Published on February 14, 2014
“Effective Health Care for Disadvantaged Populations: Managing Patient Perceptions” Important Note: Please turn off your microphone while the presentation is taking place. Microphones should be turned on only when you wish to speak.
Special thanks and appreciation are extended to: Dr. Warren McDonald Dr. Jolly Holden Dr. Carla Bryan Reverend Larry J. Arce
Presentation Contents: -Introduction -Research Problem Statement, Sub-Problems, and Specific Participant Classification -Research Methodology -Research Study Results -Conclusion
Health Care: An Overview -Health Care Providers: Those providing medical services -Health Care Recipients: Those receiving medical services -Availability of Services ≠ Access To Services -Access To Services ≠ Same Results (Wilson, Grumbach, Huebner, Agrawal, & Bindman, 2004) Literature revealed two classifications of health care recipients (Lovasi, Hutson, Guerra, & Neckerman, 2009): -Disadvantaged: All persons having a low socioeconomic status (SES) and/or classified as a racial minority -Stable: All persons not having a low SES and are not classified as a racial minority (i.e., White)
This is not a condemnation of the medical community, and this is not a condemnation of the White race. There are responsibilities that both the health care providers and the health care recipients have in improving the quality and results of health care. For health care recipients classified as disadvantaged, these responsibilities include compliance in treatment that is prescribed by the provider. Compliance includes communication, trust, and respect. It also requires diligence on the part of the health care recipient to recognize the warning signs of disparate treatment from a provider. (Stone, 2007).
Research Problem Statement, Sub-Problems, and Specific Participant Classification
Research Problem Statement Over the last 12 months the researcher designed and implemented a health care education curriculum to be applied toward recipients of health care classified as disadvantaged at the Fresno Rescue Mission in Fresno, California, evaluated the perception of health care equality, perception of health care compliance responsibility, and intent to change health care compliance behavior post-intervention. Sub-Problem 1: Influence of self-identified race Sub-Problem 2: Influence of self-identified age
Why Study Perceptions of Health Care Equality? According to Dr. Cedric Williams (2008), a study of the perception of equality was vital because we have been conditioned to believe that instead of this issue representing a societal problem, we mistakenly view disparities in health care as a personal problem. Evidence of the problem existed in two ways: The existence of disparities in care between disadvantaged and stable populations, and the perceptions of care received by disadvantaged populations.
Do We Have A Problem? 1. Infant Mortality: 5.8/1000 Whites vs. 14.3/1000 Blacks 2. Life Expectancy: 75.3 yrs W Males, 80.3 yrs W Females 3. Life Expectancy: 75.7 yrs B Females, 68.9 yrs B Males 4. B patients lower quality care than W 41% quality measures 5. Low income patients lower quality 47% quality measures 6. Results low care: 7/10 AA 18-64 are obese or overweight 7. AA 15% more likely suffer obesity than W 8. AA men 50% likely prostate cancer than W men 9. AA new HIV infections 7 times rate of W 10. Hispanics new HIV infections 2.5 times rate of W 11. Low income Americans 3 times less likely primary care 12. Nearly half low income Hispanics lack primary care doctor 13. AA, Asian American, Hispanics reported poor communication doctors more often Whites (U.S. Department of Health and Human Services, 2010)
The Responsibility Threshold Responsibility Threshold: The point at which a stakeholder is said to share accountability for the actions and results of another stakeholder -Health Care Is Self Care -Doctors Cannot Cure Us -Doctors Can Only Facilitate Treatment This requires that we not follow blindly the directives of health care providers. We must remain informed as to our specific ailments, available treatments, and the consequences of compliance or non-compliance with recommended treatment (Shavers et al., 2012).
Research Methodology -Ten male recipients of health care classified as disadvantaged -Pre-Intervention Survey Administered (10 Questions) -Intervention: Health Care Education Curriculum -One week later: Post-Intervention Survey and Interviews -Two weeks later: Review of survey and interview notes
Research Study Results
Research Findings The research study was conducted over the course of four weeks at the research site. Ten male participants were recruited for the study, and consisted of: -5 Hispanic (50%) -3 Caucasian/White (30%) -1 Asian American (10%) -1 African American/Black (10%) Youngest Subject: 22 (Hispanic) Oldest Subject: 60 (Hispanic)
Survey Assessment Participants were provided with a survey both before and after the intervention. The survey asked 10 questions following the Affective (Likert) scale format. Responses ranged from 1 = Strongly Disagree to 5 = Strongly Agree, with 3 = Neutral. Analysis of responses focused on questions 1, 4, and 10: Question 1: Complete equality exists between health care provided to stable groups and those classified as disadvantaged. Question 4: The burden is not on the health care provider to make sure that the patient understands recommended course of treatment and consequences of non-compliance. Question 10: Compliance in health care requires more than following prescribed treatment regimen.
Cronbach’s Alpha: Measure of Internal Consistency Survey responses were measured for internal consistency using Cronbach’s Alpha statistical tool, where generally acceptable values range from 1.0 to 0.7, with values less than 0.5 indicating unacceptable internal consistency (Tavakol & Dennick, 2011). Internal consistency for all total scores ranged from 0.74 to 0.95, indicating a strong internal consistency of survey items. Cumulative Scores Pre-Intervention: 0.76 / Post-Intervention: 0.88 Hispanic Scores Pre-Intervention: 0.76 / Post-Intervention: 0.86 White Scores Pre-Intervention: 0.95 / Post-Intervention: 0.90 Asian-American Pre-Intervention: 0.74 / Post-Intervention: 0.85 African-American Pre-Intervention: 0.81 / Post-Intervention: 0.76
Cumulative Survey Results: Pre-Intervention 6 5 4 3 2 1 0 Q1 Q2 Q3 Q4 Q5 Strongly Disagree Disagree Q6 Neutral Q7 Agree Q8 Q9 Q 10 Strongly Agree Question 1: 40% SD, 0% D, 30% N, 20% A, 10% SA Question 4: 30% SD, 0% D, 40% N, 30% A, 0% SA Question 10: 0% SD, 0% D, 30% N, 40% A, 30% SA
Cumulative Survey Results: Post-Intervention 6 5 4 3 2 1 0 Q1 Q2 Q3 Q4 Q5 Strongly Disagree Disagree Q6 Neutral Q7 Agree Q8 Q9 Q 10 Strongly Agree Question 1: 40% SD, 20% D, 30% N, 10% A, 0% SA Question 4: 30% SD, 10% D, 20% N, 20% A, 20% SA Question 10: 0% SD, 10% D, 20% N, 40% A, 30% SA
Qualitative Interview Findings For health care recipients classified as disadvantaged, their perceptions have been documented to indicate that health care providers do not have high regard for their lives, causing these patients to not seek treatment or to not comply with treatment (Bostick, Morin, Benjamin, & Higginson, 2006). Survey results and interview data show perceptions that range from doubt regarding the existence of disparities in care to doubt regarding the role of self and others in helping to correct such disparities. With regard to age, survey and interview data revealed increasing trust of health care providers with participant age. This is also supported by the literature, namely, that “…trust increase[s] with respondents’ age” (Adegbembo, Tomar, & Logan, 2006, p. 795).
Who Is Responsible for Disparities In Care? The Responsibility Threshold: The responses of research participants classified as a racial minority showed perceptions acknowledging the existence of differences in health care provider treatment of minority patients and of the need for societal contribution in problem resolution (i.e., a societal problem). The responses of research participants classified as White showed neutrality toward the issue of differences in health care provider treatment along the lines of race, and were more indicative of personal accountability in problem resolution (i.e., a personal problem). SOCIETAL PROBLEM PERSONAL PROBLEM HEALTH CARE EQUALITY
Possible Reasons for Perceptions of Health Care Equality -Recipients of health care classified as disadvantaged may not be aware of the existence of disparate treatment to either themselves or to others of similar status -Stable groups may not be aware of the existence of the problem -Those who are most affected by the problem are least outspoken about the issue (Smith, 2008)
CONCLUSION The issue of health care disparities is both a societal problem as well as a personal problem (Williams, 2008). While there is no quick solution to this social ill, we can begin to bridge the gap through communication, cooperation, trust, and concern among all stakeholders (Stone, 2007). A pivotal method of achieving this is to continue the research into the perception of equality in health care for disadvantaged populations. Our lives and our way of life may very well depend on it…
References Adegbembo, A., Tomar, S., & Logan, H. (2006). Perception of racism explains the difference between Blacks’ and Whites’ level of health care trust. Ethnicity & Disease, 16, 792-798. Retrieved from http://www.ishib.org/ed/journal/16-4/ethn-16-04-792.pdf Agency for Health Care Research and Quality. (2011). National health care disparities report. Retrieved from http://www.ahrq.gov/qual/nhdr11/nhdr11.pdf Bostick, N., Morin, K., Benjamin, R., & Higginson, D. (2006). Physicians’ ethical responsibilities in addressing racial and ethnic health care disparities. Journal of the National Medical Association, 98(8), 13291334. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2569559/pdf/jnma001 95-0091.pdf Cawthorne, A. (2009). Weathering the storm: Black men in the recession. Retrieved from http://www.americanprogress.org/wpcontent/uploads/issues/2009/04/pdf/black_men_recession.pdf
References (continued) Lovasi, G., Hutson, M., Guerra, M., & Neckerman, K. (2009). Built environments and obesity in disadvantaged populations. Epidemiologic Reviews, 31(1), 7-20. Retrieved from http://epirev.oxfordjournals.org/content/31/1/7.full.pdf+html doi:10.1093/epirev/mxp005 Shavers, V., Fagan, P., Jones, D., Klein, W., Boyington, J., Moten, C., & Rorie, E. (2012). The state of research on racial/ethnic discrimination in the receipt of health care. American Journal of Public Health, 102(5), 953-966. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3347711/pdf/nihms37 0135.pdf Smith, B. (2008). Far enough or back where we started: Race perception from Brown to Meredith. Journal of Law and Education, 37(2), 297305.
References (continued) Stone, J. (2007). Ethics and health care for African Americans. Retrieved from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd =1&ved=0CCEQFjAA&url=http%3A%2F%2Fchpe.creighton.edu%2 Fpeople%2Fprofiles%2Fppts%2Fethics_african_americans.ppt&ei=I MqJUPCpLuKrigLEi4CIDQ&usg=AFQjCNGZjbbKrvl6FN29FF2SWcWD5pQLg&sig2=ThtmaOx4ViqVvLKZ0kyIwQ Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach’s alpha. International Journal of Medical Education, 2, 53-55. Retrieved from http://www.ijme.net/archive/2/cronbachs-alpha.pdf U.S. Department of Health and Human Services. (2010). Health disparities: A case for closing the gap. Retrieved from http://www.healthreform.gov/reports/healthdisparities/
References (continued) Williams, C. (2008). The Perception of Equality. Retrieved from http://www.youtube.com/watch?v=nusMoV4fuKc Wilson, E., Grumbach, K., Huebner, J., Agrawal, J., & Bindman, A. (2004). Medical student, physician, and public perceptions of health care disparities. Medical Student Education, 36(10), 715-721. Retrieved from http://www.stfm.org/fmhub/fm2004/november/elisabeth715.pdf
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