A Conceptual Framework for Examining Healthcare Access and Navigation: A Behavioral-Ecological Perspective

Overview

Journal Soc Theory Health

Specialty Public Health

Date 2019 Apr 23

PMID 31007612

Citations 32

Authors

Miriam Ryvicker

Affiliations

Soon will be listed here.

Abstract

This paper introduces a conceptual framework for investigating individual ability to navigate healthcare in the contexts of the built environment, social environment, and healthcare infrastructure in which a person is embedded. Given the complexity of healthcare delivery in the United States, consumers are expected to have an increasingly sophisticated set of skills in order to effectively navigate and benefit from the healthcare resources available to them. Addressing barriers to navigation in vulnerable populations may be essential to reducing health disparities. This paper builds on previous conceptual developments in the areas of healthcare use, navigation, and ecological perspectives on health in order to present a behavioral-ecological framework for examining healthcare navigation and access. The model posits that healthcare navigation is an ecologically informed process not only because of the spatial distribution of health services, but because of the spatial distribution of individual and environmental factors that influence decision-making and behavior with respect to service use. The paper discusses areas for further research on healthcare navigation, challenges for research, and implications for reducing health disparities.

Citing Articles

Profiles and predictors of access to human and veterinary healthcare in multispecies households.

Applebaum J, Dunn C, McDonald S, Escobar K, King E, Corona R One Health. 2025; 20:100981.

PMID: 39974706 PMC: 11835633. DOI: 10.1016/j.onehlt.2025.100981.

Developing and validating a HEalthCare NAvigation Competency (HECNAC) Scale for refugees in the United States.

Yeo S, Lee I, Ehiri J, Magrath P, Ernst K, Kim Y PLoS One. 2025; 20(1):e0314057.

PMID: 39883736 PMC: 11781618. DOI: 10.1371/journal.pone.0314057.

Healthcare system navigation difficulties among informal caregivers of older adults: a logistic regression analysis of social capital, caregiving support and utilization factors.

Kim B, Wister A, Mitchell B, Li L, Kadowaki L BMC Health Serv Res. 2024; 24(1):1159.

PMID: 39354489 PMC: 11443938. DOI: 10.1186/s12913-024-11549-0.

A qualitative study exploring the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States.

Yeo S, Kim-Hines Y, Ehiri J, Magrath P, Johnson-Agbakwu C, Ernst K PLoS One. 2024; 19(8):e0307192.

PMID: 39150938 PMC: 11329121. DOI: 10.1371/journal.pone.0307192.

"They made me feel like I mattered": a qualitative study of how mobile crisis teams can support people experiencing homelessness.

McDaniel M, Sundaram S, Manjanatha D, Odes R, Lerman P, Handley M BMC Public Health. 2024; 24(1):2183.

PMID: 39135047 PMC: 11320767. DOI: 10.1186/s12889-024-19596-2.

References

CUNNINGHAM P . Pressures on safety net access: the level of managed care penetration and uninsurance rate in a community. Health Serv Res. 1999; 34(1 Pt 2):255-70. PMC: 1088999. View

Laditka S, Johnston J . Preventable hospitalization and avoidable maternity outcomes: implications for access to health services for Medicaid recipients. J Health Soc Policy. 2000; 11(2):41-56. DOI: 10.1300/j045v11n02_04. View

Gelberg L, Andersen R, Leake B . The Behavioral Model for Vulnerable Populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000; 34(6):1273-302. PMC: 1089079. View

Laditka S, Laditka J . Geographic variation in preventable hospitalization of older women and men: implications for access to primary health care. J Women Aging. 2000; 11(4):43-56. DOI: 10.1300/J074v11n04_04. View

Subramanian S, Kim D, Kawachi I . Social trust and self-rated health in US communities: a multilevel analysis. J Urban Health. 2002; 79(4 Suppl 1):S21-34. PMC: 3456618. DOI: 10.1093/jurban/79.suppl_1.s21. View

Andersen R, Yu H, Wyn R, Davidson P, Brown E, Teleki S . Access to medical care for low-income persons: how do communities make a difference?. Med Care Res Rev. 2003; 59(4):384-411. DOI: 10.1177/107755802237808. View

Lochner K, Kawachi I, Brennan R, Buka S . Social capital and neighborhood mortality rates in Chicago. Soc Sci Med. 2003; 56(8):1797-805. DOI: 10.1016/s0277-9536(02)00177-6. View

Goodman D, Mick S, Bott D, Stukel T, Chang C, Marth N . Primary care service areas: a new tool for the evaluation of primary care services. Health Serv Res. 2003; 38(1 Pt 1):287-309. PMC: 1360885. DOI: 10.1111/1475-6773.00116. View

Caughy M, OCampo P, Muntaner C . When being alone might be better: neighborhood poverty, social capital, and child mental health. Soc Sci Med. 2003; 57(2):227-37. DOI: 10.1016/s0277-9536(02)00342-8. View

10.

Leyden K . Social capital and the built environment: the importance of walkable neighborhoods. Am J Public Health. 2003; 93(9):1546-51. PMC: 1448008. DOI: 10.2105/ajph.93.9.1546. View

11.

Northridge M, Sclar E, Biswas P . Sorting out the connections between the built environment and health: a conceptual framework for navigating pathways and planning healthy cities. J Urban Health. 2004; 80(4):556-68. PMC: 3456215. DOI: 10.1093/jurban/jtg064. View

12.

Guagliardo M . Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr. 2004; 3(1):3. PMC: 394340. DOI: 10.1186/1476-072X-3-3. View

13.

Diez Roux A . Estimating neighborhood health effects: the challenges of causal inference in a complex world. Soc Sci Med. 2004; 58(10):1953-60. DOI: 10.1016/S0277-9536(03)00414-3. View

14.

Davidson P, Andersen R, Wyn R, Brown E . A framework for evaluating safety-net and other community-level factors on access for low-income populations. Inquiry. 2004; 41(1):21-38. DOI: 10.5034/inquiryjrnl_41.1.21. View

15.

Cunningham G, Michael Y . Concepts guiding the study of the impact of the built environment on physical activity for older adults: a review of the literature. Am J Health Promot. 2004; 18(6):435-43. PMC: 3115687. DOI: 10.4278/0890-1171-18.6.435. View

16.

LaVela S, Smith B, Weaver F, Miskevics S . Geographical proximity and health care utilization in veterans with SCI&D in the USA. Soc Sci Med. 2004; 59(11):2387-99. DOI: 10.1016/j.socscimed.2004.06.033. View

17.

Laditka J, Laditka S, Probst J . More may be better: evidence of a negative relationship between physician supply and hospitalization for ambulatory care sensitive conditions. Health Serv Res. 2005; 40(4):1148-66. PMC: 1361189. DOI: 10.1111/j.1475-6773.2005.00403.x. View

18.

Rosenthal M, Zaslavsky A, Newhouse J . The geographic distribution of physicians revisited. Health Serv Res. 2005; 40(6 Pt 1):1931-52. PMC: 1361233. DOI: 10.1111/j.1475-6773.2005.00440.x. View

19.

Mobley L, Root E, Finkelstein E, Khavjou O, Farris R, Will J . Environment, obesity, and cardiovascular disease risk in low-income women. Am J Prev Med. 2006; 30(4):327-332. DOI: 10.1016/j.amepre.2005.12.001. View

20.

Pattussi M, Hardy R, Sheiham A . The potential impact of neighborhood empowerment on dental caries among adolescents. Community Dent Oral Epidemiol. 2006; 34(5):344-50. DOI: 10.1111/j.1600-0528.2006.00283.x. View