Cultural Opinions of Oklahomans Toward Health

Care

Cultural Opinions of Oklahomans Toward Health

Care

Chris Ray, Yan Yang, Jovette Dew,Jerilyn Thorman, & Diane Montgomery

Oklahoma State University

firstname.lastname@okstate.edu

Chris Ray, Yan Yang, Jovette Dew,Jerilyn Thorman, & Diane Montgomery

Oklahoma State University

firstname.lastname@okstate.edu

2

Institute of Medicine report (2002) Racial and ethnic minorities are more likely to be uninsured

and tend to receive a lower quality of healthcare.

Watson (2001) Minority Americans have fewer doctors visits, receive less

primary care, and have fewer preventative procedures.

United Health Foundation (2005) Oklahoma is listed as the 44th lowest state concerning

healthcare equality.

Oklahoma Health Disparity Task Force (2004) African Americans have elevated blood pressure and higher

rates of obesity, and American Indians have decreased access to affordable healthcare.

Institute of Medicine report (2002) Racial and ethnic minorities are more likely to be uninsured

and tend to receive a lower quality of healthcare.

Watson (2001) Minority Americans have fewer doctors visits, receive less

primary care, and have fewer preventative procedures.

United Health Foundation (2005) Oklahoma is listed as the 44th lowest state concerning

healthcare equality.

Oklahoma Health Disparity Task Force (2004) African Americans have elevated blood pressure and higher

rates of obesity, and American Indians have decreased access to affordable healthcare.

IntroductionIntroduction

3

Cultural Competence Study (Majumdar, et. al., 2004) Health care providers must be educated to be culturally

competent. Cultural Competence (Marks, et. al., 2004)

Many doctors and nurses are lacking in cultural competence.

Health Care Providers (Betancourt et. al., 2002) Failure of providers to understand differences between

them and their clients leads to patient dissatisfaction. Previous Q-study (Sylvester, 2000)

Examined African American attitudes toward health care in Missouri and Louisiana.

Cultural Competence Study (Majumdar, et. al., 2004) Health care providers must be educated to be culturally

competent. Cultural Competence (Marks, et. al., 2004)

Many doctors and nurses are lacking in cultural competence.

Health Care Providers (Betancourt et. al., 2002) Failure of providers to understand differences between

them and their clients leads to patient dissatisfaction. Previous Q-study (Sylvester, 2000)

Examined African American attitudes toward health care in Missouri and Louisiana.

IntroductionIntroduction

4

The purpose of this study is to explore the attitudes and opinions of racially, ethnically, and socio-economically diverse groups toward health care in Oklahoma.

The purpose of this study is to explore the attitudes and opinions of racially, ethnically, and socio-economically diverse groups toward health care in Oklahoma.

PurposePurpose

5

MethodMethod

Invitation by the Cultural Competency sub-committee of the Oklahoma Task Force to Eliminate Health Disparities

Invitation by the Cultural Competency sub-committee of the Oklahoma Task Force to Eliminate Health Disparities

6

Participants From 4 Data Collection Sites Latino Community Development Agency Oklahoma Conference on Aging Indian Health Services Clinic African American Church

43 total participants

Participants From 4 Data Collection Sites Latino Community Development Agency Oklahoma Conference on Aging Indian Health Services Clinic African American Church

43 total participants

P-setP-set

7

Q-setQ-set Development of Concourse

Sylvester Study Informal Conversations Researcher Experience

Structure of Concourse Racial and Economic Prejudice and Discrimination Socio-Economic Statuses Cultural Perceptions Language Barriers Personal Beliefs

47 Q-Statements

Development of Concourse Sylvester Study Informal Conversations Researcher Experience

Structure of Concourse Racial and Economic Prejudice and Discrimination Socio-Economic Statuses Cultural Perceptions Language Barriers Personal Beliefs

47 Q-Statements

8

Data CollectionData Collection

Magnetic Boards Condition of Instruction

“What Are Your Thoughts About Health Care?”

Most Unlike Me (-5) to Most Like Me (+5) Form Board Distribution

2 - 3 - 4 - 5 - 6 - 7 - 6 - 5 - 4 - 3 - 2 Demographic Survey

Magnetic Boards Condition of Instruction

“What Are Your Thoughts About Health Care?”

Most Unlike Me (-5) to Most Like Me (+5) Form Board Distribution

2 - 3 - 4 - 5 - 6 - 7 - 6 - 5 - 4 - 3 - 2 Demographic Survey

9

Factor Analysis Using PCMethod Software (Schmolck, 2002) Attempted CFA with Hand Rotation Chose PCA with Varimax Rotation Correlations Between Factor Scores

Automatic Pre-Flagging r12 = .60; r13 = .59; r23 = .55

Hand flagging r12 = .52; r13 = .48; r23 = .47

Factor Analysis Using PCMethod Software (Schmolck, 2002) Attempted CFA with Hand Rotation Chose PCA with Varimax Rotation Correlations Between Factor Scores

Automatic Pre-Flagging r12 = .60; r13 = .59; r23 = .55

Hand flagging r12 = .52; r13 = .48; r23 = .47

Data AnalysisData Analysis

10

Three-factor solution 12 sorts loaded on factor 1 8 sorts loaded on factor 2 7 sorts loaded on factor 3

Three-factor solution 12 sorts loaded on factor 1 8 sorts loaded on factor 2 7 sorts loaded on factor 3

Data AnalysisData Analysis

11

Participant DemographicsParticipant DemographicsFactor 1 Factor 2 Factor 3

Gender

Male 5 1 2

Female 7 7 5

Age

18 - 30 2 1 0

31 - 50 1 7 3

51 - 70 5 0 1

Over 71 4 0 3

12

Participant DemographicsParticipant DemographicsFactor 1 Factor 2 Factor 3

Race/Ethnicity

African American 2 2 1

Hispanic 0 1 0

American Indian 10 5 5

White American 0 0 1

Income

Less than $25k 7 1 2

$25k - $50k 2 2 2

More than $50k 0 2 1

13

Consensus StatementsConsensus Statements

12. If I felt by taking some precautions I could save myself some money down the line, then I would take better care of myself. (+2, +2, +4)

18. Preventative health efforts must be improved in poor areas of our state. (+3, +2, +4)

29. I think medicine is poison. All medicine has side effects. So whenever I get ill, I resort to my own home remedies rather than the health care system. (-4, -4, -4)

12. If I felt by taking some precautions I could save myself some money down the line, then I would take better care of myself. (+2, +2, +4)

18. Preventative health efforts must be improved in poor areas of our state. (+3, +2, +4)

29. I think medicine is poison. All medicine has side effects. So whenever I get ill, I resort to my own home remedies rather than the health care system. (-4, -4, -4)

14

Factor 1: Care Through PreventionFactor 1: Care Through Prevention

Most Like Me Statements 8.* It doesn’t matter to me what a doctor’s race is as

long as they pay attention to my needs. (+5, 2.280) 39.* The real key to good health is good, clean living.

(+5, 2.102) 13. If I’m not feeling well, I have no trouble finding

time to go to the doctor. (+3, 1.264) 18. Preventative health efforts must be improved in

poor areas of our state. (+3, 0.890)

Most Like Me Statements 8.* It doesn’t matter to me what a doctor’s race is as

long as they pay attention to my needs. (+5, 2.280) 39.* The real key to good health is good, clean living.

(+5, 2.102) 13. If I’m not feeling well, I have no trouble finding

time to go to the doctor. (+3, 1.264) 18. Preventative health efforts must be improved in

poor areas of our state. (+3, 0.890)

15

Factor 1: Care Through PreventionFactor 1: Care Through Prevention

Most Unlike Me Statements 21.* Illness can be a punishment from God. (-5, -1.732) 2. Doctors are prejudiced against me and my family.

(-5, -1.681) 17. I am trying to survive and don’t have time or

money to worry about health right now. (-4, -1.423) 3.* The health care system makes me feel like I am

poor or stupid. (-3, -1.212)

Most Unlike Me Statements 21.* Illness can be a punishment from God. (-5, -1.732) 2. Doctors are prejudiced against me and my family.

(-5, -1.681) 17. I am trying to survive and don’t have time or

money to worry about health right now. (-4, -1.423) 3.* The health care system makes me feel like I am

poor or stupid. (-3, -1.212)

16

Factor 1: Care Through PreventionFactor 1: Care Through Prevention

Participants defining this view: Take charge of their health and are actively

engaged in promoting their well-being. Are not focused on illness, but instead focused

on wellness. Have faith in the medical community. Make it a priority to get medical attention when

they do become sick.

Participants defining this view: Take charge of their health and are actively

engaged in promoting their well-being. Are not focused on illness, but instead focused

on wellness. Have faith in the medical community. Make it a priority to get medical attention when

they do become sick.

17

Most Like Me Statements 7.* The ultimate solution to providing adequate health

care for minorities and poor people is to educate enough doctors and nurses from minority groups. (+5, 1.813)

4.* Doctors and nurses need to respect the pride, values, and backgrounds of people they are trying to reach. (+5, 1.681)

8.* It doesn’t matter to me what a doctor’s race is as long as they pay attention to my needs. (+4, 1.547)

Most Like Me Statements 7.* The ultimate solution to providing adequate health

care for minorities and poor people is to educate enough doctors and nurses from minority groups. (+5, 1.813)

4.* Doctors and nurses need to respect the pride, values, and backgrounds of people they are trying to reach. (+5, 1.681)

8.* It doesn’t matter to me what a doctor’s race is as long as they pay attention to my needs. (+4, 1.547)

Factor 2: Care Through RelationshipsFactor 2: Care Through Relationships

18

Most Unlike Me Statements 21.* Illness can be a punishment from God.

(-5, -2.266) 25.* I like to use herbs for medicine first and

only go see doctors last. (-5. -1.517) 22.* When I get sick, I just read my Bible and

pray. (-4, -1.367) 19. I think medicine is poison. All medicine has

side effects. (-4, -1.341)

Most Unlike Me Statements 21.* Illness can be a punishment from God.

(-5, -2.266) 25.* I like to use herbs for medicine first and

only go see doctors last. (-5. -1.517) 22.* When I get sick, I just read my Bible and

pray. (-4, -1.367) 19. I think medicine is poison. All medicine has

side effects. (-4, -1.341)

Factor 2: Care Through RelationshipsFactor 2: Care Through Relationships

19

Participants defining this view: View effective relationships as an essential part

of adequate health care. Place a strong emphasis on the need for doctors

to understand the unique needs of the patient based upon cultural background.

Feel that disparities can be addressed best through more minority practitioners.

Deemphasize the role of religion in primary care.

Participants defining this view: View effective relationships as an essential part

of adequate health care. Place a strong emphasis on the need for doctors

to understand the unique needs of the patient based upon cultural background.

Feel that disparities can be addressed best through more minority practitioners.

Deemphasize the role of religion in primary care.

Factor 2: Care Through RelationshipsFactor 2: Care Through Relationships

20

Factor 3: Care for Each OtherFactor 3: Care for Each Other

Most Like Me Statements 19.* I believe that all Americans have a right, not a

privilege by money, to health care. (+5, 2.607) 10.* It is more important for Oklahoma health care

system to give free medical care to the poor and needy than to give free care to middle and upper class citizens. (+5, 1.644)

13. If I’m not feeling well, I have no trouble finding time to go to the doctor. (+4, 1.516)

18. Preventative health efforts must be improved in poor areas of our state. (+4, 1.455)

Most Like Me Statements 19.* I believe that all Americans have a right, not a

privilege by money, to health care. (+5, 2.607) 10.* It is more important for Oklahoma health care

system to give free medical care to the poor and needy than to give free care to middle and upper class citizens. (+5, 1.644)

13. If I’m not feeling well, I have no trouble finding time to go to the doctor. (+4, 1.516)

18. Preventative health efforts must be improved in poor areas of our state. (+4, 1.455)

21

Factor 3: Care for Each OtherFactor 3: Care for Each Other

Most Unlike Me Statements 1.* My family is reluctant to obtain early treatment for

illness because care is provided by white and wealthy medical personnel. (-5, -1.816)

3.* The health care system makes me feel like I am poor or stupid. (-5, -1.750)

43.* The future will take care of itself; I only need to worry about today. (-4, -1.455)

15.* My family is stuck in an economic system that dictates both our ability to receive health services and the quality of our health. (-3, -1.059)

Most Unlike Me Statements 1.* My family is reluctant to obtain early treatment for

illness because care is provided by white and wealthy medical personnel. (-5, -1.816)

3.* The health care system makes me feel like I am poor or stupid. (-5, -1.750)

43.* The future will take care of itself; I only need to worry about today. (-4, -1.455)

15.* My family is stuck in an economic system that dictates both our ability to receive health services and the quality of our health. (-3, -1.059)

22

Factor 3: Care for Each OtherFactor 3: Care for Each Other

Participants defining this view: View health care is a priority both for

themselves, and more importantly, for others. Feel it is society’s responsibility to ensure

health care equality. Have adequate access to the health care system

as well as the necessary time and knowledge to take care of their own health.

Feel that prevention alone is insufficient.

Participants defining this view: View health care is a priority both for

themselves, and more importantly, for others. Feel it is society’s responsibility to ensure

health care equality. Have adequate access to the health care system

as well as the necessary time and knowledge to take care of their own health.

Feel that prevention alone is insufficient.

23

Three Views of Healthcare Based upon people currently utilizing

healthcare system.

Preventative health care is important to all of the people studied.

Perhaps medication is viewed as part of prevention. Usefulness of Q Well-suited for the purpose of this study

Three Views of Healthcare Based upon people currently utilizing

healthcare system.

Preventative health care is important to all of the people studied.

Perhaps medication is viewed as part of prevention. Usefulness of Q Well-suited for the purpose of this study

DiscussionDiscussion

24

Obtain a sample that is more diverse in their health usage.

Study each racial, ethnic, and socio-economic group independently.

Expand Q-set to address what specific needs are not currently being met concerning healthcare (i.e., mental health).

Conduct interviews to identify what we do not know about issues impacting health disparities.

Study the perceptions from the perspectives of healthcare providers and administrators.

Obtain a sample that is more diverse in their health usage.

Study each racial, ethnic, and socio-economic group independently.

Expand Q-set to address what specific needs are not currently being met concerning healthcare (i.e., mental health).

Conduct interviews to identify what we do not know about issues impacting health disparities.

Study the perceptions from the perspectives of healthcare providers and administrators.

Implications for Future ResearchImplications for Future Research

25

Questions?Questions?

For additional information, please contact:

Chris Ray - chris.ray@okstate.edu

Jovette Dew - jovette.dew@okstate.edu

Yan.Yang - yan.yang@okstate.edu

Jerilyn Thorman - jerilyn.thorman@okstate.edu

Diane Montgomery - diane.montgomery@okstate.edu