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Cayla R. Teal, PhD¹, Debora A. Paterniti, PhD², Karyn Kirkendoll, BS¹, Maria Chang, BS, RD¹, Marvella E. Ford, PhD³, and Robert O. Morgan, PhD¹. (1) Houston Center for Quality of Care and Utilization Studies, Michael E. Debakey VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030, 713.794.8548, cteal@bcm.tmc.edu, (2) Center for Health Services Research in Primary Care, University of California, Davis Medical Center, 2103 Stockton Blvd., Grange Building, Suite 2224, Sacramento, CA 95817, (3) Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, 135 Cannon Street, Suite 303, PO Box 250835, Charleston, SC 29425

Members of minority groups in the U.S. bear a disproportionate burden of disease for the most serious and prevalent health conditions. Causes of racial and ethnic health disparities have been discussed as a complex array of factors, which includes cultural factors that influence patient and provider interactions. Despite national recognition that addressing culture is a critical factor in addressing disparities, little research has examined the clinical impact of cultural factors on health outcomes. This is due, in part, to the lack of a method for measuring cultural influences. The current understanding of culture's role is limited to the measurement of race and/or ethnicity and the use of stereotypical cultural descriptions commonly associated with various racial and ethnic groups. The purpose of our research is to develop a multidimensional measure of cultural influences on health. As a first step, we conducted 16 in-depth focus groups with African Americans, Chinese and Chinese Americans, Latinos and Latino Americans, and Caucasian Americans. Each group was conducted in the participants' preferred language (English, Mandarin, or Spanish). These groups systematically explored dimensions of culture previously identified in interdisciplinary literature as potentially related to health. Dimensions include spiritual beliefs and practices, family affiliation and roles, communication, individualist vs. collectivist values, physician as authority figure, beliefs about death, and beliefs about disease. We explored the dimension and its relationship to physician selection and interactions between patient and providers. A team of 4 qualitative analysts examined the data (transcripts, staff observations) using an iterative process to determine thematic codes within each dimension as well as themes not captured by the dimensions under study. Coded text was organized by race and ethnicity and by cultural dimension using Atlas.ti 5.0 software. The analyses revealed cultural themes in each dimension influential to the interaction between physicians and patients. For example, one communication theme was physician style – if the physician was straightforward and direct, or could talk meaningfully about health concerns without medical jargon. Themes regarding beliefs about disease depended on the characteristics of the disease, for example, chronicity (such as with diabetes) and threat of death (as with cancer). The analysis identified those themes that were unique to a particular racial or ethnic group, as well as those that were common to multiple groups. Finally, the results suggested mechanisms for measuring each dimension and its associated themes. These results and recommendations for measurement of cultural influences are described in this presentation.

Learning Objectives:

• Describe concerns in measuring cultural influences on patient expectations of and decisions about physicians.
• Evaluate cultural influences in a more multidimensional manner.
• Identify racial and ethnic cultural commonalities in seeking and interacting with physicians.

Keywords: Culture, Minority Health

Presenting author's disclosure statement:

Any relevant financial relationships? No