The number of fragile families where a child is born to unwed parents has increased greatly over the past half-century and now represents a diverse population in the United States (Ventura, 2009). These families, who are predominantly African American and Hispanic (Hummer & Hamilton, 2010) and are more likely to live in poverty and experience poorer health, face significant barriers to access and utilize health care services (De Marco & De Marco, 2009; Williams, 2008). Limited research exists on how these facets of the illness experience might differ for fragile families whose resources are limited prior to illness. The Biopsychosocial Spiritual Model asserts that illness is impacted by biological, psychological, social, and spiritual facets of family life (Engel, 1977; Wright, Watson, & Bell, 1996). This model was originally developed as an assessment tool to aid in the diagnosis and treatment planning process (Engel, 1977) and as a result is limited in its application to issues like health access and utilization that may occur prior to symptom onset or illness diagnosis and treatment. The Family Systems-Genetic Illness Model expands the Biopsychosocial-Spiritual model to include the time period prior to illness diagnosis (Rolland & Williams, 2005). Using data from the Fragile Families and Child Wellbeing study (Reichman, Teitler, Garfinkel, & McLanahan, 2001), structural equation modeling and actor-partner interdependence models will be employed to test two theoretical models. The first model proposes to identify how biological, psychological, social, and spiritual facets impact the health care utilization of fragile families. The second model will examine the impact of biopsychosocial-spiritual factors (identified in model one) on health care utilization of fragile families over time.

LLU Discipline

Marital and Family Therapy


Counseling and Family Sciences


School of Behavioral Health

First Advisor

Distelberg, Brian

Second Advisor

Oloo, Winetta A.

Third Advisor

Williams-Reade, Jacqueline M.

Fourth Advisor

Woods, Sarah

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Primary Health Care - Utilization; Vulnerable Populations; Attitude to Health; Family Characteristics - Psychology; Child Welfare

Subject - Local

Fragile Families; Unwed parents; Biopsychosocial Spiritual Model; Family Systems-Genetic Illness Model; Actor-partner Interdependence Models



Page Count


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