Determinants of health service utilization: A secondary analysis of the comprehensive multi-level nursing practice model for rural Hispanics

Rural Hispanic communities in America face socioeconomic barriers that are costly in terms of morbidity and mortality. Explication of the community qualities that influence healthcare utilization of rural Hispanic populations is critical to overcoming these socioeconomic barriers. Yet, empirical support for community concepts and relational links to explain healthcare utilization in rural Hispanic communities have not been addressed in the nursing literature. This study sought to improve understanding of the inner workings and coping mechanisms within the community. The study was a secondary analysis of data sets obtained from a larger study entitled Comprehensive Multi-Level Practice Model for Rural Hispanics (CMLNP). The original study was conducted in four rural communities in the southwest region of the United States. The primary purpose of the current study was to explore and describe conceptual meanings of community, community health issues, and community health beliefs from interviews conducted in two rural, primarily Hispanic communities. Thematic content analysis explored the relationships between themes that emerged from interviews and lexical variables from computer analysis. The themes most frequently shared among informants in interviews reflected a strong belief in caring for one another, which was evidenced in their volunteerism and perception of community as family. Barriers to health care included transportation, multigenerational acquiescence, and community dependency. Computerized language analysis of texts demonstrated low complexity and variety scores. Language scores indicating ambivalence, tenacity, denial and motion were higher than the normal range. There was evidence of relational links between theoretical concepts and health service utilization. Themes from interviews were closely related to services provided, health education topics, and nursing diagnoses during clinical encounters. Assessment and screening, case management, and skilled care services were the most frequently used health care services. Predominant health education topics in each town concerned specific medical conditions, preventive health care, medications, and anticipatory guidance. Nursing diagnoses were related to themes concerning Graying, Substance Abuse, and Community Knowledge Development. The study explored underlying mechanisms influencing utilization of healthcare services in rural, Hispanic communities, confirming theoretical perspectives. Confirmation came through the stories of community residents who demonstrated where health lies in the context of their lives