Are Marital Relationships a Barrier to Health Care Utilization in Southern Appalachia?: A Dyadic Examination of the Link Between Marital Quality and Individual Health Care Usage

Introduction: There are substantial health disparities in Appalachia partially due to the poor access and utilization of health care. Social support, especially in Appalachia, is consistently linked to the utilization of available health care. The present study aims to identify how on aspect of social support, relationship functioning, are associated with health care utilization for couples in Southern Appalachian. Method: Individual and couple data (N = 147, individuals; n = 76, couples) were collected from participants interested in a brief couple interventions. Individuals and Dyadic Path analyses were conducted in Mplus using methods to account for the dependence in the data. Results: Relational aggression was the only marital factor linked to health care utilization in multivariate analyses while constructive communication was only linked to health care utilization in bivariate correlations, r = .24, p < .05. Dyadic results indicate that men's health care utilization may benefit from partner's relational aggression while women's utilization may be negatively influenced by her own self-reported relational aggression. Discussion: An individual's social context must be considered in order to completely understand barriers to health care utilization. Further, the inclusion of couple/dyadic level interventions should be considered in order to improve health care utilization in the Appalachian region and similarly rural regions. Keywords: health care utilization, relationship functioning, Appalachia, dyadic path analysis, marital quality