Andersen's Healthcare Utilization Model Research Articles

Factors Associated With Medical Expenses Among Long-Term Care Insurance Recipients Aged 65 Years or Older in Korea.

This study examined the factors associated with medical expenses among LTCI (long-term care insurance) recipients in Korea. Secondary data analysis was performed using the 2019 Korea National Health Insurance (KNHI) reimbursement data of I metropolitan city. Data from 52 434 older adults who were LTCI recipients and living in I metropolitan city areas were included. Based on the Andersen healthcare utilization model, the variables included the predisposing (age, sex, and living alone), enabling (health insurance and place of residence), and need factors (disability, LTC grade, use of LTCI services, and participation in health screening). All the predisposing, enabling, and need factors were significant. Older age, higher LTC grade, use of visiting nursing service, admission to an aged care facility, and participation in health screenings were negatively associated with medical expenses. Females, those living alone, non-disabled individuals, medical aid beneficiaries, and rural residents were less likely to incur medical expenses. Appropriate use of LTCI services (e.g., visiting nursing) will help reduce unnecessary medical expenses. Nevertheless, access to health care services for older adults living alone in rural areas must be improved.

Prediction of Utilization of Psychological Support During Vocational Rehabilitation

Comprehensive psychological support is a distinctive feature of vocational retraining centers, pivotal in stabilizing the health of the rehabilitants, reducing dropout rates and facilitating return to work. For optimal resource planning within the vocational retraining centers, and thereby ensuring the best possible psychological support during vocational rehabilitation, it is crucial to be able to estimate the number of appointments of the rehabilitants in advance. Even though routine data is available, predictions using regression analysis have not been undertaken previously. To predict the number of appointments in the psychological service, a hierarchical linear regression analysis with 25 potential predictors was conducted using retrospective routine data from 404 rehabilitants. In specifying the regression model, data-driven methods and theory were combined. The Andersen healthcare utilization model served as the theoretical background. The final regression model accounted for 39.5% of the variance in the utilization of the psychological service. Ten variables predicted a higher number of appointments: female gender, boarding status, low resilience, desire for psychological support, past psychological treatment, intake of psychotropic drugs, absence of two specific professional fields, Federal Employment Agency/Jobcenter as the paying institution, and non-participation in a specific preparatory course. The routine data available at the beginning of vocational rehabilitation in a vocational retraining center is generally suitable to predict the number of appointments in the psychological service. As such, it can be utilized for resource planning. Various factors prove to be informative, suggesting that a focus on single factors (e. g., the presence of an ICD-10 F-diagnosis) seems disadvantageous. Limitations of the regression-analytic approach are highlighted.

Using the andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 american men’s internet survey

BackgroundPre-exposure prophylaxis (PrEP) to prevent HIV is severely underutilized among sexually minoritized men (SMM). Inequitable access to PrEP-prescribing facilities and providers is a critical barrier to PrEP uptake among SMM. Integrating HIV prevention services, such as PrEP screening, into pharmacy-based settings is a viable solution to addressing HIV inequities in the US. We aimed to examine willingness to obtain PrEP screening in a pharmacy and its associated correlates, leveraging Andersen’s Healthcare Utilization Model (AHUM), among a national sample of SMM in the U.S.MethodsData from the 2020 American Men’s Internet Survey, an annual online survey among SMM, were analyzed. Drawing on AHUM-related constructs, we used a modified stepwise Poisson regression with robust variance estimates to examine differences in willingness to screen for PrEP in a pharmacy. Estimated prevalence ratios (PR) were calculated with 95% confidence intervals (CI95%).ResultsOut of 10,816 men, most (76%) were willing to screen for PrEP in a pharmacy. Participants were more willing to screen for PrEP in a pharmacy if they (1) had a general willingness to use PrEP (PR = 1.52; CI95% =1.45, 1.59); (2) felt comfortable speaking with pharmacy staff about PrEP (PR = 2.71; CI95% =2.47, 2.98); and (3) had HIV-related concerns (PR = 1.04; CI95% =1.02, 1.06). There were no observed differences in men’s willingness to screen for PrEP in a pharmacy by race/ethnicity, education level, annual household income, nor insurance status.ConclusionsStrategically offering PrEP screening in pharmacies could mitigate access-related barriers to HIV prevention services among SMM, particularly across various sociodemographic domains. Importantly, this approach has vitally important implications for addressing broader inequities in HIV prevention. Future studies should examine strategies to successfully integrate PrEP screenings in pharmacies among diverse populations, especially among those at elevated risk for HIV.

Development of a Questionnaire for Dental Utilization Based on the Andersen Model.

Background and aim Oral health is an integral part of overall general health. Understanding the variables that affect the use of dental services can help overcome the challenges and lessen disparities in oral health. There are no significant reliable questionnaires available for determining factors that influence dental care utilization.This study aimed to develop and validate a questionnaire based on the Andersen model of healthcare utilization to assess these factors. Materials and methods A preliminary questionnaire consisting of 34 items was developed based on the Andersen model of healthcare utilization.The questionnaire's final version consisted of24 items after five subject area experts analyzed its face validity and content validity. Content validity ratio (CVR) was used to evaluate the validity of the questionnaire. The Cronbach's alpha coefficient was then used to establish the internal consistency and test-retest for the reliability of the questionnaire. Results The final version of the questionnaire included 24 items based on CVR, and the data of the final version suited the model well. The internal consistency measured with Cronbach's alpha coefficient was above the threshold for each item. The Cronbach's alpha value for test-retest reliability was found to be 0.72, which was acceptable. Conclusions The current results show that the proposed questionnaire for dental utilization based on the Andersen model has satisfactory validity and reliability. This questionnaire can be used as an instrument to determine the various factors that affect the utilization of dental services.

Examining Factors Related to Medical Home Attainment for Youth in Working Poor Households

The medical home model has been recognized as an effective approach for promoting comprehensive primary health care services. Even though income-related disparities have been highlighted as a barrier for equal access to health care, within pediatrics, youth in working poor households have been vastly understudied regarding risk factors for medical home attainment. To address this gap, this study uses conceptual guidance from the Andersen Health Care Utilization Model and applies hierarchical logistic regression methods to examine factors related to medical home attainment for youth in working poor homes. Results indicate that race, parental education, insurance coverage, English language proficiency, and health status are all significant predictors of medical home attainment, yielding important implications for policy and program planning.

Investigating Factors Influencing the National Cancer Screening Program among Older Individuals in Republic of Korea-Data from the Korea National Health and Nutrition Examination Survey VIII.

This study aims to determine the influencing factors of the participation of older individuals aged 65 years and above in South Korea's National Cancer Screening Program (NCSP) using data from the eighth wave (2019-2021) of the Korea National Health and Nutrition Examination Survey (KNHANES VIII), and discuss potential problems and coping strategies. Variables were selected based on Andersen's healthcare utilization model. "Participation in the NSCP" was considered the dependent variable, with independent variables including sociodemographic characteristics (sex, marital status, residence, education level, income level, economic activity, medical coverage type, and private insurance), health conditions (subjective health status, hypertension, and diabetes), and health behaviors (physical activity, monthly alcohol consumption, and current smoking status). The analysis revealed that higher participation rates correlated with being married, having an education level beyond elementary school, being employed, subscribing to private insurance, perceiving oneself as having average or poor health, engaging in physical activity, and not smoking. Sex, residence, income, medical coverage type, hypertension, diabetes, and monthly alcohol consumption were found to be insignificantly correlated. These findings underscore the importance of tailored promotion and health education for older individuals to boost NCSP participation rates, which could ultimately elevate public health standards.

Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada.

LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.

Analysis of factors related to the use of Korean medicine treatment in adult patients with depressed mood: Based on the Korea Health Panel Annual Data 2019

Objectives: This study analyzed the factors related to outpatient service to Western medicine (WM) and Korean medicine (KM) of Korean adults with depressed mood using data from the 2019 Korea Health Panel Study.Methods: The general characteristics according to group of 827 individuals, and the factors influencing the use of integrative medicine (IM) medical service were identified using the Chi-square test and binary logistic regression results. The factors were classified based on the Andersen healthcare utilization model. The results of regression analysis were presented as odds ratio (OR) and 95% confidence interval (CI).Results: Among the individuals of the study, 658 (79.6%) were in the WM group and 169 (20.4%) were in the IM group. In the WM group and the IM group, the presence of suicidal ideation was common at 37.7% and 43.2%, respectively. As a result of regression analysis, the living in Busan/Daegu/Ulsan/Gyeongsang compared to living in Seoul/Gyeonggi/Incheon [OR = 0.522 (95% CI = 0.328 to 0.830)], and presence of musculoskeletal [OR = 1.686 (95% CI = 1.071 to 2.653)] and mood disorders [OR = 1.737 (95% CI = 1.106 to 2.726)] were the most influential factors on the use of IM medical service.Conclusions: This study is the first in Korea to analyze the patterns of medical institution use and factors used in KM treatment among adults with depressed mood. The results of this study provide preliminary evidence for the contribution of KM to national mental health in the context of depression.

The Role of Hospice Tours in Promoting Hospice Enrollment: A Study of Taiwanese Family Members

In Taiwan, hospice nurses often take family members of terminally ill patients on hospice ward tours and provide information on transfers. We conducted a study to investigate the tour’s effectiveness in encouraging family members to transfer their loved ones to hospice. We conceptualized our study framework based on the Andersen healthcare utilization model. The hospice nurses invited family members who participated in the tour to complete the survey to investigate the tour and hospice facilities’ influence on their willingness to transfer. A total of 87 participants responded to the study, with an average age of 48.84 ± 12.08 years. Most participants were women (78.16%) and the children of patients (55.17%). The results showed that the tour significantly increased willingness scores (before 4.46 ± 0.73, after 4.74 ± 0.58, p = .0036). Practical and activity-related facilities had the highest influence scores. However, binary logistic regression revealed that patients aged ≥65 years (odds ratio [OR]: 0.281, 95% confidence interval [CI] [0.099, 0.797]) and higher influence scores for psychospiritual care features (OR: 0.182, 95% CI [0.040, 0.821]) negatively affected the change in willingness score, possibly due to family members’ anticipatory grief. Hospice tour guides should be able to identify, assess, and deal with this issue. Overall, hospice tours can effectively encourage transfer to the hospice ward, but addressing psychological barriers such as anticipatory grief is crucial for success.

Regional disparities in health literacy for chronic diseases: focusing on healthcare resources and local extinction index.

This study compared disparities between community health characteristics and health literacy levels for hypertension and diabetes by combining community-level characteristics, such as the local extinction index and healthcare resources, with individual-level characteristics based on the Andersen healthcare utilization model. Data obtained from the 2017, 2019, and 2021 Community Health Surveys, Korean Statistical Information Service, and National Health Insurance Service were analyzed. The analyses included spatial analysis, propensity score matching, and cross-analysis. Twenty-five extinction-risk regions (ERRs) were identified in 2017, 26 in 2019, and 29 in 2021, indicating a high risk of extinction and insufficient healthcare resources in non-metropolitan regions. Based on analyses of demographic changes and unmet medical needs at the individual level, we observed increased age and economic activity, decreased healthcare access, and lower education levels in ERRs compared to non-extinction-risk regions (NERRs). No significant differences were found between the regions regarding diagnosis or medication use concerning the health literacy gap for hypertension and diabetes. However, individuals in ERRs were significantly less likely than those in NERRs to be aware of such diseases or educated about their management. Given that healthcare services in ERRs focus on chronic disease management rather than prevention, we propose two directions to reduce health disparities in ERRs. First, the government should encourage cooperation with private healthcare organizations to ensure the provision of health education programs in vulnerable areas. Second, improvements in awareness and education regarding chronic disease management can be achieved through digital healthcare and telemedicine. This study identifies regional disparities in chronic disease prevention and management, providing a basis for policies to ensure healthier communities with health equity.

Exploring Preventive Health Care Utilization Among Black/African American Men.

Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.

Exploring Socio-Economics and Its Role in the Oral Health Care of Patients in A Philippine Government Hospital

Despite the availability of dental services and educational programs, as well as, established national health system responses, and oral health interventions and procedures, oral health problems (dental caries, gum diseases and unmet dental needs) persist in the Philippines. The aim of this study was to investigate the socioeconomic factors in terms of sex, age, marital status, educational attainment, occupation, and monthly income and their effect on the oral health awareness in terms of benefit and practices. A total of 100 patients from a selected government hospital were surveyed. The respondents were asked to answer a standardized questionnaire about their socioeconomic status, awareness on the benefits of oral health care, and awareness on the practices for oral health care. Chi-Square Test for Independence was used to identify which demographic and socioeconomic indicators determined the level of awareness of the respondents on the benefits of and practices for good oral health. The Chi-Square Test showed that only sex had a significant relationship with the awareness on the benefits of good oral health (p-value = 0.05). All the other indicators had insignificant effects; Age group (p-value = 0.435), Civil Status (p-value = 0.443), Education (p-value = 0.244), Employment status (p-value = 0.722), Income (p-value = 0.986). For the awareness on good oral practice, both sex and civil status showed a significant relationship (p-values 0.028 and 0.01). For the other indicators, null hypothesis was accepted; Age group (p-value = 0.61), education (p-value = 0.914), employment status (p-value = 0.334), income (p-value = 0.64). The results of this study are in line with the Andersen Healthcare Utilization Model, which holds that people's use of healthcare services is influenced by several predisposing, enabling, and need-related factors. The knowledge of, and observance of, good oral health is essential in determining the need for oral healthcare. Moreover, a variety of socioeconomic and personal factors (enabling and predisposing) are crucial in facilitating or impeding people's ability to access and make use of oral healthcare services. Addressing these issues and promoting education and knowledge about the value of excellent oral health practices are crucial for good oral health.

TELEHEALTH UTILIZATION BY RURAL OLDER CANCER SURVIVORS: A COMMUNITY-BASED QUALITATIVE ASSESSMENT

Abstract In a nationwide survey, rural clinic uptake of telehealth utilization increased by 70% compared to pre-pandemic utilization. Despite advancements in tele-delivered cancer care for rural residents, older adults are slower to engage the technology; yet examinations of the challenges rural older cancer survivors face when incorporating telehealth into complex cancer care are limited. Guided by the Andersen Healthcare Utilization Model, we qualitatively examined barriers and facilitators of telehealth utilization for rural older cancer survivors. Ongoing interviews began in March 2022. We purposively sampled telehealth-using rural older cancer survivors, caregivers of rural older cancer survivors, and healthcare professionals that served this population. The interview guide probed participants regarding telehealth utilization for cancer and survivorship care. We used thematic analysis and deductively coded to the Andersen Model constructs. Preliminary findings are based on six rural older cancer survivors, caregivers, and healthcare professionals. Most participants were Non-Hispanic White, had at least some college, traveled greater than 31 minutes to an oncologist, and used their cell phone or computer to access telehealth. We coded similar perceptions between survivors, caregivers, and healthcare providers. Emergent themes included (1) Telehealth provided critical and necessary services, (2) Existing technological literacy and infrastructure enabled telehealth uptake, (3) Geographic isolation related to the rural environment impaired participant’s ability to access telehealth-delivered care, and (4) Real-time provider-patient communication at critical points in participants’ care facilitated telehealth utilization. Overall, participants reported that telehealth was useful for overcoming barriers common to rurality and often a suitable strategy to deliver cancer care.

Patient perspectives on a proposed pharmacy-based colorectal cancer screening program.

Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.

Potential Factors Associated with Healthcare Utilization for Balance Problems in Community-Dwelling Adults within the United States: A Narrative Review.

Falls are the leading cause of mortality and chronic disability in elderly adults. There are effective fall prevention interventions available. But only a fraction of the individuals with balance/dizziness problems are seeking timely help from the healthcare system. Current literature confirms the underutilization of healthcare services for the management of balance problems in adults, especially older adults. This review article explores factors associated with healthcare utilization as guided by the Andersen Healthcare Utilization Model, a framework frequently used to explore the factors leading to the use of health services. Age, sex, race/ethnicity, BMI, and comorbidities have been identified as some of the potential predisposing factors; socioeconomic status, health insurance, and access to primary care are the enabling and disabling factors; and severity of balance problem, perceived illness, and its impact on daily activities are the factors affecting need for care associated with healthcare utilization for balance or dizziness problems. Knowledge about these barriers can help direct efforts towards improved screening of vulnerable individuals, better access to care, and education regarding effective fall prevention interventions for those who are at risk for underutilization. This can aid in timely identification and management of balance problems, thereby reducing the incidence of falls.

Andersen health care utilization model: A survey on factors affecting the utilization of dental health services among school children.

Children's quality of life, academic performance, and future achievement can all be negatively affected by poor dental health. The present study aimed to assess the need for dental health services and the factors influencing their utilization using the Andersen health care utilization model among school children. The current cross-sectional study was conducted among schoolchildren aged 13 to 15 in Bangalore, India (n = 1100). A questionnaire was developed using the concepts of the Andersen healthcare usage model. The parents of the children filled out the questionnaire. The factors were investigated using bivariate analysis and multivariate logistic regression analysis. About 78.1% of the children did not utilize dental health services. Regarding the reasons for not visiting a dentist, 65.8% said they did not have a dental problem, and 22.2% said they could not afford it. Bivariate analysis showed that age, gender, education level, occupation of the family's head of household, monthly family income, socioeconomic status, perceived oral health problems, accessibility of dental health facilities, and parental attitudes toward their children's oral health were significantly associated with using dental health services (p<0.05). Multiple regression analysis showed dental health service utilization was directly related to age (OR = 2.206), education, family size (OR = 1.33), and brushing frequency twice a day (OR = 1.575) with no significant relationship between distance to reach the dental facility, the number of dental visits, and socioeconomic status. Dental health service utilization was low in the past year. The age, number of family members, parent's education level, travel time to the dental facility, the child's oral health behaviors, and positive parental attitude all play a role in a children's utilization of dental health service.

Socioeconomic Inequality and Associated Factors Affecting Health Care Utilization among the Elderly: Evidence from the China Health and Retirement Longitudinal Study

Background: Elderly population is particularly vulnerable to socioeconomic disparities. This study assessed inequalities in health care utilization among the elderly in China and identified contributing factors. Methods: This study used data from the 2018 China Health and Retirement Longitudinal Study survey. A non-linear probit regression model based on the Andersen Health Care Utilization Model was used to identify determinants of health care utilization among the elderly. The concentration index (CI) and the decomposition of the CI were calculated to evaluate inequalities in health care utilization among the elderly and identify related contributors. Results: The CI for actual and standardized outpatient visits was 0.0889 and 0.0945, respectively, and the corresponding values for inpatient service utilization were 0.1134 and 0.1176, respectively. Factors that contributed to greater inequalities in the utilization of outpatient and inpatient service included income (73.68% for outpatient service; 85.20% for inpatient service), Urban Employee Basic Medical Insurance (UEBMI) (40.75% for outpatient service; 32.03% for inpatient service) and non-agricultural Hukou status (12.63% for outpatient service; 18.73% for inpatient service). New Rural Cooperative Medical Scheme (NRCMS) (−34.30% for outpatient service; −33.18% for inpatient service) and poor health status (−7.36% for outpatient service; −8.30% for inpatient service) reduced inequalities in outpatient and inpatient utilization. Conclusions: This study found that a key contributor to these inequalities was income, followed by UEBMI coverage. Meanwhile, health care coverage through NRCMS was associated with fewer disparities in health care utilization.

Does health insurance solve health care utilization puzzle in Tanzania?

ObjectivesThe global target of achieving universal health coverage by 2030 is a nightmare in most developing countries. To seek in-depth reasons, this study examines the effects of health insurance on healthcare utilization in Tanzania. Study designThis study used a non-experimental research design. MethodsProbit model, negative binomial regression, and instrumental variable Poisson with generalized method of moments were used to solve the healthcare utilization puzzle by the use of Andersen Health Care Utilization Model by using the Tanzania Panel Survey data of 2020/21. ResultsThe findings showed that education level, income, age, residence, household size, insurance, and distance from homestead to health facilities are significant policy intervention factors for improving households' healthcare utilization behavior among households in Tanzania. ConclusionPrioritize should be made on interventions that ensure the affordability of health services without compromising the quality of services offered and expanding the share of the government budget on health sector.

Improving Cancer Care for People Living With HIV: A Qualitative Study of Provider Knowledge, Attitudes, and Practice

Cancer is now the leading cause of non-AIDS death in the US population with HIV. People living with HIV (PLWH) are known to have lower cancer treatment rates and worse cancer outcomes. Disparate cancer treatment is driven by health system, patient, and clinician factors. Little attention has been given to the factors oncologists consider when making cancer treatment recommendations to PLWH. This study sought to examine oncologists' knowledge, attitudes, and practices that influence cancer treatment decision-making. This study used qualitative methods to explore oncologists' treatment decision-making processes for PLWH and cancer. The sample included 25 radiation, medical, and surgical oncologists from 2 academic centers and 5 community practices. The interview domains were developed from the Andersen Healthcare Utilization Model, the Health Belief Model, and the PEN-3 Model, as well as our prior survey research. This study describes elements of cancer treatment decision-making for PLWH. Oncologists highlighted the need for formal HIV education to support cancer treatment. One main concern with patient-provider interactions pertained to maintaining patient confidentiality during clinical encounters. Lastly, the importance of multidisciplinary care among health care providers allowed oncologists to facilitate both cancer care and logistical support. As cancer becomes an increasingly common cause of death among PLWH, it is critical to understand the drivers of the observed disparities in cancer treatment. To our knowledge, this is the first qualitative study to describe oncologists' knowledge, attitudes, and practices toward patients who have a comorbid diagnosis of HIV and cancer. Several themes for future interventions emerge, including HIV training for cancer care providers, fostering interdisciplinary collaboration, enhancing HIV education for oncology learners and clinicians, and minimizing implicit bias.

African Immigrant Women's Maternal Health Experiences in Clarkston, Georgia: A Qualitative Study.

The maternal health experiences of African immigrant women, their utilization of health care services, and the effects on maternal health have received limited attention in research. This research explored the maternal health experiences of African immigrant women residing in Clarkston, Georgia, and their use of health services. Fourteen African immigrant women responded to semistructured interviews. An adapted version of the Andersen health care utilization model explained the predisposing factors, enabling factors, and need factors, which influence the use of maternal health care for African immigrant women. Findings were presented according to the Andersen health care utilization model. Analysis of the interviews resulted in 11 themes. The themes were as follows: (1) Community social structure, (2) community health beliefs, (3) health organization concerning the use of women, infants, and children, (4) social support at the individual level, (5) limited English proficiency, (6) need for better health education, (7) perception of care, (8) health financing, (9) long wait times and lack of transportation, (10) fear of medication and obstetrical interventions, and (11) impact of Female Genital Mutilation/Cutting. Maternal health practices of African immigrant women are impacted by environmental and cultural factors. Public health interventions should be implemented to advance African immigrant women's health care utilization practices through required health education and tailored care, which will translate to positive maternal health experiences.