Does access to care still affect health care utilization by immigrants? Testing of an empirical explanatory model of health care utilization by Korean American immigrants with high blood pressure (Song, et al., 2010)
Research question
The research was aimed to study the extrapolative capability of the health care utilization model by exploring the interaction of predisposing, enabling, and need factors and their effects on health care utilization of Korean American immigrants (KAIs) with high blood pressure.
Research hypothesis tested in this study
On the basis of Andersons’ behavioural model approach (Anderson, Behavioral model of families’ use of health services , 1968), the initial model framework was developed on the basis of the assumption that individuals’ use of health …show more content…
service is affected by three main factors, namely predisposing factors, enabling factors, and their need for care. The predisposing factors taken into consideration were years of residence in the US and competing life priorities; these were hypothesized to affect health care utilization both directly and indirectly (through their effect on enabling and need factors), since competing life priorities of KAIs can be one of main reasons why the people make delays in seeking healthcare (Han, Kim, Kang, Jeong, Kim, & Kim, 2007). Need factors, like HBP (high blood pressure) -relevant medical history and self-reported clinical symptoms, were hypothesized to exert a direct influence on health care utilization (Bae, Yoo, Yoon, & Kim, March 2002). Apart from these, enabling factors like health insurance and perceived income were hypothesized to play a significant role (Anderson, Revisiting the behavioural model and access to medical care : does it matter?, 1995).
Study design employed in the study
The study design employed in the study was observational, i.e. non-experimental, implying there was no targeted manipulation of the participants. It was more of a confirmatory than an exploratory research since the group tried to test a theoretically driven model in the context of a specific test sample. Confirmatory research design comes with the built-in bias that the researchers tend to favor information and figures that confirm their hypotheses. That may at times lead to the ignorance of more important factors which might be involved in the concerned process.
The data used in this study was collected from the Self-Help Intervention Program for HBP Care (SHIP-HBP), a community- based prospective trial involving middle-aged KAIs with HBP in the Baltimore–Washington area. Andersons’ behavioural model approach was used to develop the initial model framework and hypotheses about the possible factors affecting healthcare utilization by the immigrants. Structured questionnaires were used to collect baseline data. Descriptive statistics and Pearson’s correlation coefficients were used thereafter to describe the sample characteristics and calculate bivariate correlations among the study variables. A path analysis was further carried out to pin point the unique direct and indirect contribution of each study variable to explain the health care utilization of hypertensive KAIs. Goodness-of-fit statistics, like chi-square, normed-fit-index (NFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA), were used to estimate the goodness of fit of the hypothesized model.
Summary of the univariate findings displayed in Table 1
The ages of participants varied from 40-64 years; the mean age being 52 years (51.9 ± 5.7).
Most of them (93%) were married. On an average, the years of their residence in the US were 16 years (16.2 ± 8.9). When they were enquired about their life priorities, 59.8% of the participants rated health and HBP care as one of their top five life-priority issues. Another query was whether the income earned was enough to sustain life; in response, 35.7% reported a comfortable life, 39.1% had a fair enough living while 25.2% weren’t really comfortable with their earnings. It was sad that 59.1% of them didn’t have any sort of health insurance. While the average figures for relevant medical history stood at 1.2 ± 0.9, those for clinical symptoms were still higher at 8.3 ± 5.4. The Health care utilization scores ranged from 10 to 29, with a mean of 23.4 (SD = 3.4, alpha = 0.67).
Summary of the bivariate findings reported in Table 2
The correlation matrix of predisposing, enabling, and need factors showed that several variables were significantly associated with health care utilization at the bivariate
level.
It was observed that those who were married, had resided longer in the US, had health insurance, and had HBP-relevant medical conditions were more likely to seek health care.
Significant associations among the predisposing, enabling, and need factors could be seen when it was observed that years of residence in the US was positively related to perceived income level and health insurance. Moreover, there was a link between competing life priorities and health insurance status; those giving higher priority to health and HBP care were more likely to be insured.
Limitations with regard to the study’s findings
Since the study sample was recruited from a single ethnic group, it limits the extent to which inferences can be drawn regarding other ethnic groups. Moreover, the model hasn’t incorporated other influential variables like acculturation stress and the level of the language barrier. The parameters like the level of accessibility to and availability of health care providers of the same cultural and linguistic background could have been considered separately.
Conclusion
This paper is possibly one of the first to put to test a theoretically driven, comprehensive model for understanding the health care utilization of KAIs in the context of chronic illness management. The findings show that enabling as well as need factors influence health care utilization by KAIs significantly. Insurance status and HBP relevant medical status seem to be very crucial in this context. Years of residence in the US did not seem to have any significant direct effect on health care utilization; rather, it had an indirect effect through health insurance. KAIs who associated more importance with health and HBP care over other competing life-priority issues were more likely to have health insurance than those who prioritized other life issues over health. To achieve adequate health care utilization by hypertensive KAIs, intensive efforts needs to be made for improving community awareness of chronic disease management and community resource availability (e.g., low-income health clinics, directories of Korean-speaking health care providers, and translation services), and community infrastructures have to come to place to support sustainable health promotion programs for HBP control.