This study examines health services utilization in two rural areas of eastern Bolivia, both of which are inhabited primarily by recent migrants from other Bolivian communities. The major objective of the research is to propose a model of utilization for each area which includes both individual and community level predictors. Multilevel logistic regression techniques are used The data were collected through a cross-sectional household survey and through focus group interviews of community leaders in each of the colonies surveyed. In the first region, San Julian, 1258 individuals living in 267 households were surveyed. In the second area, Mineros, 1808 individuals residing in 300 households were interviewed. After a brief description of the characteristics of these samples, the subsamples of recently ill respondents in each region are selected for further analysis. Those who have been ill represent the potential users of formal health services The models differed substantially between San Julian and Mineros. In San Julian, the multilevel model showed that individuals were more likely to use health services if they had a severe illness, had lived in the community longer, and were of a higher socioeconomic status. At the community level accessibility and presence of a community health promoter were positively associated with use. In Mineros, likelihood of use of health services increased among individuals who felt that community health services were adequate, were of a higher socioeconomic status, had a severe illness, spoke an Indian language, and participated more in community activities. Availability of drugs and demographic stability were positively associated with use at the community level. Two interaction terms between a community and an individual level predictor were significant in Mineros: availability of drugs and attitudes toward local health services formed one interaction term and demographic stability and language spoken formed another The study concludes that both individual and community factors condition the health seeking behavior of people who are sick. Even after controlling for individual differences between users and non-users of health services, the community environment was shown to influence health services. Over the long term, as socioeconomic status of colonists in eastern Bolivia improves, use of health services is likely to increase. (Abstract shortened with permission of author.) / acase@tulane.edu
| Identifer | oai:union.ndltd.org:TULANE/oai:http://digitallibrary.tulane.edu/:tulane_23366 |
| Date | January 1987 |
| Contributors | O'Connor, Patricia (Author), Bertrand, William E (Thesis advisor) |
| Publisher | Tulane University |
| Source Sets | Tulane University |
| Language | English |
| Detected Language | English |
| Rights | Access requires a license to the Dissertations and Theses (ProQuest) database., Copyright is in accordance with U.S. Copyright law |
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