Applying the Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services Utilization in Homeless Women
We applied the Gelberg-Andersen Behavioral Model for Vulnerable Populations to predict health services utilization (HSU) in 875 homeless US women. Structural models assessed the impact of predisposing (demographics, psychological distress, alcohol/drug problems, homelessness severity), enabling (health insurance, source of care, barriers) and need (illness) variables on HSU (preventive care, outpatient visits, hospitalizations). Homelessness severity predicted illness, barriers and less insurance. Distress predicted more barriers, illness and less outpatient HSU. Drug problems predicted hospitalizations. Barriers predicted more illness and less outpatient HSU. Health and homelessness indicators were worse for White women. Better housing, access to care and insurance would encourage appropriate HSU.
Available from: Frederick Altice
- "health insurance, income, competing needs, information about accessible local healthcare resources, available physicians, clinical, and treatment services), and need factors (i.e. perceived needs, medical comorbidities, and severity of illness for vulnerable population with STIs, SUDs, mental illness, and HIV/AIDS) (Gelberg et al., 2000; Stein et al., 2007). Measures of geographic access and spatial behavior (e.g. "
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ABSTRACT: We mapped mobile medical clinic (MMC) clients for spatial distribution of their self-reported locations and travel behaviors to better understand health-seeking and utilization patterns of medically vulnerable populations in Connecticut. Contrary to distance decay literature, we found that a small but significant proportion of clients was traveling substantial distances to receive repeat care at the MMC. Of 8404 total clients, 90.2% lived within 5 miles of a MMC site, yet mean utilization was highest (5.3 visits per client) among those living 11-20 miles of MMCs, primarily for those with substance use disorders. Of clients making >20 visits, 15.0% traveled >10 miles, suggesting that a significant minority of clients traveled to MMC sites because of their need-specific healthcare services, which are not only free but available at an acceptable and accommodating environment. The findings of this study contribute to the important research on healthcare utilization among vulnerable population by focusing on broader dimensions of accessibility in a setting where both mobile and fixed healthcare services coexist.
Health & Place 05/2014; 28C:153-166. DOI:10.1016/j.healthplace.2014.04.008 · 2.81 Impact Factor
Available from: Vijaya K Hogan
- "While theoretically, the domains of the Andersen model capture an appropriate and broad conceptualization of factors associated with care utilization, it is how the components are operationalized that ultimately define how well it will predict preventive care utilization. The specific factors included in the model must reflect the unique contexts and experiences of the population under study [25,26]. While we operationalized all suggested model variables, and other known barriers were addressed as part of the care protocol, none of the currently known factors accounted for the non-participation of some women receiving free care nor do they explain the full participation (100%) of other women. "
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ABSTRACT: We describe participation rates in a special interconceptional care program that addressed all commonly known barriers to care, and identify predictors of the observed levels of participation in this preventive care service.
A secondary analysis of data from women in the intervention arm of an interconceptional care clinical trial in Philadelphia (n = 442). Gelberg-Andersen Behavioral Model for Vulnerable Populations to Health Services (herein called Andersen model) was used as a theoretical base. We used a multinomial logit model to analyze the factors influencing women's level of participation in this enhanced interconceptional care program.
Although common barriers were addressed, there was variable participation in the interconceptional interventions. The Andersen model did not explain the variation in interconceptional care participation (Wald ch sq = 49, p = 0.45). Enabling factors (p = 0.058), older maternal age (p = 0.03) and smoking (p = < 0.0001) were independently associated with participation.
Actively removing common barriers to care does not guarantee the long-term and consistent participation of vulnerable women in preventive care. There are unknown factors beyond known barriers that affect participation in interconceptional care. New paradigms are needed to identify the additional factors that serve as barriers to participation in preventive care for vulnerable women.
BMC Public Health 02/2012; 12(1):93. DOI:10.1186/1471-2458-12-93 · 2.26 Impact Factor
Available from: Scott L Tomar
- "This model was originally developed to explain health services use in terms of individual determinants; it has undergone several revisions since to include health system and societal factors (Aday & Andersen, 1974; Andersen, 1995; Gelberg, Andersen, & Leake, 2000). Its utility as a framework to study utilization of care has been demonstrated empirically by variety of studies (Coulter et al., 2000; Shiboski et al., 2005; Stein, Andersen, & Gelberg, 2007). As our study sample was recruited from primary care clinics and is homogenous in terms of access to primary care, the present study seeks to describe individual level characteristics associated with recent utilization of oral health services (within the past 24 months) among a cohort of HIV-positive patients who have accessed HIV primary care. "
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ABSTRACT: We investigated the use of dental care services among a population of low-income persons living with HIV/AIDS who had not seen a dental care provider during the 12 months prior to study enrollment. A total of 593 participants were recruited from five HIV primary care clinics in two South Florida counties and interviewed regarding past utilization of dental care services, HIV primary care service utilization, and barriers to care. Multivariate logistic regression analysis was used to determine correlates of oral care utilization within the preceding two years. One-third of respondents reported seeing a dentist in the preceding two years. The odds of having seen a dentist were greater for respondents with stable housing, more than a high school education, and who had received help in getting dental care; black respondents (compared to Hispanics and non-Hispanic whites) were less likely to have seen a dentist in the preceding two years. Despite the availability of dental services for low-income HIV-positive persons, utilization of dental care remains low. This study reinforces the need to provide assistance to HIV-positive persons in obtaining dental care. In particular, it indicates that such assistance should be targeted toward Black Americans, persons with low income and unstable housing situations, and those with limited help to navigate the health care system.
AIDS Care 01/2011; 23(1):98-106. DOI:10.1080/09540121.2010.498861 · 1.60 Impact Factor
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