Association of race, cultural factors, and health related quality of life

This cross-sectional, multi-site study was designed to examine the association of race and cultural factors (experience of discrimination, perceived racism, healthcare system distrust, health literacy, communication with provider) with quality of life (QOL) factors (participation, life satisfaction, perceived health status) among people with spinal cord injury (SCI).

Structured questionnaires were used to interview 275 people with SCI at 6 national Spinal Cord Injury Model Systems centers. Outcome measures included: participation (Craig Handicap Assessment and Reporting Technique Short Form); satisfaction (Satisfaction with Life Scale); and, perceived health status (two items from the SF-36).

African Americans (n=96) with SCI reported more experiences of discrimination in healthcare, greater perceived racism, more healthcare system distrust, and lower health literacy than did Whites (n=156) (ps range <.001 to <.05). Participants who reported experiencing more discrimination in health care reported better occupational functioning (OR=1.5, p<.05). Those who perceived more racism in healthcare settings reported better occupational functioning (OR=1.65, p<.05) and greater perceived health (â=.36, p<.05). Those who reported more distrust in the healthcare system reported better current health compared to 1 year ago (â=.38, p<.05). Those who reported better communication with their healthcare provider reported higher levels of mobility (OR=1.5, p<.05) and better general health (â=.27, p<.05).

These associations are different from those reported in other clinical study populations examining racial differences in health outcomes. Taken together, it is possible that possessing high levels of certain cultural factors may be associated with an increase in participation and functioning, and improvements in perceptions of well-being.