Frameworks for Modeling Secondary Preventive Health Behavior

Data for this study were collected by the Health Services Research Center at the University of Michigan. The authors wish to express their gratitude to Beverly C. Payne, M.D., Director of the Center, William Horvath, Ph.D., Principal Investigator, and T.E. Dielman, Ph.D., Project Director. We also thank two anonymous reviewers for their thoughtful comments. Funds to support this study were provided by the Arkell Hall Foundation. ABSTRACT: A comprehensive model of secondary preventive health behavior, defined as the use of physician services for preventive care, is constructed which specifies the interrelationships among people’s health beliefs, their health status, their accessibility to care, their sociodemographic characteristics, and their use of services. The model is tested by applying path analysis to a household survey of adult residents of Washtenaw County, Michigan. The results support the contention that many factors influence secondary preventive utilization, some principally directly and some largely indirectly through their effects on other variables. Accessibility to care, health status, health beliefs, and sex all directly influence use, while education and age have indirect effects. Income has indirect effects on use which, because they are in opposing directions, cancel each other out.