Sociocultural factors influencing delay in seeking routine health care among Latinas: A community-based participatory research study

Department of Epidemiology and Biometrics, University at Albany, Albany New York, USA.
Ethnicity & disease (Impact Factor: 1). 03/2010; 20(2):148-54.
Source: PubMed


To assess sociocultural factors associated with delaying routine healthcare among Latinas.
Using community-based participatory research; we interviewed 287 Latinas from the Capital District, NY. The Andersen model of healthcare utilization was used to assess predisposing, enabling and need factors influencing delay in seeking care. Modified Poisson regression was used to estimate prevalence risk ratios (PRR) and 95% confidence intervals.
Overall 70% of women reported delaying care. After controlling for other factors, women who were not married (PRR 1.21), had chronic disease (PRR 1.24), preferred a Latino doctor (PRR 1.18), used alternative medicine (PRR 1.28), were uninsured (PRR 1.29), or had faced discrimination during earlier health care visits (PRR 1.23), were significantly more likely to delay care.
Delay in seeking care among Latinas is determined by cultural and social factors that need to be incorporated in interventions aimed at improving access.

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Available from: Tabassum Z Insaf, Dec 31, 2013
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    • "Instead, we found a cost-reducing effect of 12 or more years of schooling on inpatient costs with an amount of 161 €. Nor did we find a significant association of marital status and health care costs; yet, associations of marital status and health service use have been reported in different directions by other studies applying the Andersen model [68,69]. "
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    ABSTRACT: To analyze the association of health care costs with predisposing, enabling, and need factors, as defined by Andersen's behavioral model of health care utilization, in the German elderly population. Using a cross-sectional design, cost data of 3,124 participants aged 57-84 years in the 8-year-follow-up of the ESTHER cohort study were analyzed. Health care utilization in a 3-month period was assessed retrospectively through an interview conducted by trained study physicians at respondents' homes. Unit costs were applied to calculate health care costs from the societal perspective. Socio-demographic and health-related variables were categorized as predisposing, enabling, or need factors as defined by the Andersen model. Multimorbidity was measured by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Mental health status was measured by the SF-12 mental component summary (MCS) score. Sector-specific costs were analyzed by means of multiple Tobit regression models. Mean total costs per respondent were 889 [euro sign] for the 3-month period. The CIRS-G score and the SF-12 MCS score representing the need factor in the Andersen model were consistently associated with total, inpatient, outpatient and nursing costs. Among the predisposing factors, age was positively associated with outpatient costs, nursing costs, and total costs, and the BMI was associated with outpatient costs. Multimorbidity and mental health status, both reflecting the need factor in the Andersen model, were the dominant predictors of health care costs. Predisposing and enabling factors had comparatively little impact on health care costs, possibly due to the characteristics of the German social health insurance system. Overall, the variables used in the Andersen model explained only little of the total variance in health care costs.
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    • "Several studies found that being insured significantly increased the likelihood of service use or decreased the delay of health care in different population groups [23], [25], [26], [27], [28], [30], [34]. In the US, uninsured women from Latin America were significantly more likely to delay care than their insured counterparts [23]. "
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    ABSTRACT: Objective: This systematic review aims to assess the use and implementation of the Behavioral Model of Health Services Use developed by Ronald M. Andersen in recent studies explicity using this model. Methods: A systematic search was conducted using PubMed in April 2011. The search strategy aimed to identify all articles in which the Andersen model had been applied and which had been published between 1998 and March 2011 in English or German. The search yielded a total of 328 articles. Two researchers independently reviewed the retrieved articles for possible inclusion using a three-step selection process (1. title/author, 2. abstract, 3. full text) with pre-defined inclusion and exclusion criteria for each step. 16 studies met all of the inclusion criteria and were used for analysis. A data extraction form was developed to collect information from articles on 17 categories including author, title, population description, aim of the study, methodological approach, use of the Andersen model, applied model version, and main results. The data collected were collated into six main categories and are presented accordingly. Results: Andersen’s Behavioral Model (BM) has been used extensively in studies investigating the use of health services. The studies identified for this review showed that the model has been used in several areas of the health care system and in relation to very different diseases. The 1995 version of the BM was the version most frequently applied in the studies. However, the studies showed substantial differences in the variables used. The majority of the reviewed studies included age (N=15), marital status (N=13), gender/sex (N=12), education (N=11), and ethnicity (N=10) as predisposing factors and income/financial situation (N=10), health insurance (N=9), and having a usual source of care/family doctor (N=9) as enabling factors. As need factors, most of the studies included evaluated health status (N=13) and self-reported/perceived health (N=9) as well as a very wide variety of diseases. Although associations were found between the main factors examined in the studies and the utilization of health care, there was a lack of consistency in these findings. The context of the studies reviewed and the characteristics of the study populations seemed to have a strong impact on the existence, strength and direction of these associations. Conclusions: Although the frequently used BM was explicitly employed as the theoretical background for the reviewed studies, their operationalizations of the model revealed that only a small common set of variables was used and that there were huge variations in the way these variables were categorized, especially as it concerns predisposing and enabling factors. This may stem from the secondary data sets used in the majority of the studies, which limited the variables available for study. Primary studies are urgently needed to enrich our understanding of health care utilization and the complexity of the processes shown in the BM.
    Full-text · Article · Oct 2012 · GMS Psycho-Social-Medicine
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    • "Second, CAM users tend to be less reliant on and more questioning of their physicians' authority (Astin, 1998), a disposition that could stem from a sense of marginalization among Black Americans (although personality also may play a role; see Hildreth & Elman, 2007). In a related sense, some evidence indicates that distrust in conventional medicine can affect CAM use (Insaf et al., 2010). Third, the uncomfortable legacy of institutionalized racism in American medicine has given the Black community an incentive to develop strategies of resistance to mainstream institutions (Shorter-Gooden, 2004). "
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    ABSTRACT: This article examines whether self-reported racial discrimination is associated with greater use of complementary and alternative medicine (CAM) and assesses whether the effects of reported racial discrimination are specific to the setting in which the unfair treatment occurred (i.e., medical or nonmedical settings). Data were drawn from the National Survey of Midlife Development in the United States (MIDUS) of Black adults aged 25 and older at baseline (N=201). Analyses account for multiple forms of discrimination: major lifetime discriminatory events and everyday discrimination (more commonplace negative occurrences). Using logistic and negative binomial regression, results reveal that racial discrimination was associated with a higher likelihood of using any type of CAM as well as using more modalities of CAM. Also, both discrimination in health care and discrimination in nonmedical contexts predicted greater use of CAM. The findings underscore the tenet that health care choices, while influenced by health status and availability of health care resources, are also shaped by perceived barriers. The experience of racial discrimination among Black people is associated with greater use of alternative means of health care, as a way to cope with the barriers they experience in institutional settings in the United States.
    Full-text · Article · Feb 2012 · Social Science [?] Medicine
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