Expanding the Andersen Model: The Role of Psychosocial Factors in Long-Term Care Use

Objective. To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long‐term care. Study Setting. Twelve focus groups of African‐American (five groups)...

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Bibliographic Details
Published in:Health services research Vol. 37; no. 5; pp. 1221 - 1242
Main Authors: Bradley, Elizabeth H, McGraw, Sarah A, Curry, Leslie, Buckser, Alison, King, Kinda L, Kasl, Stanislav V, Andersen, Ronald
Format: Journal Article
Language:English
Published: Oxford, UK Blackwell Science Ltd 01.10.2002
Health Research and Educational Trust
Blackwell Publishing Ltd
Blackwell Science Inc
Subjects:
Access
African Americans
African Americans - psychology
Aged
Attitude to Health - ethnology
Attitudes
Caregiver burden
Caregiving
Conceptual models
Connecticut
Continental Population Groups
Effectiveness
Ethnicity
European Continental Ancestry Group - psychology
Female
Focus Groups
Health aspects
health service use
Health services
Health Services Research
Health services utilization
Humans
Locus of control
Long term
Long term care insurance
Long term health care
Long-term care
Long-Term Care - psychology
Long-Term Care - utilization
Male
Minority & ethnic groups
Minority aged
Minority elderly
Minority groups
Models, Theoretical
Patient Acceptance of Health Care - ethnology
Perceived control
Privacy
Psychological aspects
Psychosocial factors
Qualitative Research
Race
Race/ethnicity
Racial differences
Self determination
Social Environment
Social factors
Social norms
Socioeconomic factors
Studies
Utilization Review
Connecticut
United States
United States > US
ISSN:0017-9124, 1475-6773
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Summary:Objective. To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long‐term care. Study Setting. Twelve focus groups of African‐American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000. Study Design. Using qualitative analysis, data were coded and analyzed in NUD‐IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African‐American and white focus groups. Data Collection. Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation. Principal Findings. Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African‐American and white focus group members differed in their reported accessibility of information about long‐term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self‐determination. Conclusions. More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long‐term care use as well as the effectiveness of policies and programs designed to address disparities in long‐term care service use among minority and nonminority groups.
Bibliography:istex:21800650E73D87C58E99B09494A0D120BA83DEDD
ArticleID:HESR01053R
ark:/67375/WNG-G1NMTSMM-N
This research was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation, the Robert Wood Johnson Foundation, and the Connecticut Department of Social Services, Integrated Care Unit.
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ISSN:0017-9124
1475-6773
DOI:10.1111/1475-6773.01053