LaVeist T A, Keith V M, Gutierrez M L
Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Health Serv Res. 1995 Apr;30(1):43-58.
This article reports on analysis of the predisposing and enabling factors that affect black/white differences in utilization of prenatal care services.
We use a secondary data source from a survey conducted by the Michigan Department of Public Health.
The study uses multivariate analysis methods to examine black/white differences in (1) total number of prenatal care visits, (2) timing of start of prenatal care, and (3) adequacy of care received. We use the model advanced by Aday, Andersen, and Fleming (1980) to examine the effect of enabling and predisposing factors on black/white differences in prenatal care utilization.
A questionnaire was administered to all women who delivered in Michigan hospitals with an obstetrical unit.
Enabling factors fully accounted for black/white differences in timing of start of prenatal care; however, the model could not fully account for black/white differences in the total number or the adequacy of prenatal care received.
Although there are no black/white differences in the initiation of prenatal care, black women are still less likely to receive adequate care as measured by the Kessner index, or to have as many total prenatal care contacts as white women. It is possible that barriers within the health care system that could not be assessed in this study may account for the differences we observed. Future research should consider the characteristics of the health care system that may account for the unwillingness or inability of black women to continue to receive care once they initiate prenatal care.
本文报告了对影响产前护理服务利用中黑/白差异的诱发因素和促成因素的分析。
我们使用了密歇根州公共卫生部进行的一项调查中的二手数据源。
该研究使用多变量分析方法来检验黑/白在以下方面的差异：（1）产前护理就诊总数；（2）开始产前护理的时间；（3）所接受护理的充分性。我们使用Aday、Andersen和Fleming（1980年）提出的模型来检验促成因素和诱发因素对产前护理利用中黑/白差异的影响。
对在密歇根州设有产科病房的医院分娩的所有女性进行了问卷调查。
促成因素完全解释了开始产前护理时间上的黑/白差异；然而，该模型无法完全解释所接受产前护理的总数或充分性方面的黑/白差异。
尽管在开始产前护理方面不存在黑/白差异，但按照凯斯纳指数衡量，黑人女性获得充分护理的可能性仍然较低，或者产前护理总接触次数不如白人女性多。本研究中无法评估的医疗保健系统内部障碍可能是我们观察到的差异的原因。未来的研究应考虑医疗保健系统的特征，这些特征可能导致黑人女性在开始产前护理后不愿意或无法继续接受护理。
