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Expanding the Andersen Model: The Role of Psychosocial Factors in Long-Term Care Use


  • Elizabeth H Bradley,

  • Sarah A McGraw,

  • Leslie Curry,

  • Alison Buckser,

  • Kinda L King,

  • Stanislav V Kasl,

  • Ronald Andersen

  • This research was supported by the Patrick and Catherine Weldon Donaghue Medical Research Foundation, the Robert Wood Johnson Foundation, and the Connecticut Department of Social Services, Integrated Care Unit.

Address correspondence to Elizabeth H. Bradley, Ph.D., Associate Professor, Yale School of Medicine, Department of Epidemiology and Public Health, 60 College Street, New Haven, CT 06520-8034. Sarah A. McGraw, Ph.D., is with New England Research Institutes, Watertown, MA. Leslie Curry, Ph.D., M.P.H., is with the Braceland Center for Mental Health and Aging and the Institute of Living in Hartford, CT. Alison Buckser, M.P.H., is with the Department of Health, State of Rhode Island. Kinda L. King, B.A., and Stanislav V. Kasl, Ph.D., are with the Yale School of Medicine, Department of Epidemiology and Public Health in New Haven, CT. Ronald Andersen, Ph.D., is with the UCLA School of Public Health, Department of Health Services, Los Angeles, CA.


Objective. To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care.

Study Setting. Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000.

Study Design. Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups.

Data Collection. Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation.

Principal Findings. Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination.

Conclusions. More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups.