Satisfaction with and Perceived Cultural Competency of Healthcare Providers
INTRODUCTION
Despite the overall improvement of health in the American population, statistics has shown that there is a disparity in the health of certain racial groups. Infant mortality rates for African Americans and Native Americans are twice those of whites, heart disease is 40% higher for blacks than for whites, and Hispanic and Native Americans have a higher rate of diabetes than non-Hispanic whites. In addition, maternal mortality for African-American women is almost three times that of the nation. This pattern of disparity is evident in both healthcare utilization and outcome.
The Problem
Many African Americans distrust the healthcare establishment. This is frequently attributed to the Tuskegee study, conducted from 1932-1973. Poor, black males were recruited for observation but not informed of or offered treatment for active syphilis. Recent studies have shown that blacks are less trusting of healthcare providers than whites. However, in order to decrease health disparities, it is necessary for blacks and other minorities to trust the healthcare system arid to participate in healthcare research. Lack of trust in healthcare provider is an impediment to participation.
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Researchers have found that trust is associated with listening, information provided, time spent and participation in decision-making. Physicians who show comforting and caring behavior, encourage questions and provide answers are associated with trust. Patients with low levels of trust are less satisfied with their care.
Some studies have indicated that trust is greater when the provider is of the same race. Patient’s rating of doctor’s care and effort are higher when patient and doctor are both African-American. However, these results contradict an earlier study that found no preference for physicians of the same race but did find physician nonverbal behavior associated with satisfaction and trust. Continuity of care has also been associated with trust for African-American females. Women who rated their doctors high on being able to take care of all their healthcare needs were more trustful of their physician. Higher trust was also associated with use of recommended preventive services. Women with less trust in their physician were less willing to follow his/her advice. Female patients trust female physicians more than male physicians and rated them higher on time spent with and concern shown for patients. Patients who consult a doctor they trust have higher levels of satisfaction.
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Lack of trust is just one impediment to the participation of African Americans and other minorities in healthcare research. Shavers-Hornaday et al. found that poor access to primary care, the failure of researchers to recruit African Americans actively, alienation of minority healthcare professionals, lack of knowledge about clinical trials and cultural barriers contribute to low African-American participation in healthcare research. More recent research has shown African Americans less willing to participate in healthcare research if they attribute high importance to the race of the physician when seeking medical care, believed that minorities or the poor bear most of the risks of medical research and were familiar with the Tuskegee Study.
Creighton University’s Office of Health Sciences: Multicultural and Community Affairs (HS-MACA), in an attempt to increase the participation of African Americans and other minorities in healthcare research, conducted a study to assess satisfaction with healthcare providers among minorities in the Omaha community. HS-MACA wanted two questions answered: 1) are minority healthcare clients satisfied with healthcare services within the Omaha medical community, and 2) why minority healthcare clients do not participate in healthcare research in larger numbers. Because trust has been shown to be related to satisfaction, we sought to assess satisfaction and not trust. Moreover, existing physician trust scales were inadequate for our multicultural population. Preliminary analysis of the data revealed that more than 30% of our sample received their healthcare in the emergency room, not a doctor’s office. Physician trust scales usually assume continuity of care with a single provider, something that is not possible with emergency room treatment. It was therefore necessary to develop an instrument, the Community Assessment Instrument (CAI), that took this into consideration. This instrument assesses patient satisfaction, patient perception of healthcare providers’ cultural competency and minorities’ willingness to participate in healthcare research. HS-MACA theorized that if minority clients are satisfied with their care, this satisfaction would be related to cultural competency of the healthcare provider, and that satisfaction and cultural competency would imply trust between provider and minority patient. If there is trust, perhaps minority patients would be more willing to participate in healthcare research when the opportunity occurs. cialis soft tabs online
Category: Health
Tags: community, cultural competency, health disparities, minority population, researchers, satisfaction, trust