Qualitative research method has been proposed for the research study because it allows the researcher to get the opinions, attitudes, and beliefs of the subjects under study (Williams, 2007; Russell, 2005; Prat, 2006; Runciman, 2002). In addition, the research study shall be conducted in a social context which makes qualitative research method appropriate. The approach allows for in-depth analysis of the social context surrounding racial disparities with regard to differences in health insurance coverage
between African Americans and the whites in South Carolina. As noted by Al-Busaidi (2008), “qualitative research methods are the most suitable for this approach because of their emphasis on people’s lived experience” (p. 12). What this means is that qualitative research explores the experiences of an individual, makes an inquiry based on these experiences, and carries out a study undertaking to understand the environment and the context of the topic under study.
Multiple data collection methods will be used to collect the required data for the research study. The proposed methods are semi-structured interviews, surveys, focus groups, internal data, and observation. The combination of these methods will minimize errors and increase data validity and reliability (Creswell 2003; Creswell, 2007). Data will be collected among the blacks, Caucasians and whites of between 18 and 64 years of age in the state of South Carolina and analysed qualitatively.
The researcher plans to use semi-structured interviews, in which formulated questions related to health insurance coverage between African Americans and Whites in South Carolina will be used. The questions will be formulated and used to develop an interview guide. Interviews have been selected for the study as they allow a researcher to access knowledge and information from people’s perspective (Kajornboon, 2005). In addition, interviews allow a researcher to probe more on the issue understudy, thus giving firsthand information. Each interview session shall be carried out for a maximum of 45 minutes. During the interview sessions, audio recording will be carried out after getting consent from participants. Informed consent to record the interviews shall be sought from the respondents before the research study is conducted. Thematic and coding analyses will be used to analyse the collected data before it is made available for interpretation (Maxwell, 2008; Powell & Renner, 2003; Stacks, 2010). Semi-structured interviews are appropriate for the research study because the issues and themes arising such as levels of disparity between white and blacks with reference to health insurance will be easily noted. Moreover, the researcher has the chance to rephrase any question that the respondents are unable to answer promptly (Kajornboon, 2005). Lastly, since semi-structured interviews are carried in a face to face communication, the researcher is able to develop a rapport, which is necessary in digging deeper.
Survey is among the oldest form of data collection instruments applied in social and health sciences. In most cases, surveys are conducted using questionnaires. Questionnaires have a large appeal to the target population because they are easy to answer and are convenient. Questionnaires can either be postal self-completion questionnaire, online questionnaires, or self-administered questionnaires. The application of surveys as a method of engaging and capturing the behaviours, beliefs and attitudes of a given sample population is appropriate in the healthcare research. According to Athanasiou, Debas and Darzi (2009), surveys as data collection method are appropriate for descriptive studies. For example, the method can be used to investigate the number of African Americans who lack access to health insurance compared to the number of whites in South Carolina. Based on past research carried out in the health domain, surveys encourage reliability when all questions answered, are standardized and answered in a transparent manner (Athanasiou et al. 2009). Surveys have been selected for the research study because they form a straightforward and simple approach that can be used to study motives, beliefs, values, and attitudes and they are applicable to any form of human population. From this perspective, surveys can be used to collect information and data from Caucasians, African Americans (blacks) and whites in South Carolina with regard to disparities in health insurance.
Focus groups are categorized as qualitative research methods which are used to gather people to get their attitudes or opinion towards a certain concept and phenomenon (Leung & Savithiri, 2009). According to Webb and Kevern (2001), focus groups are focused interviews which explore interactions between respondents. In the last decade, focus groups have emerged as one of the best data collection methods applied in social and health care arena. Mansell, Bennett, Northway, Mead and Moseley (2004) define focus groups as “‘simply a discussion in which a small group of people under the guidance of a facilitator or moderator, talk about topics selected for discussion” (p.79). A moderator or a facilitator is used to moderate the discussion carried in focus group discussion (Walden, 2008). Focus discussion groups are arranged which are used to explore the issues under study. For example, in this research study, different groups will be formed from the selected sample population based on age groups between 18-64 years, where the issue of disparities in healthcare insurance with reference to whites and blacks will be discussed. To collect the data, the facilitator and the researcher will audiotape all the interviews which will later be transcribed and categorized into independent themes ready for analysis.
Focus groups are a better choice for the research study because they provide in-depth insights, reliable, and richer data that could be collected through quantitative methods (Curry, Fazio-Griffith, Carson, & Stewart, 2010). Moreover, homogenous groups are required in focus groups who share the same experiences (Mansell, Bennett, Northway, Mead, & Moseley 2004). One of the key benefits of using focus groups is that it facilitates ease of interaction between participants. In addition, participants feel empowered as they are given a chance to articulate feelings, attitudes and beliefs (Curry, Fazio-Griffith, Carson, & Stewart, 2010).
Internal secondary data entails information collected within the population in the area under study. With reference to the research study, internal secondary data is available data collected within the state of South Carolina which could be health insurance reports, health insurance databases, and reports from previous primary research. Reports from previous primary research could be from focus groups or survey results, while health insurance databases might entail descriptive data which gives health history, phone number, contact person, and age among others (McQuarrie, 2005). Internal secondary data is appropriate in the research study because this kind of data is already analyzed and interpreted ready for use. In addition, this form of data is easy to collect, its more accurate, and is the quickest and cheapest form of data (McQuarrie, 2005). The implication made is that internal data unlike data collected from focus groups, surveys, observations, and interviews, requires no labour or facilitators to gather the information. Moreover, this form of data from health insurance perspective other than being accurate is dependable which increases the level of research validity and reliability. The data will be used to supplement primary data during primary data collection process.
Observations as a primary method may either be obstructive observation or participants observations. Owing to the nature of the research study, participant observation has been chosen. This is because this form of observation is used in ethnographic research and it allows the researcher to freely interact with the target sample population and be part of that community (Driscoll 2010). As noted by Fox (1998), participants’ observations allow the researcher to understand and see the situation in the ground rather than relying on a set of participants. With reference to the research study, the researcher will be part of the groups understudy so as to understand the level of disparities with regard to health insurance in South Carolina. The method is appropriate for the research as it allows the researcher to collect first hand information which is free from participants bias (Biabbie, 2010). In addition, this form of data collection method will allow the researcher to study the ethnic diversity of Caucasians, African Americans, and whites and try to understand the behaviour of these people and why the issue of health insurance arise (Taylor-Powell & Steele, 2005). Lastly, the objective of adopting a research design which uses participant observation is to create a holistic understanding of the issue being studied (Kawulich 2005; DeWalt & DeWalt, 2002).
This chapter is based on question 1 which is “What are the racial disparities to access to health insurance in South Carolina?” The question is about racial disparities to access to health insurance in South Carolina. Based on available data, there exist significant disparities among blacks, Caucasians, and whites of between 18 and 64 years of age in the state of South Carolina with regard to access to health care. Blacks in South Carolina are more likely to lack healthcare insurance in comparison with their white counterparts. In addition, an increasingly larger number of blacks in South Carolina live below the poverty line, have reduced annual incomes, report poorer health statuses, and are likely to be less educated in comparison with their white counterparts (Mead et al., 2008). Airhihenbuwa and Liburd (2006) observe that the racial disparities to access to affordable health insurance are high among African Americans. Minority races are less likely to afford insurance cover which makes them prone to poor health condition.
This chapter is based on question 2 which is “How does employment and income level affect health insurance coverage between African American’s and Caucasian’s in South Carolina?” The question explores the influence of income level and employment on health insurance coverage between African Americans and Caucasians in South Carolina. Based on available data and information, African Americans and Caucasians record the highest number of unemployment, hence low annual income (Bennett, Olatosi & Probst, 2008). As a result, African American and Caucasians are less likely to have access to affordable and reliable health insurance in Carolina. Given that these two groups have the highest level of unemployment in South Carolina, they lack employer-sponsored form of health insurance. In South Carolina, 21.7% of the population is uninsured because these people are unemployed and cannot afford self-sponsored health insurance (Kaiser Family Foundation, 2011). Therefore, lack of employment and adequate income has led to an increase in the number of uninsured blacks and Caucasians in South Carolina (Bennett, Olatosi & Probst, 2008). Collins, Hughes, Doty, Ives, Edwards & Tenney, (2002) conducted a study which shows that in 2002, an estimated 41% of the black population in the US lacked employer based insurance, compared to 30 percent of the Whites. These findings could perhaps explain why more blacks in the state of South Carolina tend to have higher uninsured rates compared with their white counterparts.
This chapter is based on question 3 which is “How is the PPACA projected to impact health insurance of African American’s and Caucasian’s in South Carolina?” The question explores the projection or forecasts on how Patient Protection and Affordable Care Act (PPACA) is likely to impact health insurance of African Americans and Caucasians living in South Carolina. The Patient Protection and Affordable Care Act (PPACA), or Obamacare, was passed with the objective of reducing the healthcare costs and the number of uninsured Americans. Under the PPACA, insurance companies are required to offer health insurance to all applicants and provide same rates. The PPACA is projected to positively impact health insurance of African Americans and Caucasians in South Carolina. The projections also indicate that although the number of uninsured residents will reduce, illegal immigrants and citizens not part of Medicaid will remain uninsured. In South Carolina an estimate of between 10.8%-12.5% of women will remain uninsured by 2014 (Levy, Bruen & Ku, 2012).
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