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African American patients' level of acculturation, perceived cultural sensitivity, and satisfaction with health care PDF

155 Pages·2001·5.6 MB·English
by  WalterTodd J
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Preview African American patients' level of acculturation, perceived cultural sensitivity, and satisfaction with health care

AFRICANAMERICANPATIENTS'LEVELOFACCULTURATION,PERCEIVED CULTURALSENSITIVITY,ANDSATISFACTIONWITHHEALTHCARE By TODD WALTER J. DISSERTATIONPRESENTEDTOTHEGRADUATESCHOOLOFTHE UNIVERSITYOFFLORIDAINPARTIALFULFILLMENTOFTHE REQUIREMENTSFORTHEDEGREEOF DOCTOROFPHILOSOPHY UNIVERSITYOFFLORIDA 2001 Formywife,LoraAnnWalter,whosefriendship,support,assistance, andunconditionallovemadethisachievementpossible. ACKNOWLEDGMENTS IwouldfirstliketoacknowledgeDr.CarolynM.Tucker,mycommitteechair, andtheBehavioralMedicineResearchTeamwithintheDepartmentofPsychologyfor theireffortandsupportinthecompletionofthisproject.Iwouldalsoliketothankallof thefacultyandfellowstudentswhohaveenrichedmypersonalandprofessional developmentduringmygraduatestudyattheUniversityofFlorida.Iamespecially indebtedtotheArndtfamilyandMr.JosephLynchfortheircontinuedsupport, friendship,andhospitalityinthecompletionofthisproject. IwouldliketoextendmymostsincereappreciationtothestaffoftheSyracuse VAMedicalCenterwithoutwhoseassistancethisresearchprojectwouldnothavebeen possible.IwouldespeciallyliketothankDr.RobertSprafkinforhissupervision, support,andtremendousassistanceincarryingoutthisproject.Iwouldalsoliketo extendmysinceregratitudetoDr.LarryLantingaforhissupportandassistanceinthe approvalandfundingofthisinvestigation.IwouldliketothankMr.OdieFreeman,the MinorityVeteransCoordinatorattheSyracuseVAMedicalCenter,forhissupportand assistanceincompletingthisproject.Last,butnotleast,Iwouldliketothankthe AfricanAmericanveteransfromtheVAMedicalCenterinSyracuse,NewYork.Not onlyamIgratefulforthesacrificesthattheyhavemadeforourcountry,butIam indebtedtothemforentrustingmeandparticipatinginthisproject. iii TABLEOFCONTENTS page ACKNOWLEDGMENTS iii ABSTRACT vi CHAPTERS 1 INTRODUCTION 1 StatementoftheProblem 1 NeedfortheStudy 6 PurposeandHypothesesofThisInvestigation 8 2 REVIEWOFTHELITERATURE 10 PatientSatisfaction 10 WhatIsPatientSatisfactionandHowIsItStudied? 10 NeedforStudyingPatientSatisfaction 13 SatisfiedPatientsasHealthCareConsumers 14 PatientSatisfactionandHealthStatus/Outcomes 15 SociodemographicCharacteristicsAssociatedwithPatientSatisfaction 17 PatientSatisfactionamongAfricanAmericanPatients 19 CulturalSensitivityinProvidingHealthCare 23 ProvidingCulturallySensitiveHealthCare 26 RelationshipsamongCulturallySensitiveHealthCare,PatientSatisfaction, andHealthOutcomes 30 CulturalSensitivityandPatients'SociodemographicCharacteristics 37 Acculturation 39 AcculturationandHealthOutcomes/PatientSatisfaction 41 AcculturationandthePerceptionofCulturalSensitivityinHealthCare Received 45 AcculturationandPatientSociodemographicCharacteristics 48 HealthCareProviders'DemographicVariablesandPatientSatisfaction andPerceivedCulturalSensitivity 50 HealthCareandAfricanAmericanVeteranPatients 53 iv 3 METHODOLOGY 59 Participants 59 Instruments 61 Procedure 70 PhaseI:RecruitmentofParticipants 70 PhaseII:CollectionofData 73 4 RESULTS 76 DescriptiveStatisticsfortheMajorResearchVariables 76 PreliminaryCorrelationalAnalyses 77 AnalysisofHypotheses1,2,and3 80 MultipleRegressionAnalysisofHypothesis4 82 AnalysesofResearchQuestions1and2 83 5 DISCUSSION 90 SummaryandInterpretationofResults 91 LimitationsofStudy 106 ImplicationsforFutureResearch 110 ImplicationsforPsychologists 113 ImplicationsforHealthCareProviders 114 Conclusion 115 APPENDICES A PATIENTDEMOGRAPHICDATAQUESTIONNAIRE 117 B AFRICANAMERICANACCULTURATIONSCALE-REVISED 119 C PATIENTSATISFACTIONQUESTIONNAIRESHORT-FORM 122 D TUCKERCULTURALLYSENSITIVEHEALTHCAREINVENTORYFOR AFRICANAMERICANS 124 E PATIENTCOVERLETTERFROMVAMINORITYVETERANS COORDINATOR 133 F PATIENTINVITATIONCOVERLETTER 134 REFERENCES 136 BIOGRAPHICALSKETCH 146 v AbstractofDissertationPresentedtotheGraduateSchooloftheUniversityofFloridain PartialFulfillmentoftheRequirementsfortheDegreeofDoctorofPhilosophy AFRICANAMERICANPATIENTS'LEVELOFACCULTURATION,PERCEIVED CULTURALSENSITIVITY,ANDSATISFACTIONWITHHEALTHCARE By ToddJ.Walter August2001 Chair:CarolynM.Tucker,Ph.D. MajorDepartment:DepartmentofPsychology ThisstudyexaminedAfricanAmericanveteranpatients'levelofacculturation, levelofperceivedculturalsensitivityinhealthcarereceived,andlevelofsatisfaction withhealthcarereceived.Anassessmentbattery,consistingofthefollowing instruments,wasadministeredbymailto106maleAfricanAmericanveteranswho receivedoutpatientprimaryhealthcareservicesattheSyracuseVAMedicalCenter:(1) ThePatientSatisfactionQuestionnaireShort-Form(PSQ-18);(2)TheTuckerCulturally SensitiveHealthCareInventoryforAfricanAmericans(T-CUSCHI-AA);(3)The AfricanAmericanAcculturationScale-Revised(AAAS-R);(4)TheMarlowe-Crowne SocialDesirabilityScale-ShortForm[M-C(20)];and(5)ADemographic Questionnaire. Resultsshowedthatpatients'perceptionsoftheirhealthcareproviders'levelof culturalsensitivitywasstronglyandpositivelyassociatedwithpatients'reported satisfactionwithhealthcarereceived.Patients'levelofperceivedculturalsensitivity vi withhealthcarereceivedandwhetherpatientswererequiredtopayfortheirhealthcare weresignificantpredictorsoftheirsatisfactionwithhealthcarereceivedsuchthathigher satisfactionwasassociatedwithgreaterperceivedculturalsensitivityinhealthcare receivedandnotbeingrequiredtopayforhealthcarereceived.Highersatisfactionwas alsoassociatedwithpatientsbeingolderandoflowerincome;andperceivedcultural sensitivityinhealthcarereceivedwasassociatedwithpatientsbeingolderandless educated.Patients'levelofacculturationwasnotsignificantlyassociatedwitheither patients'perceptionsofthelevelofculturalsensitivityinhealthcarereceivedor patients'reportsofsatisfactionwithhealthcarereceived.Finally,resultsofa MANCOVAshowednosignificantdifferencesinpatients'satisfactionorperceived culturalsensitivityinhealthcarereceivedasafunctionoftheirhealthcareproviders' gender.However,patientswithethnicminority,butnotAfricanAmerican,healthcare providersperceivedtheirproviderstobelessculturallysensitivethandidpatientswith Caucasianhealthcareproviders.Theimplicationsofthisresearchforthetrainingof physiciansintheprovisionofculturallysensitivehealthcare,therolethatpsychologists canplayinhealthcaresettings,thelimitationsofthisstudy,andsuggestionsforfuture researcharediscussed. vii CHAPTER 1 INTRODUCTION StatementoftheProblem Withtheonsetofthe21stcentury,physiciansandotherhealthcareprovidersin theUnitedStatesarefacedwiththetremendouschallengeofprovidinghealthcare servicestoanincreasinglyculturallydiversepopulation.RecentestimatesbytheUnited StatesDepartmentofCommerce,BureauofCensus(2000)projected9%population growthintheUnitedStatesbetween1990and2000.AlthoughCaucasianAmericans stillaccountforthelargestpopulationgroupbyraceintheUnitedStates,their populationgrowthduringthislastdecadewasamere4%.TheUnitedStatesCensus Bureau'sstatisticsshowthatgreaterprojectedpopulationincreasesmaybefoundamong America'sethnicminoritygroups.Specifically,duringthedecadefrom1990to2000, theUnitedStatesNativeAmericanpopulationgrewbyaprojected15%,theUnited StatesHispanicpopulationgrewbyaprojected30%,andtheUnitedStatesAsian populationgrewbyaprojected33%.Moreover,giventhatthepopulationofAfrican Americancitizensgrewanestimated13%overthelastdecadesuchthattheycomprise nearly13%ofthenation'spopulation,itisprobablynotsurprisingthatCaucasian Americansarepredictedtobeintheminority,demographicallyspeaking,bytheyear 2056(May,1992). WithAmericaincreasinglyassumingamulti-ethnicandmulti-racialidentity, statisticssuchasthesestronglysupporttheneedtoprovideculturallysensitivehealth 1 2 caretomeettheneedsofanincreasinglyculturallydiversepopulation.Unfortunately, currentevidencesuggeststhatethnicminoritygroupssuchasAfricanAmericansdonot enjoythesamelevelofhealthstatusastheirCaucasianAmericanpeers,afindingthat maybepartlyattributabletoculturaldifferences. Forinstance,AfricanAmericansandotherracially/ethnicallynon-majority personshistoricallyhavebeenunderservedbyhealthcareworkersandinstitutionsinthe UnitedStates(Brookins,1993).CurrentdifferencesbetweenAfricanAmericanand CaucasianAmericanpatientsinboththeavailabilityofhealthcareandtheoutcomes associatedwithhealthcaredeliveryremainquitenotable.EvidenceshowsthatAfrican AmericanpatientshavethehighestmortalityrateforcancerofanyUnitedStates populationgroup;andthattheyhavesignificantlyhighermortalityratesfor hypertension,heartdisease,cirrhosis,anddiabetesthanCaucasianAmericans (CommonwealthFund,1999;Loue,1999).Moreover,theaveragelifeexpectancyof AfricanAmericansisapproximately6yearslessthantheaverageforCaucasian Americans(Anderson,1991;Loue,1999). Giventheabovedisparitiesinhealth-relatedoutcomesbetweenCaucasian AmericansandAfricanAmericans,suchfindingsbegthequestion,"Whataccountsfor thesedisparitiesinhealthstatus?"Theanswertothismaylieinresearchshowingthat thefailuretoseekpreventivehealthcareortoadheretoprescribedmedicaltreatment plans(e.g.,toadheretomedicalregimens,attendfollow-upvisits,etc.)isfrequently associatedwithnegativehealthcareoutcomesinpatients(Brookins,1993;Harris,Luft, Rudy,&Tierney,1995;Levy,1985;Loue,1999).Thatis,AfricanAmericansandother ethnicminoritymembersmaybemorepronethanCaucasianAmericanstounderuse 3 healthcare(Brookins,1993).Suchatendencytounderusehealthcaremaythus predisposeAfricanAmericansandsimilarethnicminoritiestoexperiencehigher morbidityandmortalityrates. AcommonattributionforAfricanAmericans'underuseofhealthcare istheirlackofaccesstoavailablemedicalhealthresources.Thatis,AfricanAmerican andotherethnicminoritiesmaynothaveadequatehealthresourcesinproximityto wheretheylive.Likewise,giventhatethnicminoritiesareover-representedinlow socioeconomicstatus(Levy,1985),andthatethnicminoritypersonssuchasAfrican AmericansaremorelikelytolackhealthinsurancerelativetoCaucasianAmericans (Lieberman,Stoller,&Burg,1997),ethnicminoritygroupmemberssuchasAfrican Americansmaynotbeabletopursuemedicalcarewhenitisavailabletothem. Althoughitisundeniablethataccesstoappropriatehealthservicescontributestothe disparityinuseofhealthcareservicesbetweenAfricanAmericansandCaucasian Americans,researchshowsthatthesedifferencesstillexistevenwhenfinancial incentives(e.g.,healthinsurance)havebeenadjustedfor(Loue,1999). AnotherreasonforAfricanAmericans'underuseofhealthcareservicesmaylie inthedisparitybetweenAfricanAmericanpatients'health-relatedbeliefs,values,and practices;andthoseespousedbyAmericanhealthcareprofessionals.Thatis,evenunder circumstanceswhenappropriatehealthcareisavailableandaccessibletoethnicminority persons,suchpersonsmayperceivethehealthcarethattheyreceiveasunacceptableand incongruentwiththeirculturalbeliefsandpractices.ThismaybethecaseforAfrican Americans,whohavehistoricallyhadtheirculturalbeliefs,practices,andtraditions ignoredbycliniciansandresearchersalike.IthasbeensuggestedthatmanyAfrican

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