic growth and found that there are underlying factors that shape their decision on where to locate.The creative class is drawn to certain areas based on specific criteria, which Florida termed as the “new geography of creativity”.

Richard Florida argues that cities should focus less on infrastructural attractions and focus more on becoming centers of cultural experiences. Rather than building sports and entertainment districts, Florida argues the focus should be on marketing their cities as diverse and creative communities.

Peggy Levitt “Social Remittances: Migration Driven Local-Level Forms of Cultural Diffusion”

As echoed by Stoller and McConatha, Levitt writes on binational societies that form when immigrants bring their former home life to their current host life. The word used to describe these transfers is social remittance. Developing out of this flow of practices, identities and social capital from the host nation to home country communities leading to a transnational public sphere.

Unlike in previous times, ties between the two nations are easily maintained through the process of globalization including advancements in technology and telecommunications. Levitt posits to 5 factors that strengthen and sustain these transnational ties:

  1. ease of travel and communication;
  2. important role migrants play in the economies of their home nations;
  3. legitimization attempts by home nations in supporting migrants and there families;
  4. importance of host nations in the politics and economics of home nations;
  5. marginalization of migrants in their host nation.

If ties to home nations are severed, the transnational public sphere will fall apart.

Levitt presented the case of the United States/Dominican Republic (DR) community. Because of their close proximity, it is relatively easy and affordable to travel between the two countries and the quality telecommunications structures allow migrants to connect with family through telephone calls. Through the ease of free flowing social remittance transfers, the American culture can already bee seen in the DR. America has also been involved in the public and economic affairs of the islands for years, also raising the intensity of social remittance.  Immigrants to the DR hold strongly to their home nationalities and cultures, creating a strong social remittance transfer.

During these transfers, normative structures, systems of practice and social capital are exchanged between the two nations. In order for remittances to be successfully transmitted, they must be broken down, or compressed, which can lead to misinformation and confusion, as in the case of values and norms, which are interregnal belief systems that are sometimes lost in translation, and become weak remittances.

There are pros and cons to this process of remittance, a major positive outcome has been the constructive change brought about in the political and legal domains in the home nations; immigrants communicate back to their families and former compatriots, their high opinion of the fair systems experienced in the US, which in turn can provide the catalyst for that nations reformation of the political and judicial systems.

I certainly have a deeper understanding of the power of globalization and how its has had a major impact on the ways in the which the world operates and communicates and has even influenced social reform.