246849 Discrimination, acculturation, and desire for control over healthcare among breast patients receiving patient navigation

Tuesday, November 1, 2011

Nancy L. LaVerda, MPH , George Washington Cancer Institute (GWCI), The George Washington University, Washington, DC
Heather A. Young, PhD, MPH, CHES , Department of Epidemiology and Biostatistics, The George Washington University, Washington, DC
Steven R. Patierno, PhD , George Washington Cancer Institute (GWCI), The George Washington University, Washington, DC
Identification of patients' feelings of discrimination, acculturation, and desire for control over their own healthcare could assist patient navigators and providers in delivery of recommended care. We examined scores on three validated instruments: the Discrimination Scale (race and SES), Marin Acculturation Scale (MAS), and the Wallston Desire for Control over Healthcare (DCON), among 989 navigated patients with suspicious breast findings or cancer who presented at sites participating in a navigation effectiveness study. We used analysis of variance to understand the impact of marital status, household size, number of dependents, employment status, insurance status, income, education, and use of a primary care physician on the respective scale scores while controlling for race, age, and ethnicity. Neither the Discrimination Scale race subscale nor the SES subscale were related to any of these factors. The full models for the MAS were also non-significant but there was a tendency for more acculturated patients to have no insurance and to be employed full-time compared to their less acculturated counterparts. All models examining the DCON scores were highly significant but these findings were driven by the highly significant findings for race and ethnicity in the models (p range: 0.0273 to <0.0001) non-Hispanics tended to want more control over their healthcare than Hispanics and patients of other races desired more control than either whites or blacks. Examining age, race, and ethnicity each in comparison to each of the scale scores revealed that the DCON was significantly related to race, age, and ethnicity (all p <0.0001) with other races wanting the most control compared to whites and blacks, younger subjects wanting more control than older subjects and non-Hispanics wanting more control than Hispanics. The Discrimination scale SES measure was significantly related to age (p=0.0357), race (p=0.0332), and ethnicity (p=0.0017). There was a tendency for SES discrimination to decrease with age and for whites to experience less SES discrimination than blacks or other races. The Discrimination scale race measure was significantly related to age (p=0.0441) with a tendency for discrimination to decrease with age. We conclude that patients' demographic background is associated with feelings of discrimination, acculturation, and desire for control over healthcare. These data could be useful in targeting interventions or identifying individuals who may have attitudinal barriers to needed cancer care.

Learning Areas:
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
List the demographic characteristics associated with feelings of discrimination, acculturation, and desire for control over health care. Name the validated psychosocial instruments for measuring discrimination, acculturation, and desire for control over health care. Assess how feelings of discrimination, acculturation, and desire for control over healthcare can be associated with patient demographic factors. Evaluate how different racial, ethnic, and age groups can have different feelings about discrimination, acculturation, and desire for control over healthcare.

Keywords: Health Disparities, Patient Perspective

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a senior researcher at GWCI and have worked extensively on the PNRP project, from which this sample is drawn.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.