MSP-540 Final Project: International Illnesses and State Health System

This research proposal investigates the effects of international illnesses on the New Jersey state health system. The study aims to determine the impact of global illnesses on mortality and morbidity, healthcare costs, and the awareness and perceptions of healthcare workers. The research will employ a qualitative phenomenological approach, utilizing one-to-one interviews with healthcare staff from primary healthcare organizations in Trenton, New Jersey. The data analysis will involve coding, categorization, and interpretation of interview transcripts to identify key themes and meanings related to the impact of international illnesses. The study is expected to be completed within six months and will adhere to ethical considerations, ensuring participant confidentiality and informed consent.

Running head: PROPOSAL
The effects of international illnesses on the state health system
Name of the Student
Name of the University
Author Note

1PROPOSAL
Executive summary
Comparable to trade, globalisation has created significant impact on international travel, with
severe outcomes for global health. A dramatic increase has been observed in the prevalence
and incidence of international illnesses that were previously restricted to particular nations,
owing to globalisation. The rates of HIV, Ebola, arboviruses, and other diseases have
increased in New Jersey in recent years. This assignment contains a research proposal for
identifying the impact of international illnesses on the state healthcare system. The research is
intended to be based on qualitative phenomenological approach and will focus on interviews
as the method of data collection.

2PROPOSAL
Table of Contents
Introduction................................................................................................................................3
Background and problem statement...........................................................................................4
Research question.......................................................................................................................5
Research aim..............................................................................................................................5
Research objective.....................................................................................................................5
Research methodology...............................................................................................................6
Study design...........................................................................................................................6
Study population and sampling..............................................................................................6
Data collection.......................................................................................................................7
Data analysis..........................................................................................................................7
Study period...............................................................................................................................8
Ethical consideration..................................................................................................................8
References................................................................................................................................10

3PROPOSAL
Introduction
Globalisation is commonly described as a powerful development, which helps
economies become inter-dependent and increasingly integrated. In other words, it is not an
end state, rather dynamic and exerts both a positive and negative impact on health and
wellbeing (Hanefeld, 2015). One major issue that has gained attention in recent years is
increase in the internationalisation of health hazards and risks and this aspect has numerous
dimensions namely, technological, economic, political, scientific, social, and cultural aspects.
The world is currently subjected to a range of challenges and these commonly range from
vaccine-preventable illness outbreak like diphtheria and measles to an augmentation in drug-
resistant pathogen, to climate change and environmental pollution (Fidler, 2016). In addition,
increasing rates of sedentary lifestyle and obesity also create negative health impacts and lead
to humanitarian crisis. According to the World Health Organization (2019) the 10 most
severe threats that demand attention, in order to reduce impact of international illnesses are
namely, air pollution and climate change, global influenza pandemic, non-communicable
diseases, fragile and vulnerable settings, high-threat pathogen like Ebola, antimicrobial
resistance, vaccine hesitancy, weak primary healthcare, HIV and dengue. The New Jersey
department of health is a government agency that oversees several types of health and social
care facilities such as, family planning, hospital, drug abuse treatment, nursing homes,
primary care facilities, adult day care, assisted living, and hospice care. Taking into
consideration the fact that the healthcare system has a range of programs such as State Health
Insurance Program (SHIP), Doulas, Zika Hotline, Population Health Heroes, ScreenNJ, and
Practitioner Orders for Life-Sustaining Treatment (POLST), there is a need to determine the
impact of globalisation and global illnesses on the healthcare system.

4PROPOSAL
Background and problem statement
According to Hawkey (2015) mobility and global trade of individuals has
demonstrated a rapid increase over the last two decades and this has exerted profound impact
on movement and evolution of antibiotic resistance genes. An increase in population
exposure all across the globe to resistance bacteria that arise in emerging economies has also
triggered the spread of the CTX-M group specific extended-spectrum β-lactamases (ESBLs).
Furthermore, the impact of increased ESBL production amid Enterobacteriaceae in Asian
nations is the significant use of carbapenem antibiotics. Meyding-Lamadé and Craemer
(2018) argued that arthropods are responsible for transmission of arboviruses and most of
them contain neurotropic characteristics like Japanese encephalitis virus (JE-V) and dengue
viruses (DENV). Climatic variations, food importations from tropical regions and travel
behaviour have enormously increased the proportion of illnesses caused due to subtropical
and tropical viruses in Europe. Apart from Germany, vaccination has been approved since
2015 for endemic nations. Delaney et al. (2018) also confirmed the prevalence of Zika virus
at the time of pregnancy and the serious birth related defects that occur as a consequence. The
researchers stated that overall 2,962 babies and fetuses (3.0 babies per 1,000 live births; 95%
CI = 2.9–3.2) were able to meet the definition for being affected with Zika virus. In zones
that reported local transmission, a non-statistically significant upsurge was observed in
complete birth defects that were potentially connected to Zika virus infection. The number of
cases increased from 2.8 per 1,000 live births during initial months of 2016 to 3.0 cases
during the later months (p = 0.10).
It has also been stated by Kulkarni et al. (2018) that there occurred a fatal case in New
Jersey, which was associated to the occurrence of Lassa fever that had been diagnosed in a
Liberian traveller. As per reports from the US government, the man worked in diamond
mines and had been subjected to entry screening during his arrival at the airport since he

5PROPOSAL
returned from a nation that had experienced Ebola outbreak during 2014-2015. The findings
of this article were essential since they helped in identifying the fact that Ebola transmission
in New Jersey occurred through travellers, thus called for the need of implementing routine
screening and management policies.
According to Johnson, Ruiguang and Hall (2017) estimated percentage of individuals
aged less than 13 years who had been living undiagnosed with HIV infection during 2014 in
New Jersey was 10.4%. In addition, around 39,200 people aged less than 13 years
demonstrated prevalence of HIV during the same year in the state, with an incidence among
1,100 people of that age. The same was confirmed by Hall et al. (2015) who reported that
43,100 aged less than 13 years had been diagnosed with HIV in New Jersey during 2012, and
of them 16,800 patients were male. This prevalence was attributed to male-to-male sexual
intercourse.
It was also stated by McDonald et al. (2019) on 24th October, 2018, the New Jersey
Department of Health (NJDOH) had been alerted by the Ocean County (New Jersey) Health
Department about a case of measles that was found in an international traveller. The person
manifested signs and symptoms of rash. The department concluded that recent travel of
unvaccinated travelers to Israel, where there had been an outbreak of roughly 3,150 cases of
measles was the reason for this incidence in New Jersey.
Research question
What are the effects of international illnesses on the state health system?
Research aim
To determine the impacts of global illness on New Jersey’s health system.

6PROPOSAL
Research objective
 To explore the impact of international illness on mortality and morbidity
 To explore the effect of international illness on healthcare associated costs
 To determine the awareness and perception of healthcare workers towards
international illness
Research methodology
Study design
The research will primarily be exploratory in nature, hence will be based on
qualitative approach. This approach will facilitate gaining a sound understanding of the
underlying opinions, motivations, and reasons regarding the phenomenon under investigation.
It will also provide a clear insight into the issue, thus facilitating development of hypotheses
and/or ideas for potential quantitative investigation (Silverman, 2016). It will also encourage
the research participants to expand on their responses, while discussing about areas that had
not been initially considered. The research will be based on phenomenological approach
where reliance on the participant’s perspectives will provide intuition into their impulses and
outlooks (Vagle, 2018).
Study population and sampling
The study participants will comprise of healthcare staff such as, nurses, direct care
practitioners, physicians, and physical and behavioural therapists who have been employed in
primary healthcare organisations located in the capital city of Trenton. These primary
healthcare organisations must have received funding on a capitation basis from the
government through the district health boards. Staff who are employed in non-funded
organisation, have not completed at least a year, near retirement age (if any), or those who are
not proficient in English language will be excluded from the study. The enrolment of study

7PROPOSAL
participants will be based on purposive sampling, thus they will be recruited based on the
needs of the research. Expert sampling is a category of purposive sampling that is based on
drawing sample from experts in the domain that is being investigated. The major advantage
of using this sampling procedure is that it will help in assessing opinions of people with high
knowledge about the research domain (Etikan, Musa & Alkassim, 2016). An estimated 50
participants will be selected for the study.
Data collection
One-to-one interviews will be selected as the data collection procedure for this
qualitative research owing to the interest in the connotation of the research phenomenon, as it
is experienced by the healthcare staff. Gathering explanations from the research participants
is also an effort at unearthing of a human methodical connotation of the impacts of
international illnesses. In order to ensure similar rigorous excellence as natural scientific
research, both processes of data collection and data analysis will be based on descriptive
phenomenological approach. Interviews will help in capturing non-verbal and verbal cues
from the participants and also facilitate paying attention to their expression and language,
thus indicating their level of discomfort or excitement brought about by particular questions
(Castillo-Montoya, 2016). A semi-structured interview (approximate 15 questions), which
will not be based on any formalised question list, and focus more on open-ended questions
will be asked to the participants.
Data analysis
This process will involve coding, followed by categorisation and making connotation
of the essential meanings of the research phenomenon. The interview responses will be audio
recorded and transcribed verbatim. These transcripts will be read in entirely for getting a
global sense of the responses. On re-reading the transcript, responses will be divided into
meaningful units or sections, followed by their integration into units that have been identified

8PROPOSAL
to comprise of similar content or focus. These integrated meaningful units or sections will be
subjected to the procedure of free imaginative variation. The findings of each unit will be
elaborated, concomitant with revisiting the raw data description for justifying the
interpretations of the general structure and the essential meanings (Cronin & Lowes, 2016).
Study period
The research will be conducted over a period of six months.
Stages of
research
November December January February March April
Research
question
development
Literature
review
Sampling
Data
collection
Data analysis
Writing the
report
Dissemination
of findings
Table 1- Timeline of project

9PROPOSAL
Ethical consideration
In assessing the impact of international illness on state health system among
healthcare staff, recollection of certain events might be distressing. Hence, efforts will be
taken not to create any psychological disturbance while asking the questions. Due
consideration must be given to sensitivity of the responses they shall be guaranteed that none
of the responses shall be disclosed to any third party. In addition, satisfactory information
concerning the research will be provided, and the participants will have the power of free
will, allowing them to accord to or refuse participation, or withdrawal voluntarily. This
principle will demonstrate respect for participant autonomy and will also encompass
providing them information about potential benefits and risks (if any) of the research (Corbin,
Strauss & Strauss, 2015).

10PROPOSAL
References
Castillo-Montoya, M. (2016). Preparing for interview research: The interview protocol
refinement framework. The Qualitative Report, 21(5), 811-831.
Corbin, J., Strauss, A. L., & Strauss, A. (2015). Basics of qualitative research. Sage.
Cronin, C. J., & Lowes, J. (2016). Brief encounters with qualitative methods in health
research: Phenomenology and interpretative phenomenological analysis. Cumbria
Partnership Journal of Research Practice and Learning,, 5(1), 8-12.
Delaney, A., Mai, C., Smoots, A., Cragan, J., Ellington, S., Langlois, P., ... & Scotto-Rosato,
N. (2018). Population-based surveillance of birth defects potentially related to Zika
virus infection—15 states and US territories, 2016. Morbidity and Mortality Weekly
Report, 67(3), 91.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Fidler, D. P. (2016). A pathology of public health securitism: Approaching pandemics as
security threats. In Governing Global Health (pp. 57-80). Routledge.
Hall, H. I., An, Q., Tang, T., Song, R., Chen, M., Green, T., & Kang, J. (2015). Prevalence of
diagnosed and undiagnosed HIV infection-United States, 2008–2012. MMWR.
Morbidity and mortality weekly report, 64(24), 657.
Hanefeld, J. (2015). Globalisation and health. McGraw-Hill Education (UK).
Hawkey, P. M. (2015). Multidrug-resistant Gram-negative bacteria: a product of
globalization. Journal of Hospital Infection, 89(4), 241-247.

11PROPOSAL
Johnson, A. S., Ruiguang, S., & Hall, I. (2017). State-level estimates of HIV incidence,
prevalence, and undiagnosed infections. Montana, 15, 0-0.
Kulkarni, P. A., Chew, D., Youssef-Bessler, M., Hamdi, H. A., Montoya, L. A., Cervantes,
K. B., ... & Sutherland, A. (2018). Case report: imported case of Lassa fever—New
Jersey, May 2015. The American journal of tropical medicine and hygiene, 99(4),
1062-1065.
McDonald, R., Ruppert, P. S., Souto, M., Johns, D. E., McKay, K., Bessette, N., ... & Frontin,
S. (2019). Notes from the field: Measles outbreaks from imported cases in Orthodox
Jewish communities—New York and New Jersey, 2018–2019. Morbidity and
Mortality Weekly Report, 68(19), 444.
Meyding-Lamadé, U., & Craemer, E. M. (2018). Winners of globalization: dengue viruses
and Japanese encephalitis virus-Diseases in neurology. Der Nervenarzt.
Silverman, D. (Ed.). (2016). Qualitative research. Sage.
Vagle, M. D. (2018). Crafting phenomenological research. Routledge.
World Health Organization. (2019). Ten threats to global health in 2019. Retrieved from
https://www.who.int/emergencies/ten-threats-to-global-health-in-2019