Determinants of Utilization of Health Services Provided for Children with Cerebral Palsy in Jordan

  • Nihad A. AlmasriEmail author
  • Carl J. Dunst
  • Maysoun Saleh
  • Rasha Okasheh


Enhancing services utilization for children with cerebral palsy is a national priority particularly in middle and low income countries. Based on Andersen’s (1995) Behavioral Model of Health Services Use and previous research findings, a conceptual model was developed to identify child, family, and service determinants of utilization of services by children with cerebral palsy in Jordan. 1 hundred and 16 families of children with cerebral palsy agreed to participate in the study. Children were 4.6 ± 4.3 years of age. The most common types of cerebral palsy were spastic quadriplegia followed by spastic diplegia. Data were collected in 2 sessions. Physiotherapists’ research assistants administered the Gross Motor Classification System, the Gross Motor Function Measure-66-Item Set Version, Child Information Questionnaire, the Family Support Scale, the Family Resources Scale, Family Information Questionnaire, Services Questionnaire, and the Measure of Processes of Care-20 Item Version. Hierarchical multiple regression analysis by blocks was used to determine the predictors of the utilization of services. The model explained 57.5% of the variance in access to services. Satisfaction with services was the most influential determinant of utilization of services followed by family resources, child needs for services, associated health problems, father employment, and processes of care. Professionals and policy makers are encouraged to attend to parents’ satisfaction with services, processes of care, and family resources as key indicators of improving access and utilization of services by families of children with cerebral palsy.


Utilization of service Cerebral palsy Jordan Anderson model Satisfaction Children 



The authors would like to thank the participant families and children for their time and commitment. A special gratitude for the participant sites including Albasheer Hospital, the Cerebral Palsy Foundation, and the University of Jordan Hospital for support during data collection.

Author’s Contributions

All authors participated in designing the study. NA and MS supervised data collection, NA and CD performed data analysis and prepared the first draft of the manuscript. All authors edited and approved the final manuscript.

Compliance with Ethical Standards


This study is funded by the Deanship of Scientific Research – The University of Jordan Amman- Jordan.

Ethical Approval

This study was approved by the Institutional Review Boards of the University of Jordan Hospital and the Ministry of Health.

Informed Consent

Informed consent was obtained from all participants included in the study.

Conflict of Interests

The authors declare no conflict of interest.


  1. Almasri, N. A., Saleh, M., & Dunst, C. J. (2014a). Family resources for families of children with cerebral palsy in Jordan: Psychometric properties of the Arabic-family resources scale. Child: Care, Health and Development, 40(3), 354–362. Scholar
  2. Almasri, N. A., Saleh, M., & Dunst, C. J. (2014b). Psychometric properties of the Arabic family support scale for families of children and youth with cerebral palsy in Jordan. Journal of Intellectual and Developmental Disability, 39(3), 223–232. Scholar
  3. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. Scholar
  4. Anderson, J. G. (1973). Health services utilization: Framework and review. Health Services Research, 8(3), 184–199 Retrieved from Scholar
  5. Avery, L. M., Russell, D. J., & Rosenbaum, P. L. (2013). Criterion validity of the GMFM-66 item set and the GMFM-66 basal and ceiling approaches for estimating GMFM-66 scores. Developmental Medicine & Child Neurology, 55(6), 534–538. Scholar
  6. Babitsch, B., Gohl, D., & von Lengerke, T. (2012). Re-revisiting Andersen’s behavioral model of health services use: A systematic review of studies from 1998-2011. Psycho-Social Medicine, 9, Doc11.
  7. Bright, T., Felix, L., Kuper, H., & Polack, S. (2017). A systematic review of strategies to increase access to health services among children in low and middle income countries. BMC Health Services Research., 17, 252. Scholar
  8. Bronfenbrenner, U., & Morris, P. A. (2007). The bioecological model of human development. In Handbook of child psychology. Hoboken: John Wiley & Sons, Inc.. Scholar
  9. Coakes S. J. (2005). SPSS: Analysis without anguish: Version 12.0 for windows. Queensland: Wiley.Google Scholar
  10. Dunst, C. J. (1985). Rethinking early intervention. Analysis and Intervention in Developmental Disabilities, 5(1–2), 165–201. Scholar
  11. Dunst, C. J., & Leet, H. E. (1987). Measuring the adequacy of resources in households with young children. Child: Care, Health and Development., 13, 111–125. Scholar
  12. Dunst, C., Jenkins, V., & Trivette, C. (1984). The family support scale: Reliability and validity. Journal of Individual Family and Community Wellness.Google Scholar
  13. Eichner, J. M., Johnson, B. H., Betts, J. M., Chitkara, M. B., Jewell, J. A., Lye, P. S., et al. (2012). Patient- and family-centered care and the pediatrician’s role. Pediatrics, 129(2), 394–404. Scholar
  14. Elrod, C. S., & DeJong, G. (2008). Determinants of utilization of physical rehabilitation Services for Persons with Chronic and Disabling Conditions: An exploratory study. Archives of Physical Medicine and Rehabilitation, 89(1), 114–120. Scholar
  15. Kadushin, G. (2004). Home health care utilization: A review of the research for social work. Health & Social Work, 29(3), 219–244 Retrieved from Scholar
  16. King, G. A., Rosenbaum, P. L., & King, S. M. (1997). Evaluating family-centred service using a measure of parents’ perceptions. Child: Care, Health and Development., 23, 47–62. Scholar
  17. King, S., Teplicky, R., King, G., & Rosenbaum, P. (2004). Family-centered service for children with cerebral palsy and their families: A review of the literature. Seminars in Pediatric Neurology, 11(1), 78–86. Scholar
  18. Majnemer, A., Shikako-Thomas, K., Lach, L., Shevell, M., Law, M., Schmitz, N., et al. (2014). Rehabilitation service utilization in children and youth with cerebral palsy. Child: Care, Health and Development., 40, 275–282. Scholar
  19. McCusker, J., Karp, I., Cardin, S., Durand, P., & Morin, J. (2003). Determinants of emergency department visits by older adults: A systematic review. Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine, 10(12), 1362–1370 Retrieved from Scholar
  20. McPherson, M., Arango, P., Fox, H., Lauver, C., McManus, M., Newacheck, P. W., Perrin, J. M., Shonkoff, J. P., & Strickland, B. (1998). A new definition of children with special health care needs. Pediatrics, 102(1 Pt 1), 137–140. Scholar
  21. Meehan, E. M., Reid, S. M., Williams, K. J., Freed, G. L., Sewell, J. R., & Reddihough, D. S. (2016). Medical service use in children with cerebral palsy: The role of child and family factors characteristics. Journal of Paediatrics and Child Health, 52, 621–627. Scholar
  22. Ministry of Health. (2017). Annual Report for the year ended 30 June 2017. Willington. Retrieved from
  23. Palad, Y. Y., & Madriaga, G. O. (2014). Reliability of the Filipino version of the parent satisfaction scale: A preliminary study. Hong Kong Physiotherapy Journal., 32, 73–78. Scholar
  24. Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39(4), 214–223 Retrieved from Scholar
  25. Parkes, J., Donnelly, M., Dolk, H., & Hill, N. (2002). Use of physiotherapy and alternatives by children with celebral palsy: A population study. Child: Care, Health and Development., 28, 469–477. Scholar
  26. Peters, D. H., Garg, A., Bloom, G., Walker, D. G., Brieger, W. R., & Hafizur Rahman, M. (2008). Poverty and access to health care in developing countries. Annals of the New York Academy of Sciences.
  27. Russell, D. J., Avery, L. M., Walter, S. D., Hanna, S. E., Bartlett, D. J., Rosenbaum, P. L., et al. (2010). Development and validation of item sets to improve efficiency of administration of the 66-item gross motor function measure in children with cerebral palsy. Developmental Medicine and Child Neurology, 52(2), e48–e54. Scholar
  28. Saleh, M., & Almasri, N. A. (2017). Cerebral palsy in Jordan: Demographics, medical characteristics, and access to services. Children’s Health Care, 46(1), 49–65. Scholar
  29. WHO. (2006). Health system profile - Jordan. Cairo, Eygpt. Retrieved from
  30. WHO. (2013). Research for Universal Health Coverage. Retrieved from
  31. Wood, E., & Rosenbaum, P. (2000). The gross motor function classification system for cerebral palsy: A study of reliability and stability over time. Developmental Medicine and Child Neurology, 42(5), 292–296 Retrieved from Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Physiotherapy, School of Rehabilitation SciencesThe University of JordanAmmanJordan
  2. 2.Orelena Hawks Puckett InstituteAshevilleUSA

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