Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.



Committee Chair

Speck, Barbara Jean

Committee Co-Chair (if applicable)

Ridner, S. Lee

Committee Member

McCarthy, Valerie Lander

Committee Member

Crawford, Timothy

Committee Member

Jones, M. Susan


Rural health services--Utilization; Medical care--Utilization; Risk-taking (Psychology) in adolescence; Help-seeking behavior; Rural youth--Health and hygiene


Background: Adolescents have elevated morbidity and mortality rates associated with risk-taking behaviors, but utilize health services at low levels. There is little evidence concerning health behavior, trust of health care provider, or utilization of health services among adolescents living in rural areas. Purpose: The purpose of this study was to examine individual characteristic variables and determine the extent to which these variables influence lifestyle behaviors, trust of health care provider (HCP), and utilization of health services among adolescents attending public high school in rural Indiana. Methods: This study used a cross-sectional, quantitative design. Instruments used in this study were the Wake Forest Interpersonal Trust in Physician scale, Adolescent Lifestyle Questionnaire, the Stanford Health Care Utilization Questionnaire, and an investigator-developed individual characteristic survey. Hierarchical multiple regression evaluated individual characteristic variables as predicting lifestyle behaviors and trust of HCP, while negative binomial regression predicted number of HCP visits and number of emergency room visits in the past 12 months. Results: Correlations, analysis of variance, and Kruskal-Wallis tests evaluated relationships between variables. Trust of HCP was predicted by usual source of care, health insurance, lifestyle behavior, and transportation difficulty. Lifestyle behavior was predicted by self-rated health, age, trust of HCP, and sex. Predictors of number of HCP visits were sex, household income, self-rated health, self-perceived need, health insurance, and number of ER visits, while household income and number of HCP visits predicted number of ER visits. Conclusion: This study adds to the evidence regarding health services utilization and lifestyle behavior, while providing an initial reliable quantitative measurement of trust of HCPs among American adolescents living in a rural area. Results of this study demonstrate the importance of having a HCP as a usual source of care and the need for school-based health services in rural areas. Future research should test the Wake Forest Trust in Physician scale among diverse adolescent samples, measure intention to seek health services beliefs, and evaluate informal sources of health information among rural adolescents. Additionally, research should evaluate the risk for or existence of chronic health conditions using biological markers among adolescents living in a rural area, along with behavior interventions to prevent or self-manage identified chronic health conditions. With approximately 22% of American adolescents living in rural areas and therefore at risk for poor outcomes, it is imperative that the research community place greater attention on the health of rural dwelling adolescents.

Included in

Nursing Commons