Access to Medical Care and the Use of Faith-Based Healers in the Rural Southeast

1. Access to Medical Care and the Use of Faith-Based Healers in the Rural Southeast Sharon K. Hull, MD Timothy P. Daaleman, DO Samruddhi Thaker, MHA, MBBS Donald E. Pathman, MD, MPH University of North Carolina at Chapel Hill This study was supported by grants from The Robert Wood Johnson Foundation (#036829) The Health Resources and Services Administration (#T32-HP14001)

2. Background and Rationale

3. Research Question Hypothesis: Those who have difficulty accessing medical care are more likely to use faith-based healing (FBH).

4. Primary Outcome � Use of Faith Based Healing (FBH)

5. Methods

6. Analysis 184 non-blacks and non-whites were eliminated Final analysis included 4680 subjects Four sets of variables related to access to medical care: Utilization of medical care Barriers to medical care Satisfaction with medical care Beliefs about medical care

7. Description of Population Overall response rate was 51% Population Demographics (N = 4879): Average age 50 yrs 33% male 51% employed 55% married <2% each of Native Americans, Asians, Native Hawaiians Response rates lower among African Americans Those with household incomes <$15,000 Males Those aged 18-39 years Weighting revised to adjust for oversampling and differential response rates Overall prevalence for use of FBH was 4.0%

8. Results � Differential Use of FBH by Demographic Characteristics

9. Utilization and Barriers

10. Satisfaction and Beliefs

11. Results � Stratified Analysis by Gender and Race

12. Limitations Small number of FBH users (180) No measure of religiosity was included in the survey No questions were asked about the details or context of the faith-based healing interventions Does not include use of self-prayer or participation in prayer circles, which may be more common People may not be willing to talk about religious issues on the phone Cannot address Hispanics

13. Most Important Findings Only 4% of residents in the rural south reported that they had utilized FBH Those under age 65 are more likely to use FBH Those with fair or poor self-reported health status are more likely to use FBH Clear associations between use of FBH and the following access measures (original hypothesis) Break in health insurance coverage (Barriers) Foregone or delayed medical care within the past 12 months (Utilization) Belief that people should delay or avoid seeing physicians (Beliefs)

14. Implications Prevalence: Use of FBH lower than self-prayer or other uses of prayer in healing Not a causal relationship � cannot prove causation with a cross-sectional survey; other covariates not identifiedPrevalence: Use of FBH lower than self-prayer or other uses of prayer in healing Not a causal relationship � cannot prove causation with a cross-sectional survey; other covariates not identified

15. Discussion