Need, Enabling, Predisposing, and Behavioral Determinants of Access to Preventative Care in Argentina: Analysis of the National Survey of Risk Factors

Eiman Jahangir,Adolfo Rubinstein,Vilma Irazola,Noel Christopher Barengo

doi:10.1371/journal.pone.0045053

Abstract

IntroductionHealth care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson’s Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina.MethodsWe performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year.ResultsIn the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models.ConclusionsWe explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina.

Highlights

Health care utilization is an important step to disease management, providing opportunities for prevention and treatment
[1] In a population, health care utilization is an important marker of access to and coverage of health services
The Andersen’s Behavioral Model of Health Care Utilization, initially developed in the late 1960’, suggests that people’s use of health services is a function of their predisposition to use services, factors which enable or impede use, and their need for care, providing a way to conceptualize these variations in utilization rates and consumption of medical resources. [6,7] In this model, use of services is defined as a function of 3 main elements: need, enabling, and predisposing factors

Summary

Introduction

Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Need factors, which have been shown to account for the majority of the explained variability in physician use, include the individual’s perceived health care need and other indicators of their health status. [8,9,10] Even though this model could either explain or predict use of services, and this is a matter of some debate, predisposing factors might be exogenous and enabling resources are necessary but not sufficient. In this regard, assuming the presence of predisposing and enabling conditions, the subject must perceive illness as a need for the utilization of health services. Perceived health may include different dimensions such as overall quality of life, perceived health, activities of daily living (ADL), depression, psychosocial distress and other psychological variables were among the strongest predictors of hospitalizations and physician visits. [11]

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Results

Discussion

Conclusion