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

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.