title: Expanding the Andersen model: the role of psychosocial factors in long-term care use.
abstract: OBJECTIVE
  To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care.
  
  
  METHODS
  Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000.
  
  
  METHODS
  Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups.
  
  
  METHODS
  Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation.
  
  
  RESULTS
  Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination.
  
  
  CONCLUSIONS
  More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups.
authors.affiliation: Yale School of Medicine, Department of Epidemiology and Public Health, New Haven, CT 06520-8034, USA.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Sarah A
authors.initials: SA
authors.lastname: McGraw
authors.forename: Leslie
authors.initials: L
authors.lastname: Curry
authors.forename: Alison
authors.initials: A
authors.lastname: Buckser
authors.forename: Kinda L
authors.initials: KL
authors.lastname: King
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Ronald
authors.initials: R
authors.lastname: Andersen
mesh_terms: D001741:Black or African American / Q000523:psychology*; D000368:Aged; D001294:Attitude to Health / Q000208:ethnology*; D003237:Connecticut; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008134:Long-Term Care / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D018907:Privacy; D036301:Qualitative Research; D044469:Racial Groups; D012931:Social Environment; D014600:Utilization Review; D044465:White People / Q000523:psychology*