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Newsletter | Summer 2020 | South Central MIRECC

Research to Practice | Frequency and Predictors of Health Services Use by Native Hawaiians and Pacific Islanders

Summary by Sonora Hudson, MA and Darius B. Dawson, PhD

Little is known about use of health services by Native Hawaiians and Pacific Islanders (NHPIs), despite their being one of the fastest-growing racial groups in the United States. A cross-sectional study by a Little Rock VA Medical Center researcher and others examined data from the 2014 NHPI-National Health Interview Survey to try to determine factors influencing use of health care services, specifically, use of the emergency room (ER) and outpatient services, by NHPIs.

The study was based on Andersen’s Behavioral Model of Health Services Use, which posits that a person’s use of health services is driven by three types of factors, predisposing (sociodemographic), enabling (resources facilitating access), and needs (actual or perceived condition[s] that warrant care). In the study:

  • Predisposing factors examined included age, sex, education level, marital status, employment status and place of birth;
  • Enabling factors included ability to afford, access to care and neighborhood social support, usual place of care, eHealth information, federal poverty level (FPL) and health insurance coverage; and
  • Need factors involved evaluation of the number of chronic diseases diagnosed by a healthcare provider.

The sample for the study included 2172 individuals at least 18 years of age or older. Authors performed novel analyses consisting of stereotype logistic regressions to investigate associations detailing the following findings:

  • Almost half of NHPIs used outpatient services one to three times a year, and 18.4% had visited an ER once in the preceding year.
  • Age was a significant predictor of NHPI’s frequent use of ER services and outpatient services, regardless of need.
  • Being a woman and having been born in the United States were predictors of more frequent use of outpatient services.
  • Job status had no effect on use of ER services.
  • Use of eHealth information significantly predicted multiple use of both ER and outpatient services.
  • Having a usual source of care and being able to pay for services were associated with use of outpatient services but not ER services.
  • When social support was high, individuals were less likely to use ER services.
  • Those needing services were more likely to frequently use them (those with chronic diseases were twice as likely to be multiple ER users and nearly four times as likely to be frequent users of outpatient services).
  • There was no association between health insurance coverage and use of ER and outpatient services.
  • Individuals having a usual source of care were more than eight times as likely to be frequent users of outpatient services.

This is the first national report of use of health services for this group residing in the United States and the first to use stereotype logistic regression to apply Andersen’s behavioral model of health services use. The authors conclude that more predisposing and enabling factors were significantly associated with use of outpatient than with ER services and that having perceived better health was negatively associated with use of both ER and outpatient services. More research is needed to further examine the association of use of eHealth information and how factors such as insurance status or income level affects level and type of health services use.

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*MIRECC affiliates in bold

Citation: Narcisse MR, Felix H, Long CR, Hudson T, Payakachat N, Bursac A, & McElfish PA (2018). Frequency and predictors of health services use by Native Hawaiians and Pacific Islanders: Evidence from the U. S. National Health Interview Survey. BMC Health Services Research, 18(1), 575.

Last updated: July 20, 2020