The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #64796

Lauren R. Barton, PhD, UCSF Health Psychology, University of California, San Francisco, 3333 California, Laurel Heights Suite 465, Box 0848, San Francisco, CA 94143-0848, 415-476-7014, lbar6676@itsa.ucsf.edu, Lee Anne Roman, RN, PhD, Department of Obstetric, Gynecologic, and Reproductive Medicine, Michigan State University, 224 West Fee Hall, East Lansing, MI 48824, Hiram E. Fitzgerald, PhD, Department of Psychology and University Outreach, Michigan State University, 22 Kellogg Center, East Lansing, MI 48824, Alexander von Eye, PhD, Psychology, Michigan State University, 135 Snyder Hall, East Lansing, MI 48824, Judith K. Lindsay, BSN, MPH, Consultant, 52 South Park, Zeeland, MI 49464, and Joseph S. Moore, MD, Healthier Communities Department, Spectrum Health System, 320 Michigan NE, MC 129, Grand Rapids, MI 49503.

Nurse provision of home-visiting maternal support services (MSS) can promote maternal and infant health in disadvantaged populations. However, underutilization of services remains a problem that reduces MSS effectiveness. This study investigated how individual needs were related to subsequent utilization of home-visiting services among 438 Medicaid eligible pregnant women participating in a randomized clinical trial that compared the effectiveness of two models of maternal support services. Relationships to MSS utilization intensity (number of home visits) were examined with two different indices of needs: inferred and reported needs. The level of inferred needs was based on situational characteristics described by the client indicating that needs existed. The level of reported needs was based on the participant’s reported perception that she had a need or concern with each issue. Both indices covered 13 issue areas addressed by the interventions. Regression analyses found that both inferred and reported needs were significantly positively related to intensity of MSS use. However, structural equation models showed that inferred needs provided no significant contribution to MSS intensity beyond that of reported needs when both were modeled together. Separate analyses for each intervention group revealed similar findings. Also, models of subgroups of African-American and European-American participants were not significantly different from one another. Results suggest that reported needs are related to subsequent service use and identify factors associated with reported needs. Findings will be discussed with regard to client “readiness” to participate in home-visiting services and implications for service referrals, assessment, and how to promote client “readiness”.

Learning Objectives:

• Differentiate between inferred and reported needs as defined in this study.
• Identify relationships between these individual needs and subsequent utilization of home visiting services among low-income women of diverse ethnicities.
• Describe the extent to which reported needs are similarly related to home-visiting service utilization among low-income African-American and low-income European-American women.

Keywords: Utilization, Home Visiting

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.