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Womens Health Issues. 2012 May-Jun;22(3):e243-51. doi: 10.1016/j.whi.2011.11.005. Epub 2012 Jan 24.

Multilevel analysis of the determinants of receipt of clinical preventive services among reproductive-age women.

Author information

  • 1Department of Medicine, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA. jmccallhosenfeld@hmc.psu.edu

Abstract

BACKGROUND:

We investigated the impact of individual- and county-level contextual variables on women's receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities.

METHODS:

Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004-2005) were appended to prospective survey data from the Central Pennsylvania Women's Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women's preventive care. Multilevel analyses were performed.

RESULTS:

We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations.

CONCLUSIONS:

Women's receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women's receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.

Copyright © 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

PMID:
22269668
[PubMed - indexed for MEDLINE]
PMCID:
PMC3345071
Free PMC Article
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