Table 6.
Description of factors of the expanded Andersen Model by Bradley et al. (2002)
| Factor | Domain | Description |
|---|---|---|
| Psychosocial | Attitudes | An attitude toward a behaviour is the degree to which performance of the behaviour is positively or negatively valued. It is determined by the total set of accessible behavioural beliefs linking the behaviour to various outcomes and other attributes. Behavioural beliefs link the behaviour of interest to the expected outcomes and represent the subjective probability that the behaviour will produce a given outcomea. |
| Knowledge | Instead of ensuring that people have accurate information, we should determine what information they actually possess and how this information affects their intentions and actions, irrespective of the accuracy of the information. Furthermore, we should be concerned about the information or knowledge guiding the behaviour of interest (i.e., beliefs about the behaviour), rather than about general knowledge in a behavioural domain b. | |
| Social norms | Normative beliefs refer to the perceived behavioural expectations of important referent individuals or groups such as the person’s spouse, family, friends, teachers, doctor, supervisor and colleagues. It is assumed that these normative beliefs, together with the person’s motivation to comply with the different referents, determine the prevailing subjective norm. The subjective norm is the perceived social pressure to engage in or avoid a behaviour. The subjective norm is assumed to be determined by the total set of accessible normative beliefs related to the expectations of important referents c. | |
| Perceived control | Perceived behavioural control refers to a person’s perception of their ability to perform a given behaviour. Perceived behavioural control is assumed to be determined by the total set of accessible control beliefs (i.e., beliefs about the presence of factors that may facilitate or impede performance of the behaviour) d. | |
| Enabling | Availability of support | Enabling conditions make health service resources available to the individual. These conditions can be measured according to family resources such as income, level of health insurance coverage, or other source of third-party payment, whether or not the individual has a regular source of care or the nature and accessibility of that regular source of care. Apart from family attributes, certain enabling characteristics of the community in which the family lives, such as the amount of health facilities and personnel in the community, can also affect the use of services. Other measures of community resources include the region of the country and rural/urban nature of the community in which the family lives e. |
| Financial resources | ||
| Need | Objective | In addition to perception of illness by the individual or his family, the model also includes a clinical evaluation because once an individual seeks care from a formal system, the nature and extent of that care are partly self-determined e. |
| Perceived | Assuming the presence of predisposing and enabling conditions, the individual or his family must perceive the illness or the probability of its occurrence to use health services. The illness level represents the most immediate cause of health service use e. |
aAjzen, I. (2006). TPB Diagram. Retrieved from: people.umass.edu/aizen/tpb.diag.html
bAjzen, K., Joyce, N., Sheikh, S. & Cote, N.G. (2011). Knowledge and the Prediction of Behaviour: The Role of Information Accuracy in the Theory of Planned Behaviour. Basis and Applied Social Psychology, 33, 101–117
cAjzen, I. (2006). TPB Diagram. Retrieved from: people.umass.edu/aizen/tpb.diag.html. The domain of social norms was derived from the construct of Normative beliefs and Subjective norms by the TPB Model
dAjzen, I. (2006). TPB Diagram. Retrieved from: people.umass.edu/aizen/tpb.diag.html
eAndersen & Newman (2005). Societal and Individual Determinants of Medical Care Utilization in the United States. Health and Society, 51(1), 95–124