HealthCare Engagement: Predictors of Engagement into Ambulatory and Support Services among Black and Hispanic Clients Living with HIV/AIDS

Date of Completion

January 2012


African American Studies|Black Studies|Social Work|Hispanic American Studies




The study's purpose was to identify the various factors associated with the engagement practices of black and Hispanic persons living with the Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) disease that sought health care services. Three research questions guided this investigation: 1) were there any differences between the clients who became engaged with services, and those who did not? 2) What were the significant predictors that differentiated both groups of clients? 3) Were those predictors mediated by whom the client saw during their initial contact with the agency? ^ The study sample included 453 black and Hispanic adult clients who accessed ambulatory and support services between calendar years 2003 and 2007. The Health Care Engagement Model adapted from the PRECEDE component of Green and Kreuter's (2005) program planning model, and the Needs component of Rosenstock (1974) Health Belief Model was developed, and used as the conceptual framework to guide the study. The HCEM consisted of four latent predictor domains (predisposing, enabling, reinforcing and health care needs), two contextual domains (initial point of entry and geographical accessibility) and the outcome variable engagement status. The results revealed that significant differences existed between engaged and non-engaged clients with respect to the predictor and contextual domains of the Health Care Engagement Model. Baron & Kenny's (1986) steps for mediation analysis were used to examine whether the observed significant predictors were affected by whom clients saw during the initial contact with the agency. The result showed that prior use of support services, willingness to disclose and documentation of laboratory tests results were significantly mediated by whether clients saw an infectious disease specialist at the initial point of entry. However, after controlling for the initial contact, prior use of support services, willingness to disclose and documentation of laboratory test results remained significant. The results of the study showed the usefulness of the Health Care Engagement Model as predicting health care engagement status as well as a predictive tool to guide the development of new program initiatives or modification of existing HIV/AIDS programs that are specific to the unique needs of the individuals, organizations, and communities of interests. ^