Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


case1175713347.pdf (9.23 MB)

ETD Abstract Container

Abstract Header

Contextual Associations of Unmet Health Care Needs in Rural Ohio

Peterson, Lars E
http://rave.ohiolink.edu/etdc/view?acc_num=case1175713347

Abstract Details

2007, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
Context: Establishing equitable access to health care services remains a health policy challenge. This is partly due to the multifaceted nature of access. Most prior studies have focused on individual characteristics but, there is a growing recognition that the context in which an individual lives affects health outcomes and access to health care. Further, the effect of context may differ between rural and urban settings. A better understanding of the relationships between and among indicators of access and context is needed. Purpose: To examine rural/urban variation in access to health care and in associations between operational measures of context from four conceptual domains (health care supply, socioeconomics, social disruption, and social capital) and self-reported unmet health care needs and further, to investigate the pathways through which contextual domains affect unmet needs. Methods: The study sample consisted of 39,953 adults from the Ohio Family Health Survey in every Ohio county in 2003-2004. The current study uses multiple analytic techniques (descriptive statistics, multilevel logistic regression, multilevel structural equation modeling) to analyze individual-level data linked at the county-level to contextual-level data. Dependent variables include a composite measure of access and self-reported unmet health care needs. Incorporation of survey weights in all analyses yield results that are representative of the state population. Results: The composite variable of access to health care showed significant variation with rurality (p=0.03) with rural residents reporting more problems accessing care. In multilevel regression, contrasting patterns of contextual association between rural and urban areas were seen in each of our contextual domains. Using multilevel structural equation modeling, we found no significant direct or indirect effects of health care supply, local economic conditions, social capital, or social disruption on unmet health care needs. Conclusions: We observed important rural/urban differences in access to health care and the relationship between context and unmet health care needs. Taken as a whole, our findings suggest that social and economic forces act as fundamental causes of poor access at the contextual level and that interventions to improve access must take these effects, as well as their rural/urban differences, into account to be effective.
David Litaker (Advisor)
226 p.
Health Sciences, General
Rural Health; Multi-level Models; Access to Health Care

Recommended Citations

Citations

  • Peterson, L. E. (2007). Contextual Associations of Unmet Health Care Needs in Rural Ohio [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1175713347

    APA Style (7th edition)

  • Peterson, Lars. Contextual Associations of Unmet Health Care Needs in Rural Ohio. 2007. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1175713347.

    MLA Style (8th edition)

  • Peterson, Lars. "Contextual Associations of Unmet Health Care Needs in Rural Ohio." Doctoral dissertation, Case Western Reserve University, 2007. http://rave.ohiolink.edu/etdc/view?acc_num=case1175713347

    Chicago Manual of Style (17th edition)

case1175713347
738
© 2007, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.