Date of Award

2018

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Health Professions

First Advisor

Chris Gregory

Second Advisor

Leonard E. Egede

Third Advisor

Rebekah J. Walker

Abstract

This dissertation developed a new theory-based conceptual model to understand the impact of immigrant-specific social determinants of health (SDoH) on health services utilization and outcomes in immigrants in the context of antecedents, predisposing, enabling, and need factors. One hundred eighty-one immigrants were recruited from the Greater Milwaukee Area of Wisconsin. Validated instruments were used to capture antecedents (region of origin, race/ethnicity, life-course socioeconomic status), predisposing (demographics, subjective social status, homelessness history, immigration stress, demand of immigration), enabling (healthcare access, perceived discrimination, perceived stress, health literacy, English proficiency, bicultural self-efficacy, acculturation), and need (disability, comorbidities, chronic pain) factors. Blood pressure was measured and recorded for each participant. Regression analyses, confirmatory factor analysis, structural equation modeling (SEM), and path analysis were used to assess relationships, create latent variables, identify direct and indirect effects, and to identify direct and indirect pathways between immigrant-specific SDoH and systolic blood pressure (SBP). Measured antecedents and predisposing variables were significantly associated with SBP. Five latent variables were created and found that the need latent variable had a significant direct relationship with SBP. This study validated a conceptual framework for the relationship between immigrant specific SDoH and elucidated pathways linking antecedents, predisposing, enabling, and need factors to SBP.

Rights

All rights reserved. Copyright is held by the author.

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