Phase 1 Literature Review

Rationales For Selecting Phase I of HSU For This Dissertation.
First, all of the modified and expanded Phases of the HSU retained the predisposing, enabling, and need components (determinants of individuals) as essential elements that can directly influence healthcare service utilization behaviors. This means that the determinants of individuals from Phase I capture essential elements of the HSU. So, this dissertation focused on the most central key factors of the HSU.
Second, several researchers have argued that immigrants’ health service utilization in the host country could be influenced thoroughly by social structural characteristics of individuals (e.g., employment, insurance, income status, and education; Kuo & Porter, 1998; Myers &

Phase I of HSU is not sensitive to ethnic differences that are associated with individuals’ situational or environmental components (Moon, Lubben, & Villa, 1998; Tan, 2009), because Phase I (like all other Phases of HSU) considered ethnicity as a simple predisposing demographic predictor. Most studies using HSU with diverse target populations (e.g., male and female veterans, American Indians, African Americans, or Asian immigrants) proposed that HSU has very limited generalizability, especially for ethnic minority populations (Bradley et al., 2002; Song et al., 2010). Integrating both universal factors and ethnic specific components may enhance the generalizability: some part should cover overall populations regardless of ethnicity or immigrant status of individuals, and the other part should cover unique elements associated with minority populations (Choi, 2011). However, none of the Phases of HSU have incorporated unique components such as acculturation for immigrant populations. Rather, the HSU explains a broad level of demographic (e.g., SES) and social factors (e.g., family or community resources) as predisposing or enabling factors of individuals. Researchers agree that Phase I is not sensitive to the diverse cultural and acculturation barriers/protectors in health care (Moon et al., 1998; Wallace, Levy-Storms, Kington, & Andersen, 1998). Andersen and colleagues (Andersen et al., 2011) also argued that despite the rapid growth of the Asian populations in the U.S., few studies determined cultural influences on Asian populations’ health behaviors or health outcomes. Therefore, it was essential to modify Phase I to investigate the relationships between acculturation and the healthcare utilization behavior of individuals (Choi, 2011). The acculturation measures were added to the predisposing