Research project SO/03/025 (Research action SO)
The purpose of the exploratory phase is to collect and study what has already been done in quantitative and qualitative research. One will take as a basis for this (inter alia) the "Infosource"bibliographic database of the Society and Health Support Centre. One will also seek quantitative databases from which we can ourselves distil new information relating to the health problematic of vulnerable groups. Here we are thinking in the first instance of the Belgian Health Survey, which still contains a great deal of unexploited material, but also of (e.g.) the Panel Study for Belgian Households (PSBH) and the Sentinel Health Event database developed within the Medical Sociology Department of the V.U.B. and relating to ambulatory rehabilitation patients. Special attention will be devoted to gender-related differences within the (needs of) new vulnerable groups. Finally, on the basis of the literature we will also form for ourselves a better picture of the extent to which already-existing schemes meet the inventoried needs.
The result of this first phase will be an interim report offering an overview of (1) existing qualitative and quantitative research results, (2) new quantitative findings, and (3) existing schemes relating to the needs of new vulnerable groups in health care.
However, the research material now available does not cover all vulnerable groups. Moreover, experience from studies on the profile of risk groups in health care teaches us that databases can often elucidate only one part of a more complex story, and usually offer little in the way of concrete policy solutions. Very important supplementary knowledge can be found among persons whose professions give them a good view of the profile and needs of (new) vulnerable groups in health care. Public social services centres such as the OCMW´s [Openbaar Centrum voor Maatschappelijk Welzijn] and organisations providing social services in hospitals, for example, are often the first to see which new vulnerable groups are emerging and what specific needs are still not being met within the health care system. From another perspective, researchers within insurance institutions and policy-making authorities are very well placed to acquire a comprehensive picture of the health care problematic of new vulnerable groups and potential solutions. These are only a few examples of the various ´experts´ on the problems of new vulnerable groups in health care. By surveying as representative a sample of these experts as possible, the method of the Delphi study allows one to bring together the extensive knowledge coming from all of the various policy-relevant perspectives in the broad field of health care.
The Delphi study planned in the second phase proceeds from the findings of the exploratory phase. After all, the exploratory phase provides us with a scientifically based blueprint of the profile and the needs of the new vulnerable groups, as well as of the gaps existing in the health care system. The Delphi study is then designed to refine, adapt and complete this blueprint on the basis of the knowledge of a panel of experts. The selected experts are asked to (1) evaluate and refine our selection of new vulnerable groups and their needs, (2) reflect on gender aspects in the problematic, (3) enumerate the advantages and drawbacks of existing provisions and measures, and (4) present their views of a number of possible future avenues for policymaking. This survey is conducted on the basis of a questionnaire which gives the experts enough room to their present their views in detail. Sufficient time is allotted for the precise drafting of this questionnaire.
The written answers of the panel of experts will be analysed by a team of two researchers. One consciously chose for two researchers in order to eliminate any potential interpretative bias as far as possible. The researchers are primarily seeking the points of agreement in the responses of the panel. The global findings of the researchers are then returned to the panel members, who are asked whether they are agree with them. The panel members are also offered a chance to further refine or supplement their initial responses. These answers are once again processed and brought together in a text, which forms the point of departure for a concluding workshop. At this workshop, all of the participating experts will sit down together around the table, where they will have an opportunity to propose adaptations for a last time. The objective is to arrive at a policy-relevant final text which is as broadly based as possible concerning the profile of the new vulnerable groups, their specific needs, and possible policy interventions to address them.
The specific tasks of the PROJECT are the following:
A. EXPLORATORY RESEARCH PHASE.
A.1. In the first instance, the concept ´new vulnerable group in health care´ must be defined and made more explicit. This is done in order to have a theoretically grounded, clearly delineated and empirically usable concept for the further course of the research.
A.2. Collection and stocktaking of existing databases, research results and publications which contain information about new vulnerable groups in health care.
A.3. The collected sources will be systematised and analysed with a view to:
(1) identifying ´new vulnerable groups in health care´;
(2) describing the social-economic profile of these ´new vulnerable groups´;
(3) clarifying the needs and problems which exist in their relationship with health care; and
(4) making an inventory of policy measures which have already been implemented in order to meet the needs of these groups.
This phase of the research includes both study of the relevant literature on the subject (scientific publications, policy texts, viewpoints of involved organisations, etc.) and exploration of existing quantitative databases.
A.4. The results from the above-described research will not only serve as substantive support for the Delphi study, but will also lead to an interim report on the current situation with regard to the new vulnerable groups.
B. DELPHI STUDY.
A Delphi study will be conducted in this phase of the research. The blueprint deriving from the exploratory phase will serve as the basis for this study. The objective of the Delphi method is to refine, adapt and complete this blueprint.
B.1. A first part of the Delphi study includes the development of a questionnaire in which the above-formulated objectives are expressed.
This stage also sees the constitution of the panel of professional experts for the Delphi study. These experts will be recruited from persons who are professionally involved with the problematic (OCMW´s, research institutions, health insurance funds, government institutions, aid organisations, etc.).
In this recruiting stage, contacts are also established for selecting persons who belong to vulnerable groups (based on the analysis results from phase A). These will be selected as "empirical experts" with a view to performing a number of in-depth interviews.
B.2. In a following step the questionnaire is sent to the selected experts. The experts will reflect on:
(1) the selection made in phase A of ´new vulnerable groups´ and their needs. They will evaluate and, where necessary, refine this selection;
(2) the gender aspects of the problematic;
(3) existing schemes and measures, indicating their respective advantages and drawbacks;
(4) finally, these experts will present a number of possible future avenues for policymaking, and their personal views about them.
The research group will furnish the practical and substantive support for the survey.
B.3. The research group will systematise and process the answers sent in into a synthesis which will serve as a feedback instrument for the experts.
On the basis of the answers from the previous round, a new questionnaire, personalised for each expert, will be composed. This questionnaire will refer to both the overall group answers and their own contribution.
B.4. The experts receive the feedback together with the second questionnaire. On the basis of the feedback and the questionnaire, the experts can change, nuance or further explain their earlier responses as necessary. The objective is that, on the basis of the first synthesis, the experts will - independent of one another - order the various ideas (about which groups are ´vulnerable´, the profile of these groups, what the problems are and which are the potential policy measures) into a priority list.
Here once again, the research group will play a supporting role.
B.5. The answers to the second survey are once again systematised, and interim conclusions are drafted and communicated to the experts.
This text will serve as the basis for a concluding workshop which will have been prepared in the meantime.
B.6. An already-selected group of empirical experts will be interviewed in a semi-structured way. These interviews will afford a picture of the concrete experiences of persons who belong to the defined groups. The following themes will be dealt with in the interviews:
(1) Why do the interviewees feel themselves to be in a vulnerable situation? What are the characteristics, the causes and the consequences of their vulnerable situation?
(2) Which concrete problems and needs do the interviewee’s experience, and where are the stumbling blocks in their relationship with the health care system?
(3) Do they see possible policy solutions for remedying their specific problems?
The results of these interviews will be worked up into a summary report which will be compared with the conclusions of the Delphi group.
B.7. A workshop is organised for all participating experts. Here they can propose adaptations for a last time, and the experts will also be confronted with the results of the interviews with empirical experts. The goal is to arrive at a policy-relevant final text on the profile of the ´new vulnerable groups´, their specific needs and possible policy interventions to address them.
C. REPORTING PHASE.
In the closing phase of the research, the findings will be written up in a final report. In addition, a summarising brochure for policymakers will be composed and a text prepared for publication on the Internet.
Nieuwe kwestbare groepen in de Belgische gezondheidszorg : eindrapport
Vanroelen, Christophe - Smeets, Tom - Louckx, Fred Gent : Academia Press, 2004 (PB6031)
Nouveaux groupes vulnérables en matière de santé en Belgique : résumé
Bruxelles : Politique scientifique fédérale, 2003 (SP1196)
[To download]
Nieuwe kwetsbare groepen in de Belgische gezondheidszorg : samanvatting
Brussel : Federaal Wetenschapsbeleid, 2003 (SP1197)
[To download]
New vulnerable groups in the Belgian health system : summary
Brussels : Federal Science Policy Office, 2003 (SP1198)
[To download]
