Date of Award

Spring 2001

Document Type


Degree Name

Doctor of Philosophy (PhD)


Urban Services--Health Services

Committee Director

Brenda Nichols

Committee Member

Betty Alexy

Committee Member

John Echternach

Committee Member

Clare Houseman

Committee Member

Cheryl Samuels


The purpose of this study was to determine what factors predict whether female military retirees or the female beneficiary of a military retiree, ages 40 to 64, will obtain preventive health services, specifically, Pap smears, mammograms, and clinical breast examinations. Based on the findings of the study, it is suggested that it may be important for the Department of Defense to broaden their scope of interest to include those areas that are most prominent in affecting female military retirees or the female beneficiary of a military retiree, particularly those 40 to 64, in obtaining preventive health services.

The study comprised of 8252 female, military health system beneficiaries who were retired or the female beneficiary of a retiree, 40 to 64 years of age. The 1998 Health Care Survey of Department of Defense Beneficiaries was the instrument used for this study. The theoretical framework was an adaptation of Aday and Andersen's (1975), Aday, Fleming and Andersen's (1984) and Aday et al's (1998) models known as the framework for the study of access to medical care and the framework for classifying topics and issues in health services research.

Multiple regression analyses were conducted on twenty-seven hypotheses. The results from the analyses of the individual components of the model proved that women who have less difficulty getting necessary care and less difficulty caused by delays in health care while waiting for approval will obtain the three preventive health services. Further, being enrolled in TRICARE significantly impacted the women's ability to obtain a Pap smear and a mammogram. Age, race, and the retiree's rank are additional contributors to a woman obtaining a Pap smear and a clinical breast examination. In analysis of enabling factors, level of education, income, having supplemental insurance, utilizing TRICARE Prime or other civilian insurance/HMO, and never traveling more than 30 minutes to the primary care manager's facility were found to be significant to a women obtaining the three preventive health services. Factors such as feeling downhearted and blue, having a lot of energy and a general perception of overall health were significant to the women obtaining the preventive health services. Waiting longer for an appointment with a civilian provider, in addition to satisfaction with the military health care system and overall satisfaction were significant to a woman obtaining all three preventive health services. Lastly, women who smoke were found to be less likely to obtain the three preventive health services.

Multiple regression analyses were performed to determine whether the full model predicts the subjects' ability to obtain the preventive health services. In two of the cases, Pap smear (F (41, 194) = 1.71, p < .05) and mammogram (F (41, 194) = 1.68, p < .05), the overall regression was statistically significant beyond the .05 level. Therefore, the assumption that the model of access to preventive health services will predict the likelihood of female military retirees or the female beneficiary of a military retiree to obtain preventive services is only partially supported.