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381-Handbook For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 12th Edition-Suzann

Utilisation of healthcare services refers to the accessibility and affordability of the household to avail services pertaining to health, particularly the poor household in which the elderly lived. It is well known that people in rural India are more vulnerable to death by diseases because they are not utilizing the health care facilities. The reasons of not utilizing the healthcare facilities are unawareness, illiteracy, lack of facility available in their village.With this background, current study was conducted to study healthcare service utilization amongst elderly residing in rural area in District Bareilly. A Cross sectional study was conducted from May 2013 to Apr 2014 amongst the families registered with RHTC of Department of Community Medicine, SRMS IMS at Bareilly, UP. A sample size of 200 was calculated considering prevalence of utilisation of healthcare services amongst elderly aged 60 years or more to be 68% as reported by Sanjel S et al and taking relative allowable error of 10%. Systematic random sampling was employed to select the elderly and appropriate statistical tests were used where required. 41.4 % elderly had fallen sick in the last six months and common ailments included diarrhoea, cold, pain in lower limbs and weakness. 65% of the elderly had sought medical care for their ailments. Eight percent elderly needed hospitalization and the commonest reasons were weakness (33%) followed by diarrhoea (24%). Allopathy (72%) followed by home remedies (13%) were preferred by rural elderlies for relieving themselves. Commonest reasons for not seeking healthcare services were affordability (37%) followed by other reasons including ailment not serious, no faith in doctors and ignorance.

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0% found this document useful (0 votes)
2K views4 pages

381-Handbook For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 12th Edition-Suzann

Utilisation of healthcare services refers to the accessibility and affordability of the household to avail services pertaining to health, particularly the poor household in which the elderly lived. It is well known that people in rural India are more vulnerable to death by diseases because they are not utilizing the health care facilities. The reasons of not utilizing the healthcare facilities are unawareness, illiteracy, lack of facility available in their village.With this background, current study was conducted to study healthcare service utilization amongst elderly residing in rural area in District Bareilly. A Cross sectional study was conducted from May 2013 to Apr 2014 amongst the families registered with RHTC of Department of Community Medicine, SRMS IMS at Bareilly, UP. A sample size of 200 was calculated considering prevalence of utilisation of healthcare services amongst elderly aged 60 years or more to be 68% as reported by Sanjel S et al and taking relative allowable error of 10%. Systematic random sampling was employed to select the elderly and appropriate statistical tests were used where required. 41.4 % elderly had fallen sick in the last six months and common ailments included diarrhoea, cold, pain in lower limbs and weakness. 65% of the elderly had sought medical care for their ailments. Eight percent elderly needed hospitalization and the commonest reasons were weakness (33%) followed by diarrhoea (24%). Allopathy (72%) followed by home remedies (13%) were preferred by rural elderlies for relieving themselves. Commonest reasons for not seeking healthcare services were affordability (37%) followed by other reasons including ailment not serious, no faith in doctors and ignorance.

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Appendix A.

- Instrument Development, Reliability and Validity

A question sometimes asked about the SWYS is how valid and reliable is it? In other words,
how accurate is the information that was obtained? There is no simple answer to this question.
In this chapter, we will try to clarify some of the relevant issues, and speculate about the datas
accuracy and limitations.
Validity is usually defined by the question, Are we measuring what we intended to measure
or how accurate is the measure at assessing a given behavior or belief? Reliability refers to
the consistency or reproducibility of a measure. 1 If a measure is reliable, it will agree with itself.
For example, if students are administered a measure that has a low reliability on two
consecutive days, it is likely that their responses on the first day would be different than their
answers on the second day. Reliability is a necessary, but not sufficient precondition for
validity. Validity requires looking not just at the content of the survey but also includes, how the
survey is conducted and how it relates to other surveys.
One way to increase the reliability and validity of a measure is to use a well-established
measure that has demonstrated reliability and validity. Whenever possible this was done in the
survey. Many of the measures in the survey are established measures that have demonstrated
fairly high reliability and validity. For instance, the depression measure that was used is the
short form of the Beck Depression Inventory. It is one of the most widely used measures of
depression. 2 Most of the drug and alcohol questions come from widely used national survey
instruments, as do the questions dealing with suicide.
It should also be noted that most of the measures developed specifically for this survey have
been examined for their reliability and validity. Those survey items that did not measure up to
this scrutiny were either dropped or redesigned for this present survey.
Inaccurate reporting by teens on self-report surveys such as SWYS can arise through a
number of mechanisms. The amount of social stigma that teens perceive with a given measure
and social desirability effects are thought to play a particularly important role in the accuracy of
substance use reported by adolescents. For example, a greater willingness of adolescents to
report drug use in school-based settings than at home suggests that perceived confidentiality
of responses and the acceptance of peers influence adolescents willingness to report
substance use truthfully. 3 Adolescents also have been found to revise their pasts as their
current behavior changes. 4 Studies have also found that violence including victimizing other

Farmington, Gale. (2004) Measurement. World of Sociology.


Weibe, J.,Penley, J., (2005) A Psychometric Comparison of the Beck Depression Inventory II in English and
Spanish. Psychological Assessment, 17, 481-485.
3
Harris, Katherine M., Griffin, Beth Ann, McCaffrey, Daniel F., Morra, Andrew, R., (2008) Inconsistencies in SelfReported Drug Use by Adolescents in Substance Abuse Treatment: Implications of Outcomes and Performance
Measurement. Journal of Substance Abuse Treatment, 34 347-355.
4
Rosenbaum, Janet E., (2008) Truth or Consequences: The Intertemporal Consistency of Adolescent Self-Report
on the Youth Risk Behavior Survey. American Journal of Epidemiology, 169, 1388-1397.
2

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students can be accurately measured with self-report questionnaires but has an increased
variance possibly due to social stigma. 5
While it is still being debated as to how to get students to report honestly, some researchers
suggest impressing how important it is to tell the truth, which was emphasized through the
training for survey administrators. Other suggestions include: having reliability checks within
the surveys, controlling for social desirability as much as possible, and stressing that results
will be anonymous. 6
In order to detect a more sophisticated source of error, we compared response patterns across
related questions. Two such scales were developed to check the reliability of responses to
questions regarding alcohol and sexual intercourse. In both cases, responses to the target
behaviors were compared across questions. Where possible, we compared questions that
were spaced across several pages of the survey in order to best identify consistency in
reporting. Overall, our analysis indicated a high level of reliability across the questions for
these behaviors.
On the topic of sexual intercourse, 5,528 participants consistently stated their level of sexual
experience across all questions asked. This produced an inter-question reliability of 96
percent. In addition, 5,056 participants answered consistently about their level of alcohol use.
This gives us an inter-related reliability score of 88 percent. Taken collectively, these measures
suggest the teens were motivated to remain consistent in their responses throughout the
survey.
Despite all prudent efforts, as with any self-report survey aimed at teenagers, there is always
the possibility that a small percentage of those surveyed will not take the survey seriously.
Fortunately, most teenagers who do not take the survey seriously are not subtle with their
responses. They typically exaggerate their responses to such an extent that their surveys are
easy to spot and remove.
Another question often asked about surveys of this type is how representative are the findings
for students in general? One factor to keep in mind is that the survey only represents the
responses of students who were in attendance on the day the survey was administered.
Studies have shown that students who are more frequently absent or truant are also more
likely to use illicit drugs, drink alcohol, smoke, and engage in potentially problematic and
dangerous activities. 7 As a result, the current findings are likely to be a slight underestimate of
the actual incidence of such problem behavior in all youth who are currently enrolled in school.
It should also be noted that the numbers presented in this report reflect only adolescents
enrolled in school, not those who have dropped out. There is some evidence to indicate that
school dropouts are somewhat more likely than those enrolled in school to be users of illicit

Branson, Christopher E.,, Cornell, Dewey G., (2009) A Comparison of Self and Peer Report in the Assessment
of Middle School Bullying, Journal of Applied School Psychology,25, 5-27.
6
Whitford, Jennifer L., Widner, Sabina C., Mellick, Davis, Elkins, Ralph L., (2009) Self-report of Drinking
Compared to Objective Markers of Alcohol Consumption., The American Journal of Drug and Alcohol Abuse, 35,
55-58.
7
Fletcher, Adam, Bonell, Chris, Hargreaves, James, (2008) School Effects on Young Peoples Drug Use: A
Systematic Review of Intervention and Observational Studies,. Journal of Adolescent Health, 42, 209-220.

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Crawford, Grant, Iowa, Lafayette and Richland Counties

drugs and alcohol and to engage in other problematic behaviors. 8 Consequently, the numbers
presented in this report probably underestimate the actual incidences of alcohol and other drug
use for all teens in southwest Wisconsin.
For a practical survey such as the present one, the issues of reliability and validity are only a
means to an end. The real question is How will the measure and the data it produces be
used? If the objective is to predict or evaluate the behavior of a particular individual, then the
precision of the instrument is extremely important and imprecision can be a problem. In
contrast, if the objective is to determine the prevalence of a particular behavior or behaviors for
a given population (our current interest) then greater imprecision is usually tolerable.
Use of Scales in Reporting Data
A series of scales were developed in order to ascertain general patterns for questions that are
believed to measure a similar trait. Aggregating scores in this manner helps increase the
reliability of that measure. For this study, we developed eight such scales designed to measure
dimensions such as family rules, parental communication, and monitoring; the teens
satisfaction with their school, how they use their time, and their attachment to the community; a
general measure of the teens risk factors and protective factors; and a measure of the teens
overall self-esteem. The range for each scale was then categorized into mutually exclusive and
exhaustive quartiles for comparison.
Three separate scales were developed to measure the teens descriptions of their relationships
with their parents. The first scale was Parental Monitoring. This scale summed the responses
from six questions. Higher scores corresponded to teens responding their parents had greater
awareness of the teens on-going behaviors. The second scale was parental communication.
This scale was an overall measure of the teens perception of their communication with their
parents. It included four questions.
The final parental based scale measured teens perception of their parents communication
and consequences for violating family rules. This scale summarized the responses to two
questions and higher scores corresponded to greater consistency in communicating and
enforcing consequences for violating family rules.
Two scales were developed to measure the teens perception of community involvement and
satisfaction with the community and school. The first scale measured the teens overall
satisfaction with their school and was affected by the answers to seven questions. Higher
scores correspond to greater satisfaction with the school. The second scale measured the
teens attachment with their larger community. This scale was derived from the sum of six
questions. Higher scores reflect strong connection to the community.
A scale was created to measure how teens use their time. It aggregated the responses from
six questions and higher scores indicated more constructive use of time. The next scale was a
general measure of the teens self-esteem. It was computed by combining four questions.
Higher scores correspond to more positive reports of self-worth and positive attitudes about
themselves.
8

Townsend, Loraine, Flisher, Alan J., King, Gary, (2007) A Systemac Review of the Relationship between High
School Dropout and Substance Use, Clinical Child and Family Psychology, 10, 295-317.

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The final scale measured the teens experience with factors that have been shown to put them
at risk and factors that have been shown to protect them from risky behaviors. The results
related to this scale can be found in Chapter 13: Indicators of Positive Youth Development.
This scale was created by aggregating the results of 31 questions. A high sum score
corresponded with increased number of protective factors.
Generally the scales were used to determine if the issue they measured made a difference in a
particular behavior or attitude. At times responses had to be reverse scored to be sure that
higher numbers represented a response that would indicate a higher level of the characteristic
being measured.
Not every scale is used in this report. Occasionally quartiles have been collapsed for easier
presentation of the data or because the number of students falling in a quartile was deemed
too small to give meaningful data.

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Common questions

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The Southwest Wisconsin Youth Survey ensures its results reflect actual behavior trends by utilizing demographic calibration, aggregating scales for similar traits to increase reliability, and conducting analyses to check internal consistency of responses. Despite potential inaccuracies from self-reporting biases, measures such as exclusion based on exaggerated responses and assessment of absenteeism effects help adjust and interpret findings that are representative of behavior trends among youth .

Potential limitations of self-report surveys include biases like social desirability, recall inaccuracies, and underreporting due to stigma. The Southwest Wisconsin Youth Survey addresses these limitations by employing validity and reliability checks through well-established measures, ensuring respondent anonymity, and comparing response patterns for internal consistency. Additionally, it recognizes the exclusion of certain demographics, such as truant or dropout students, which may skew findings and adjusts the interpretation accordingly .

The perceived confidentiality of responses significantly impacts reporting accuracy in self-reported surveys involving adolescents. Adolescents are more likely to accurately report behaviors, especially those that might be stigmatized, such as drug use, when they believe their responses are confidential. This suggests that the environment in which the survey is administered affects their perceived confidentiality and, consequently, their willingness to report behavior truthfully .

Social stigma and social desirability can lead to underreporting or misreporting behaviors like substance use in surveys due to fear of judgment or desire to conform to perceived norms. To mitigate these effects, surveys can assure confidentiality, use validated measures to compare response patterns for internal consistency, and employ controls for social desirability. Emphasizing anonymity and stressing the importance of truthful reporting can also help reduce these biases .

To ensure reliability and validity, the Southwest Wisconsin Youth Survey utilizes well-established measures with demonstrated reliability and validity, like the Beck Depression Inventory for depression. Measures developed specifically for the survey are examined for their reliability and validity, and those that do not meet standards are dropped or redesigned. The survey also incorporates reliability checks, such as comparing response patterns across related questions, to detect inconsistencies and ensure high reliability of reported behaviors like alcohol use and sexual intercourse .

Factors affecting the accuracy of self-reported data in youth surveys include social stigma, social desirability effects, and perceived confidentiality. These factors influence behavior reporting as adolescents may be more honest in environments they perceive as confidential and where there is peer acceptance, which is why settings like schools often yield more truthful reports of behaviors such as drug use. For example, adolescents are more willing to report drug use in school-based settings than at home . Additionally, inconsistent behavior reporting may arise as adolescents revise their pasts as their current behavior changes .

Student absenteeism on the survey day can lead to an underestimation of certain problematic behaviors. Students who are absent are generally more likely to engage in high-risk behaviors such as drug and alcohol use, thus their exclusion from the survey results may affect the accuracy of the estimated prevalence rates of such behaviors among the general student population .

Data from the Southwest Wisconsin Youth Survey indicates high consistency in adolescent self-reports for behaviors such as alcohol use and sexual intercourse, with reported inter-question reliability scores of 88% and 96% respectively. This suggests that participants were generally motivated to remain consistent in their responses throughout the survey, providing reliable data on these behaviors .

The exclusion of school dropouts affects the representativeness of the survey findings, potentially leading to an underestimate of problematic behaviors. Dropouts are more likely than enrolled students to use illicit drugs, alcohol, and to engage in other problematic behaviors . Therefore, findings based only on school attendees likely underrepresent the actual prevalence of these behaviors among all teens in the area .

Scale development plays a critical role by grouping responses to measure related traits, such as parental communication and community involvement, which enhances reliability through consistent aggregation of related questions. The use of scales allows for more systematic and precise measurement by grouping indicators of single constructs, thus improving reliability and facilitating comprehensive analysis of youth behavior and attitudes .

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