Health insurance status, psychological processes, and older African Americans' use of preventive care

Abstract

The current study examined the influence of health insurance, psychological processes (i.e. psychological competency and vulnerability), and the interaction of these two constructs on older African Americans' utilization of five preventive care services (e.g. cholesterol screening and mammogram/prostate examination) using data from 211 older African Americans (median age = 60). In addition to direct effects, the influence of health insurance sometimes varied depending on respondents' psychological competency and/or vulnerability. Policies and interventions to increase older African Americans' use of preventive health services should consider structural (e.g. health insurance) and psychological (e.g. psychological competency and vulnerability) factors along with the interaction between these factors.

Keywords: African Americans; control; health insurance; preventive care; vulnerability.

Figures

Figure 1. Two distinct factors of psychological competency and vulnerability as indicated from a confirmatory factor analysis of 12 items from the PSS (Cohen et al., 1983)

Source: Adapted from Wickrama et al. (2012b). Notes: See the text for sample scale items. Model fit indices χ2/df = 1.86, CFI = .94, RMSEA = .062. CFI: comparative fit index; df: degrees of freedom; PSS: Perceived Stress Scale; RMSEA: root mean square error of approximation.

Figure 2. Health insurance, psychological competency, and older African Americans’ utilization of five preventive care services

CFI: comparative fit index; df: degrees of freedom; RMSEA: root mean square error of approximation. Notes: (1) For ease of reader interpretation, only statistically significant paths are shown and standardized coefficients are reported. (2) Age, gender, marital status, education, and health status were included as control variables predicting all preventive care services. The only significant paths were found for gender and health status, indicating that older African American males (β = 0.22, p < .01) and those in poor health (β = −0.20, p < .01) were more likely than females and healthy individuals to have regular gender-specific cancer screenings. (3) Statistically significant interaction paths between psychological competency and health insurance status are shown as broken lines. †p = .06; *p < .05; **p < .01.

Figure 3. Health insurance, psychological vulnerability, and older African Americans’ utilization of five preventive care services

CFI: comparative fit index; df: degrees of freedom; RMSEA: root mean square error of approximation. Notes: (1) For ease of reader interpretation, only statistically significant paths are shown and standardized coefficients are reported. (2) Age, gender, marital status, education, and health status were included as control variables predicting all preventive care services. The only significant paths were found for gender and health status, indicating that older African American males (β = 0.20, p < .01) and married individuals (β = 0.13, p < .05) were more likely than females and healthy individuals to have regular gender-specific cancer screenings. Yet, married individuals were less likely to have a doctor test their blood pressure frequently (β = −0.12, p < .01). (3) Statistically significant interaction paths between psychological competency and health insurance status are shown as broken lines. *p < .05; **p < .01.