University of Illinois Urbana-Champaign

Longitudinal relationships of cardiovascular disease on preventive care service utilization among midlife adults: The roles of diagnosis, psychological factors, and the intersectionality of race and gender

Sun, Kang

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https://hdl.handle.net/2142/122110

Description

Title
Longitudinal relationships of cardiovascular disease on preventive care service utilization among midlife adults: The roles of diagnosis, psychological factors, and the intersectionality of race and gender
Author(s)
Sun, Kang
Issue Date
2023-11-26
Director of Research (if dissertation) or Advisor (if thesis)
Zhan, Min
Doctoral Committee Chair(s)
Zhan, Min
Committee Member(s)
  • Andrade, Flavia C. D.
  • Tan, Kevin P. H.
  • Xia, Yan
  • Gehlert, Sarah
Department of Study
School of Social Work
Discipline
Social Work
Degree Granting Institution
University of Illinois at Urbana-Champaign
Degree Name
Ph.D.
Degree Level
Dissertation
Keyword(s)
  • Cardiovascular disease
  • Preventive care service utilization
  • Psychological factor
  • Intersectionality
Abstract
Although cardiovascular disease (CVD) is the leading cause of disability and mortality among midlife adults in the United States, preventive care utilization remains limited. Previous studies have shown that individuals with CVD are at higher risk for subsequent health problems and may require increased preventive care. However, there is limited research exploring the specific factors that moderate the relationship between CVD diagnosis and preventive care utilization, including the potential role of depression, mastery experience, race, and gender. Informed by teachable moments as a heuristic, this study aimed to investigate the impact of CVD diagnosis on preventive care utilization among midlife adults. Employing the cognitive model of depression and agentic positive psychology, this study further examined whether depression and mastery experience moderate the impact of CVD diagnosis on preventive care utilization. Finally, informed by the theory of intersectionality, this study explored whether race and gender interact with each other in moderating the main relationship. The study employed a longitudinal design with a national representative sample (n = 6,222) from six waves of the National Longitudinal Survey of Youth 1979 (NLSY79) collected between 2006 and 2016. The study used self-reported physician diagnosis of a specific health condition to establish a CVD diagnosis. It measured depression using a seven-item short form from the Center for Epidemiologic Studies Depression Scale (CES-D) and mastery experience with the Pearlin Mastery Scale. Five types of preventive care services were included, namely, influenza vaccination; blood cholesterol, blood sugar, and blood pressure testing; and electrocardiography (EKG) testing. Logistic regression models were used to examine the main relationship and moderation. Intersectionality between race and gender was tested using two two-way moderations, by first treating race and gender as separable unitary entities to examine if race and gender, respectively, moderated the relationship between a CVD diagnosis and preventive care utilization. Then, race and gender were joined together to test for three-way moderation in the main relationship. The results showed that midlife adults with a CVD diagnosis were more likely to utilize all five types of preventive care services, with the most relevant preventive care type, EKG, having the largest strength of likelihood. Likewise, depression strengthened the relationship between a CVD diagnosis and the utilization of blood pressure tests. Mastery experience was not significant in moderating the main relationship. Although race and gender separately did not moderate the main relationship, in both cases of influenza vaccinations and EKG tests, being Hispanic weakened the moderation between women’s moderation and the main relationship. The three-way moderation was supported for influenza vaccinations and EKG tests. These findings demonstrate that a CVD diagnosis may serve as a teachable moment for individuals compelling them to better utilize multiple preventive care services. Therefore, timely interventions through health providers were recommended. In addressing different contributing forces that come into racialized and genderized living experiences, training for physicians on patient-centered communication, organized efforts through local community organizations on health beliefs and trust, and a legal endorsement of better insurance coverage on priority preventive care services were recommended. Future research needs to explore how a CVD diagnosis affects different population groups, develop and test interventions that center on teachable moments and intersectionality, and further explore the roles of depression and mastery experiences with other datasets.
Graduation Semester
2023-12
Type of Resource
Thesis
Copyright and License Information
Copyright 2023 Kang Sun

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