Insured Women's Access to Infertility Care: How 'Fair' Is It Even With Family Healthcare Insurance?

Journal of Multicultural Nursing & Health, Fall 2003 by Griffin, Martha

Overall the women who participated in the study ranged in age from 21 to 49 years (M = 34.7, SD = 5.4). The women from non-mandated states (group 1) ranged in age from 23 - 47 (M = 33.5, SD = 5.3) and from mandated states (group 2) 21 - 49 (M = 36.3, SD = 5.1). Table 1 summarizes other sample demographics and characteristics of the population such as: ethnicity, occupation (professional -nonprofessional), type of insurance (commercial, indemnity, HMO, self-insured) and status of the infertility (still in treatment, have biological children, have adopted children, not in treatment without children).

Procedure

Following approval of the University of Rhode Islands' Institutional Review Board, 450 questionnaires were distributed by mail and 242 were returned over a six month period of time. Once the Access to Infertility Care Scale_survey (was returned it was scored and grouped according to the participants geographic location and infertility insurance mandated status (social opportunity context). Confidentiality was accomplished by securing all collected data in a locked file and identifying respondents by a number only. A sample of 242 criteria appropriate women was a sufficient sample size for exploring both the perceptions of access to infertility care experience and the underlying psychometric properties of the Access to Infertility Care Scale.

Instrumentation

Based on a concept analysis and the development of a theoretical and operational definition for access to infertility care, the Access to Infertility Care Scale (Griffin, 1996) instrument was developed (Gable, 1987), pilot tested and restructured to be psychometrically sound (Munro, 1997) and used in this study. The revised Access to Infertility Care Survey (Griffin, 1999) that was used is a 22 item, four point Likert (1932) scale (range 0-88) with ten Entry-barrier items (range 0-40) and twelve Fair chance of passage items (range 0-48). Added to the questionnaire was one follow-up qualitative question asking individual women if they felt that they had a fair chance to be treated for infertility (Tilden, Nelson & May, 1990).

DATA ANALYSIS

Descriptive statistics were used to describe the sample, as performed on the Statistical Package for Social Sciences (SPSS 9.0, 1997). A t test was used to compare the means between women in states with infertility mandates and states without mandates (Table 2), based on: total access to infertility scores (Table 3); total entry barrier scores (Table 4) and total fair chance of passage scores (Table 5). The items from the IAICS related to 'Entry' and 'Passage' are compiled in Table 6. The qualitative data from the follow-up question was incorporated into the discussion section in support of the quantitative findings (Sapsford, 1999; Tilden, Nelson, & May, 1990).

Reliability analysis was conducted using Chronbach's Alpha on the items contained in the IAICS survey (Griffin, 1999). The coefficients listed in Table 5 correspond with the total items, entry barrier items and passage items respectively.