To examine factors associated with first-time use of preventive services based on the Behavioral Model of Health Services Use.
Nine panels of the Medical Expenditure Panel Survey were merged to identify first-time users of 8 preventive services: blood pressure check, cholesterol screening, colonoscopy, flu vaccination, routine physical, Pap smear, mammogram, and clinical breast examination. Multivariate logistic regressions and sample weights were used.
Insurance coverage, access to care, and racial/ethnic minorities are associated with higher odds of first-time use. Findings based on cross-sectional data may not be valid for first-time use.
Increased insurance coverage, better access to care, and a focus on minority population can help nonusers of preventive care to make the transition.
[Show abstract][Hide abstract] ABSTRACT: The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
Journal of Health and Social Behavior 04/1995; 36(1):1-10. DOI:10.2307/2137284 · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Evaluate the reliability and validity of the Medical Outcomes Study Short-Form version 2 (SF-12v2) in the 2003-2004 Medical Expenditure Panel Survey (MEPS).
Data were collected in the self-administered mail-out questionnaire and face-to-face interviews of the MEPS (n = 20,661). Internal consistency and test-retest reliability and construct, discriminate, predictive and concurrent validity were tested. The EQ-5D, perceived health and mental health questions were used to test construct and discriminate validity. Self-reported work, physical and cognitive limits tested predictive validity and number of chronic conditions assessed concurrent validity.
Both Mental Component Summary Scores (MCS) and Physical Component Summary Scores (PCS) were shown to have high internal consistency reliability (alpha > .80). PCS showed high test-retest reliability (ICC = .78) while MCS demonstrated moderate reliability (ICC = .60). PCS had high convergent validity for EQ-5D items (except self-care) and physical health status (r > .56). MCS demonstrated moderate convergent validity on EQ-5D and mental health items (r > .38). PCS distinguish between groups with different physical and work limitations. Similarly, MCS distinguished between groups with and without cognitive limitations. The MCS and PCS showed perfect dose response when variations in scores were examined by participant's chronic condition status.
Both component scores showed adequate reliability and validity with the 2003-2004 MEPS and should be suitable for use in a variety of proposes within this database.
Quality of Life Research 05/2009; 18(6):727-35. DOI:10.1007/s11136-009-9483-1 · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Studies examining predictors of preventive service utilization generally focus on individual characteristics and ignore the role of contextual variables. To help address this gap in the literature, the present study investigates whether county-level characteristics, such as racial and ethnic composition, are associated with the use of preventive services.
Data from the Medical Expenditure Panel Survey and the Area Resource Files (1996-1998) are used to identify the individual- and county-level predictors of five types of preventive services (n = 49,063).
County racial or ethnic composition is associated with the utilization of certain preventive services, net of individual-level characteristics. Specifically, individuals in high percent Hispanic counties are more likely to report cholesterol screenings, while those in counties with more blacks are more likely to have regular mammograms. Moreover, county racial or ethnic composition modifies the relationship between individual race or ethnicity and preventive use. In particular, Hispanic individuals who reside in high percent black counties report higher levels of utilization for most preventive services compared to Hispanics living in other counties.
Physical and social environments are key determinants of health behaviors and outcomes. Future studies should take into account the racial or ethnic composition of an area and how this interacts with individual race or ethnicity when investigating predictors of preventive care use.
Preventive Medicine 11/2004; 39(4):704-12. DOI:10.1016/j.ypmed.2004.02.039 · 3.09 Impact Factor
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