title: Extension of the behavioral model of healthcare utilization with ethnically diverse, low-income women.
abstract: OBJECTIVE
  Psychosocial vulnerabilities were added to a model of healthcare utilization. This extension was tested among low-income women with ethnicity addressed as a moderator.
  
  
  METHODS
  Structured interviews were conducted at 2 points in time, approximately 1 year apart. The constructs of psychosocial vulnerability, demographic predisposing, barriers, and illness were measured by multiple indicators to allow use of Structural Equation Modeling to analyze results. The models were tested separately for each ethnic group.
  
  
  METHODS
  Community office.
  
  
  METHODS
  African-American (N = 266), Euro-American (N = 200), and Mexican-American (N = 210) women were recruited from the Dallas Metropolitan area to participate in Project
  Health Outcomes of Women, a multi-year, multi-wave study. Face-to-face interviews were conducted with this sample. Participants had been in heterosexual relationships for at least 1 year, were between 20 and 49 years of age, and had incomes less than 200% of the national poverty level.
  
  
  METHODS
  Healthcare utilization, defined as physician visits and general healthcare visits.
  
  
  RESULTS
  Illness mediated the effect of psychosocial vulnerability on healthcare utilization for African Americans and Euro-Americans. The model for Mexican Americans was the most complex. Psychosocial vulnerability on illness was partially mediated by barriers, which also directly affected utilization.
  
  
  CONCLUSIONS
  Psychosocial vulnerabilities were significant utilization predictors for healthcare use for all low-income women in this study. The final models for the 2 minority groups, African Americans and Mexican Americans, were quite different. Hence, women of color should not be considered a homogeneous group in comparison to Euro-Americans.
authors.affiliation: Department of Psychology, University of North Texas, Denton 76203, USA.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Keenan
authors.forename: Linda L
authors.initials: LL
authors.lastname: Marshall
authors.forename: Susan
authors.initials: S
authors.lastname: Eve
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D044383:Black People; D003153:Community Health Services / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005060:Europe / Q000208:ethnology; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006306:Health Surveys; D006801:Humans; D017058:Mexican Americans / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011203:Poverty / Q000208:ethnology; D011336:Probability; D011584:Psychology; D012307:Risk Factors; D013179:Spouse Abuse / Q000208:ethnology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D016387:Women's Health