Browsing by Subject "Family support"

Population aging is a global phenomenon occurring both in developed and less developed countries. While families are still playing an important role in providing support for elderly people, governments are also expanding their public old-age support programs in many societies. Public pensions are one of the major policy tools geared to social protection of the elderly. However, little is known about how the programs affect elders particularly in terms of their subjective well-being. Such effectiveness depends in part on the extent to which public pension income displaces or `crowds out' family elder support. Using the introduction of the Basic Old-Age Pension (BOAP), a non-contributory old-age pension in Korea, this dissertation examines the relationship among public support, family support, and life satisfaction of the elderly.

As an introductory chapter, chapter 1, "The continuing importance of children in relieving elder poverty: evidence from Korea," describes the actual financial status of elderly Koreans and the amount of financial support they receive from children. Analysis of the 2006 Korean Longitudinal Study of Ageing shows that almost 70 per cent of Koreans aged 65 or more years received financial transfers from children and that the transfers accounted for about a quarter of the average elder's income. While over 60 per cent of elders would be poor without private transfers, children's transfers substantially mitigate elder poverty, filling about one quarter of the poverty gap. Furthermore, children's transfers to low-income parents tend to be proportionally larger, so elder income inequality is reduced by the transfers. Over 40 per cent of elders lived with a child and co-residence helps reduce elder poverty.

Using the introduction of BOAP, chapter 2, "Does money buy happiness?: Evidence from a new government pension in Korea," assesses how the program affected elders' life satisfaction. Notably, this study adds valuable evidence to the literature of whether money buys happiness, a question of great interest but notoriously difficult to answer given the difficulties associated with isolating income as a causal factor. To make the causal inference, this chapter utilizes a difference-in-difference research design and analyzes longitudinal data from the Korean Retirement and Income Study (KReIS). Results show that BOAP did raise elders' life satisfaction: annual benefits of 1,000 kW, approximately 1,000 U.S. dollars, raised elders' life satisfaction by 0.16-0.22 of one standard deviation and the effect was statistically significant.

Chapter 3, "Public support crowds out family support: Evidence from a new government pension in Korea," investigates how public financial provision affects family support. In particular, the present study provides a novel estimate of crowd-out by BOAP by using a combined measure of financial support and in-kind support received from all adult children regardless of their co-residence status with elderly parents. This paper also examines the impact on co-residence and is the first quasi-experimental study on the crowd-out question using data from an Asian nation. Results from difference-in-difference analyses of the KReIS data show that every $1 from the pension led to a 30-cent drop in children's support, netting a 70-cent increase in elders' income. The impact on the likelihood of elders' co-residing with children was positive but not statistically significant.

By showing that Korean children still play a crucial role in providing financial old-age security, chapter 1 demonstrates how important it is for the Korean government to design old-age policies that preserve the incentives for private assistance. The second chapter suggests that, at least in the context of modern-day Korea, pensions do buy happiness, or at least satisfaction. This finding suggests that researchers and policymakers need to pay further attention to public pensions as a tool to intervene people's subjective well-being. Finally, chapter 3 confirms that crowd-out of family support does occur in Korea and that increases in income, more so than other factors, have a positive impact on elders' life satisfaction found in chapter 2. These findings may generalize to other rapidly changing societies with a strong family elder-support tradition and emerging public elder-support system.

Background

Hypertension (HTN) is a serious public health problem causing an enormous disease burden globally. Non-adherence to medication among hypertensive patients has been identified as one of the major contributors to the poor control of blood pressure (BP). Despite the paucity of reliable, up-to-date data on hypertension in Kenya, existing literature suggests high HTN prevalence in that nation. Additionally, the control of hypertension in Kenya faces many challenges, including the low medication adherence rates among its hypertensive population.

Hypertension as a chronic disease requires long-term disease management, including taking medication daily and making important lifestyle changes. The role of family support for patients during this life-long process has been a topic of interest among many researchers.

The overarching goal of this study is to determine the quantitative and qualitative association between family support and medication adherence among hypertensive patients in Kenya.

Methods

A mixed-method cross-sectional study was conducted in three healthcare facilities in Nairobi, Kenya. A questionnaire and in-depth follow-up interview were included to achieve the quantitative and qualitative goals respectively.

The questionnaire consisted of five sections: demographic information; health and medical information; medication adherence measurements; family support and family function measurements; and BP measurements.

The in-depth follow-up interview was conducted among patients who were willing to participate after the questionnaire survey. An interview guide was designed to lead the semi-structured individual interview with a focus on exploring how family members may contribute to patients’ HTN management.

Descriptive statistics were used to describe the patient profiles; Fisher’s exact test and Chi-square test were used to compare the level of medication adherence and family support among different subgroups of patients; bivariate logistic regression was used to determine the predictors of medication adherence; and multiple logistic regression was used to examine the independent association between family support/function and medication adherence. Grounded theory was used to guide the thematic analysis of the qualitative data.

Results

A total of 104 patients participated in the study. The majority of participants were female (n = 71, 68.27%) and urban residents (n = 95, 91.35%), with a mean age of 56.61 (SD = 11.70).

The overall control rate of HTN among the patients was low, with only 33.98% of them under control. The percentage of highly adherent patients determined by the Morisky Green Scale was 55.77% and was 26.92% as determined by the Hill-Bone Scale. Based on the Perceived Social Support from Family Scale, most of the patients (82.69%) reported strong family support. The majority of patients (77.88%) were determined to have “functional” families by the Family Function APGAR Scale, and 22.12% had dysfunctional families. Both the bivariate logistic regression and multiple logistic regression generated non-significant results for the association between family support/function and medication adherence using either scale.

Three major themes were generated from the qualitative analysis: patients’ family relationship and situation, patients’ perceptions about HTN and medication, and patients’ family in HTN management. The qualitative results suggested that patients’ support from their family members is promising in improving HTN control and medication adherence. However, a low level of health knowledge among patients and their families may present substantial barriers to HTN patients’ medication adherence.

Conclusion

Despite strong family support and a good family function level, HTN patients in Kenya have low medication adherence and are in a critical situation concerning BP control. Lack of health knowledge, limited involvement in patients’ HTN care, and unavailability and unaffordability of antihypertensive medicines are important obstacles that compromise the positive effects of family support on HTN control in Kenya. Future HTN control interventions in Kenya should prioritize providing better health education to the patients and their families, raising people’s awareness for hypertension screening and treatment, and further engaging patients’ families in HTN care. Additionally, the Kenyan government should enhance its healthcare system to ensure people’s accessibility to hypertension medicines and services.