Academic literature on the topic 'Andersen's Behavioral Model of Health Services Utilization'

An expanded version of Andersen's Behavioral Model of Health Services Utilization is used as the theoretical and analytical framework for the International Collaborative Study of Oral Health Outcomes (ICS-II). The conceptual framework for understanding determinants of oral health is based on a "systems" perspective. The framework posits that characteristics of the external environment, the dental care delivery system, and the personal characteristics of the population influence oral health behaviors. The expanded behavioral model conceptualizes health behaviors (oral hygiene practices and dental services utilization) as intermediate dependent variables, which in turn influence oral health outcomes (evaluated, perceived, patient satisfaction). The framework is presented with an increased focus on the effects of race-ethnicity and age cohort, the major exogenous variables used in this study for systematic assessment of the differences in the multitude of factors influencing oral health. The framework can be applied by policy analysts and health services managers to help describe, predict, and explain population-based health behaviors and health outcomes.

The possible medicinal uses of cannabis are growing, yet research on how patients use medical cannabis facility services remains scarce. This article reports on the Cannabis Care Study, in which 130 medical cannabis patients at seven facilities in the San Francisco Bay Area were surveyed to gather information about demographics, personal health practices, health outcomes, service use, and satisfaction with medical cannabis facilities. The study was modeled after Andersen's Behavioral Model of Health Services Use. Results show that patients tend to be males older than 35, identify with multiple ethnicities, and report variable symptom duration and current health status. Nearly half the sample reported substituting cannabis for alcohol and illegal drugs; 74% reported substituting it for prescription drugs. Satisfaction did not differ across study sites and was significantly higher than nationally reported satisfaction with health care. Implications for the medical cannabis community and the greater system of health and social care are discussed.

ABSTRACTBackground:Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly.Methods:As part of the MentDis_ICF65+ study, N = 3,142 people aged 65–84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses.Results:Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. “I can deal with my problem on my own” (90%).Conclusion:Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.

Objective: The purpose of this article was to assess the satisfaction of adult patients who received mental health services (MHS) in healthcare networks staffed by multidisciplinary professionals and offering a range of MHS, and to identify variables associated with patient satisfaction. Methods: This cross-sectional study included 325 patients with mental disorders (MDs) among 4 Quebec health service networks. Data were collected using 9 standardized instruments and participant medical records. A 3-factor conceptual framework (predisposing, enabling, and needs-related factors) based on Andersen’s Behavioral Model was used, integrating sociodemographic, clinical, needs-related, service utilization, social support, and quality-of-life (QOL) variables. An adjusted multiple linear regression model was performed. Results: The global mean score for patient satisfaction was 4.11 (minimum: 2.0; maximum: 5.0). Among the enabling factors, continuity of care, having a case manager, and help received from services were positively associated with patient satisfaction, whereas being hospitalized was negatively associated. Among the needs-related factors, the number of needs was negatively associated with satisfaction. Conclusions: Findings demonstrated higher levels of satisfaction among patients who received good continuity of care and well-managed, frequent services in relation to their needs. Dissatisfaction was higher for patients with serious unmet needs or those hospitalized, which underlines the importance of taking these particular variables into account in the interest of improving MHS delivery and patient recovery.

OBJECTIVE: To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. METHODS: A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. RESULTS: The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). CONCLUSIONS: The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Objectives: To test the explanatory power of a model of ambulatory service use and to determine the relative roles of the main determinants of physician utilization for two chronic medical conditions in adults in Quebec. Methods: A behavioral model based on Andersen's model was developed and tested by linking two databases: the Quebec health survey as regards patient characteristics, and the Quebec health insurance board data on physician characteristics and service use. Path analysis was used for data analysis. Results: The model explained a little less than 20% of the variation in service use. The number of hospitalizations, physician's specialty and perceived health were the most important predictors of the volume of visits. Conclusion: Further specification of utilization, relating it to a particular medical condition, does not necessarily lead to an increase in the explanatory power of the model. We recommend that future research should put more emphasis on provider-related determinants rather than focusing on the type and purpose of utilization.

Undiagnosed diabetes is a threat to public health. This study aims to identify potential variables related to undiagnosed diabetes using Andersen’s behavioral model. Baseline data including blood test data from the China Health and Retirement Longitudinal Study (CHARLS) were adopted. First, we constructed health service related variables based on Andersen model. Second, univariate analysis and multiple logistic regression were used to analyze the relations of variables to undiagnosed diabetes. The strength of relationships was presented by odds ratios (ORs) and 95% confidence intervals (CIs). Finally, the prediction of multiple logistic regression model was assessed using the Receiver Operating Characteristic (ROC) curve and the area under the ROC curve (AUC). According to diagnosis standards, 1234 respondents had diabetes, among which 560 were undiagnosed and 674 were previously diagnosed. Further analysis showed that the following variables were significantly associated with undiagnosed diabetes: age as the predisposing factor; medical insurance, residential places and geographical regions as enabling factors; having other chronic diseases and self-perceived health status as need factors. Moreover, the prediction of regression model was assessed well in the form of ROC and AUC. Andersen model provided a theoretical framework for detecting variables of health service utilization, which may not only explain the undiagnosed reasons but also provide clues for policy-makers to balance health services among diverse social groups in China.

AbstractBackgroundHigh-quality prenatal care has a significant positive impact on maternal and infant health as it helps timely diagnosis and treatment of pregnancy complications.ObjectiveTo examine factors associated with the utilization of maternal health care using the optimal count regression model.MethodsA sample of 16,314 women of reproductive ages (15–49) was used. Andersen and Newman's behavioral model of health services utilization was employed for the selection of covariates. Poisson, negative binomial, zero-inflated Poisson, zero-inflated negative binomial (ZINB), Poisson hurdle, and negative binomial hurdle models were fitted and compared to identify the best model. Maternal health care utilization is found associated with maternal age and education, area of residence, domestic violence, the income level of family, access to media, knowledge about AIDS, parity, birth order, and having a child who later died.ResultsZINB model is found to be best fitted for the observed data resulting strong influence of mother's education and income level of the family on maternal health care utilization.ConclusionInterventions to improve maternal care services utilization should address individuals and systems to reduce social and economic marginalization.

The present study consisted of two parts: (1) The examination of whether demographic differences in utilization of multiple forms of health services existed among Non-Hispanic Whites, Mexican-, Cuban-, and Puerto Rican-American adolescents. (2) The examination of whether the Andersen model, revised for Latino adolescents, fit equally well for Mexican-, Cuban-, and Puerto Rican-Americans. Data for this study were drawn from the first two waves of the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative sample of 7th through 12th-grade students in the United States collected between 1994 and 1996.Logistic regression analyses indicated that there were significant differences in routine physical exams based on ethnicity. Mexican-American adolescents were less likely than Non-Hispanic White, Cuban-American, and Puerto Rican-American adolescents to receive routine physical exams. Finding based both on the logistic regressions and on the latent mean comparisons suggested that Cuban- and Puerto Rican-American adolescents are more likely to utilize health services than Mexican-American adolescents. Cuban-American adolescents were also less likely to indicate the need for medical services, whereas Mexican-American adolescents were more likely to state that they needed medical services but were unable to receive them.The results of multi-group confirmatory factor analyses provide mixed evidence toward the indication that the revised Andersen's conceptual model is an appropriate overall framework to utilize with Mexican-, Cuban-, and Puerto Rican-American adolescents. Based on the structural equation model findings, it appears that the major link between need and use of health care services is not supported in the three Latino subgroups. The Andersen model only partially addressed health care needs among the adolescent Latino subgroups. Although there are connections from the main predisposing predictors (including Latino adolescent-specific characteristics) to enabling resources and need, these indirect associations do not necessarily predict use of health services with Mexican-, Cuban-, and Puerto Rican-American adolescents. Clearly there is a great need for health care services among Latino adolescents, particularly given their health disparities in adolescent risk behavior; however current models need further revision, such as including key cultural factors and social context, to predict use of health care services.

Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

In this study, the utilization of palliative care services, acute care services, and location of death for clients who were palliative and receiving services from Champlain Community Care Access Centre (CCAC) in Ontario during their last month of life were investigated. An adaptation of Andersen?s Behavioral Model of Health Services Utilization provided context and structure to this study. This is an historical, quantitative descriptive study using chart audits for data collection. The data on CCAC clients who were palliative and who died during the month of July 2009 were tracked during their last month of life. Collection of socio-demographic data, services provided through CCAC, emergency department visits, hospital admissions, and location of death provided the data for this study. The clients who died at home used more CCAC services than those who died at other locations and frequently community palliative care physicians provided their medical care. The findings of this study included: 1) The majority of the clients, who expressed a preference, died in their preferred location. 2) The role of community palliative care physicians was an important component of the services that supported the clients to die in their location of choice. 3) Over 25% of the study sample died in a hospital and the clients used a large number of in-patient hospital days with one quarter of the hospital deaths taking place in an emergency department or an intensive care unit. 4) During the last month of life, 25% of the clients received chemotherapy and/or radiation therapy. 5) The clients who died at home used more CCAC services than those who died in other locations and who used institutional resources. The implications for practice, policy, research, and education are discussed.

Integrated behavioral health care within primary care has become a popular style of health care delivery within the United States. However, individuals with a behavioral health concern face several barriers in using these services. The purpose of this quantitative study was to identify key factors accounting for individuals' utilization and intensity of behavioral health services. Andersen's behavioral model of health care use and the integrated theory of health behavior change served as the theoretical framework. It was hypothesized that gender, age, race, ethnicity, family size, payer type, poverty level, and certain preexisting medical conditions (obesity, diabetes, hypertension, and tobacco use) would determine behavioral health care utilization and intensity. A secondary data analysis of 315 individuals who used behavioral health services within primary care was performed; the study setting was at the Center for Health, Education, Medicine, and Dentistry, located in Lakewood, New Jersey. Among the individual variables examined, only a preexisting condition of hypertension reached statistical significance, showing that those individuals were more likely to attend multiple sessions, Ï?2 (1) = 5.77, p = .02. Payer type was also found to be predictive of behavioral health care intensity. Medicare recipients were more likely to attend multiple behavioral health care sessions (74%) than were Medicaid recipients (59%) and those who were uninsured (25%). By providing insights about the barriers faced by individuals, study findings may help patient advocates and health care professionals to provide individuals with better health care. This study has implications for positive social change, as study findings may assist the United States health care system in its shift toward an integrated behavioral health care style of health care delivery.

Mental disorders among adolescents are on the rise and are among the most common chronic conditions, constituting a national epidemic. Prevalence rates indicate that 20–40% of the adolescent population in the U.S. suffers from emotional or behavioral difficulties significant enough to lead to functional impairment. Further, estimates suggest that more than 20% of the adolescent population has a diagnosable mental disorder, which significantly impacts their functioning substantially at school, at home and in their communities. Despite national agendas to address the mental health needs of adolescents, studies suggest that approximately 50 percent of adolescents with mental health needs do not seek mental health services. Framed within the Andersen Behavioral Health Model, the objective of this research was to identify and describe the factors that contribute to the under-utilization of mental health services among adolescents. A qualitative meta-synthesis of the literature was conducted to identify the contributing factors. The goal of a meta-synthesis is to provide a greater depth of knowledge and a more extensive understanding of both the theory and the phenomena being studied. A meta-synthesis of 12 qualitative studies was conducted. Focusing on qualitative studies provides a deeper understanding of the contextual issues involved in the utilization of mental health services for adolescents. Findings from this study suggest that need and enabling factors are important drivers of mental health service use and adolescents’ and parents’ perceptions of services, providers, and sigma are particularly important to determining use of services. The study also identified that opinions of families and peers can influence whether or not an adolescent will remain in treatment. It is critical to increase understanding of the role social networks as many adolescents suggest their network may provide some form of informal support. It may be beneficial to focus specifically on the provision of peer-delivered support services for adolescents as well as develop and implement strategies aimed at improving perceptions around mental health. Adolescence is a critical point in time when social and emotional development are encouraged; if mental health needs are not addressed during this developmental stage, many adolescents will potentially experience more severe disorders in adulthood.

Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.

碩士
實踐大學
家庭研究與兒童發展學系高齡家庭服務事業碩士在職專班
103
Objectives: The purpose of this study is to investigate the factors influencing the consumption of glucosamine of the middle and old-aged. Method: The subjects are the adults aged 45 years above and having used glucosamine supplement within one year. The questionnaire was developed based on Andersen's Behavioral Model of Health Services Use, to explore the relationships among predisposing factors, enabling factors, need factors, usage behavior, satisfaction and repurchase intention. The data were analyzed using SPSS18.0. Hierarchical regression technique was used to test the hypotheses. Results: Three hundred and seventy seven usable questionnaires were obtained. The study findings revealed that predisposing factors (age, product cognition, and perceived benefits) and enabling factors (contact frequency of health information) had significant positive impacts on frequency of glucosamine supplement use. Education had significant negative influence on usage frequency. Need factors had no significant impact. Predisposing factors (including sex and perceived benefits), need factors (self-assessment of joint conditions), and frequency of glucosamine supplement use had significant impact on satisfaction of symptom improvement. Predisposing factors (sex, education, perceived benefits), need factors (including self-assessment of health status and joint conditions, and chronic disease), and frequency of glucosamine supplement use had significant impacts on product satisfaction. Consumer satisfaction had significant possitive impact on repurchase intention. Discussion and Implication: The middle and old-aged tend to use glucosamine supplement to maintain joint health. Marketers of the functional food manufacturers are suggested to provide appropriate product information to educate their consumers and further enhance their satisfaction and repurchase intention.

碩士
台北醫學院
護理學研究所
90
Abstract Title of Thesis: Factors Related to the Long-Term Care Utilization and Satisfaction among Caregivers Use of the Behavioral Model of Health Services Utilization Institution: Graduate Institute of Nursing, Taipei Medical University Author: Tseng, Kwe-Chin Thesis directed by: Ching-Min Chen, RN, DNS, Associate Professor Responding to the fast growing elder population, the government of Taiwan has already developed the comprehensive long-term care service programs. However, for those with functional disability, their family caregivers frequently play the vital role to advocate the elder’s needs. This study applies Andersen’s Behavioral Model of Health Service Utilization to explore the relationships among predisposing, enabling and needs factors of caregivers with their long-term care service utilization and satisfaction toward long-term care service they used in Great Taipei area. The correlational research design was used in is study. The structural questionnaire was developed for telephone interview. The stratify random sampling was applied to selecting participating institutions based on their service types and location. Then, convenient sampling was used for every participating institution to recommend 10 users and their caregivers. A total of 125 subjects completed the interview (response rate 57%). The study indicated that caregivers were mostly female, middle age, client’s children, and had good relationship with clients. The elder client’s characteristics were mostly female, CVA diagnosis, totally disabled as measured by ADL and IADL, and need most assistance on “taking bath” and “cooking”. Only 40% of caregivers lived with the elderly, and most used service was just located within 30 minutes from their homes. Regarding reasons for selecting types of service, 45.6% of them were due to “it can reduce family people’s burden”, and 40% of them are “recommended by health care providers”. The average length of service utilization was 2 years and 5 months. The most needed service types were care center and home care service respectively. The caregivers were most satisfied with service accessibility (M=3.36, SD=0.52), and lowest on service affordability (M=2.64, SD=0.55). Among factors related to service utilization, results indicated that female caregivers utilized more home care; most institution users would not affect their work because of caring work. There were 40% of caregivers hired aids using home care. The major reasons for caregivers to select institution care was “nobody at home to take care client during daytime”, and “it care better than family members”, at the same time, they use “public praise of service” and “service content provided” as the standard for measuring service quality. Among those selecting home care, 75% was due to “health care providers’ recommendation”. Caregivers utilized institutional care has a relatively higher score on perceived health status than other service users. Clients using institutional and home care services have higher functional disability than community service users. Types of service client used were not significantly different from their caregiver expected. Result of logistic regression indicated that female caregiver (OR=0.21), reasons for selecting service such as “nobody at home to take care client during daytime” (OR=8.45), and “it care better than family members” (OR=2.27), and caregivers’ perceived health status (OR=1.79) can predict the use of institutional care. Among factors related to service satisfaction, those who lived close to service they used (less than 30 minutes) were more satisfactory with service accessibility. Caregivers with “good” relationship with their cared before they became ill were more satisfied in availability, accessibility, accommodation, and overall satisfaction than those with “excellent” and “not good” relationship ones. When the reason was not based on “reducing care burden of family member” and “environment, equipments of caring institutions”, caregivers would have higher score on service acceptability. Those who consider the reason as “ it care better than family members” had relatively high satisfaction towards availability. Those with “relatively more reasonable expenses” as major reason had relatively higher appraisal towards availability, accessibility, and accommodation of service. Those for “recommended by health care providers” had relatively higher satisfaction towards accessibility and affordability of service. Caregivers without any chronic disease had relatively higher satisfaction towards accommodation. Although accessibility is statistically different among types of service utilization, post hoc analysis could not detect the exactly group difference. Results of multiple regression indicated that the relationship between the caregiver and their client before getting ill, the distance of service providing unit and relatively reasonable expenses were three significant predictors of service satisfaction. A total of 24% of variance on service satisfaction was explained by these three variables. Since this results provide a better understanding about the utilization and satisfaction towards long term care, recommendations will be made to policymaking to improve the quality of long term care services Keywords: family caregiver, long-term care service utilization, satisfaction, behavioral model of health service utilization