Objectives: Participation in long-term care services may prevent the deterioration of family caregivers' mental and physical health, yet research suggests that Latino caregivers may forego using long-term care services in the absence of other barriers to long-term care use (e.g., lack of insurance).

Methods: An adapted version of the Andersen Model of Health Care Service Utilization served as a framework for examining familism, acculturation, gender roles, religiosity, and knowledge and perceptions about long-term care, as potential determinants of long-term care service use, alongside other factors known for their association with long-term care use (e.g. functional status of care recipient, caregiver burden and health, and socioeconomic factors). In-person interviews with a convenience sample of 66 Mexican-American family caregivers residing in San Diego, California, were utilized.

Results: A standard regression analysis of these variables found caregivers were more likely to use long-term care if they had low familism, had a physician's referral, were knowledgeable about services, had health insurance, shared the caregiving responsibility, and were less acculturated. The lack of an expected positive association between higher acculturation and long-term care use may be attributed to higher rates of Medicaid coverage in low acculturated caregivers. Higher levels of caregiver burden were most significantly predicted by higher levels of depression, knowledge about long-term care services, living with the care recipient, negative religious coping, low levels of familism, and poor caregiver health. Over 77.3% of caregivers reported being the sole care provider, and half (51%) were depressed.

Conclusion: While familism may deter long-term care use to some extent, Mexican- American family caregivers are inclined to participate in long-term care when empowered with the resources and knowledge. Providers, particularly, are important brokers of long-term care. Facilitating enrollment in Medicaid, the largest payer of long term care, may be one step toward increasing their participation in long-term care. Lastly, the large number of caregivers working in isolation in this study is alarming, given the role of family support in predicting long-term care use.


School of Public Health

First Advisor

Jerry W. Lee

Second Advisor

Naomi N. Modeste

Third Advisor

Johnny Ramirez-Johnson

Fourth Advisor

Patti Herring

Degree Name

Doctor of Public Health (DrPH)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Health Service Accessibility; Mexican Americans -- psychology; Home Care Services; Long-Term Care -- utilization; Caregivers; Nursing Homes -- utilization



Page Count

xi; 167

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives