Date of Award

Spring 5-15-2026

Degree Type

Dissertation

Degree Name

PhD Health Sciences

Department

Health and Medical Sciences

Advisor

Deborah A. DeLuca, M.S, JD

Committee Member

Genevieve Pinto Zipp, PT, EdD

Committee Member

Ronald Andersen, PhD

Keywords

health insurance, chronic disease management, Hispanic adults, health disparities, healthcare utilization, insurance literacy, language barriers, qualitative descriptive research, thematic analysis, Andersen’s Behavioral Model of Health Services Use

Abstract

This qualitative study examined how insured non-English- and English-speaking Hispanic adults perceive the role of health insurance in the management of chronic disease. Chronic conditions remain a leading cause of morbidity in the United States, and although prior research suggests that insurance coverage improves access to care, it does not always enhance how individuals understand or utilize support for chronic disease management. Limited research has explored how individuals with chronic conditions interpret the role of insurance in their daily self-management practices, particularly among Hispanic populations. Guided by Andersen’s Behavioral Model of Health Services Use, this study explored how contextual, enabling, and need factors influence perceptions of insurance and healthcare utilization. A qualitative descriptive design was used. Twenty-five insured Hispanic adults with at least one chronic condition were recruited from a community clinic in New York City. Data were collected through semi-structured interviews conducted in English or Spanish and analyzed using thematic analysis. Six themes emerged: (1) self-directed chronic disease management, (2) insurance as access rather than management, (3) structural and financial constraints, (4) language-concordant communication, (5) family and informal support networks, and (6) perceived stability of health needs. Participants described insurance as necessary for accessing services but not as an active partner in chronic disease management. Findings suggest that participants did not perceive insurance coverage alone as sufficient to support chronic disease management. Language access, cultural factors, administrative complexity, and family involvement influenced how participants used healthcare services. These findings have implications for practice, policy, and future research.

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