Cultural Opinions of Oklahomans Toward Health Care

1. Cultural Opinions of Oklahomans Toward Health Care Chris Ray, Yan Yang, Jovette Dew, Jerilyn Thorman, & Diane Montgomery Oklahoma State University firstname.lastname@okstate.edu

2. Introduction • 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.

3. Introduction • 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.

4. Purpose • 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.

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

6. P-set • Participants From 4 Data Collection Sites • Latino Community Development Agency • Oklahoma Conference on Aging • Indian Health Services Clinic • African American Church • 43 total participants

7. Q-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

8. Data 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

9. Data Analysis • 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

10. Data Analysis • Three-factor solution • 12 sorts loaded on factor 1 • 8 sorts loaded on factor 2 • 7 sorts loaded on factor 3

11. Participant Demographics

12. Participant Demographics

13. Consensus 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)

14. Factor 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)

15. Factor 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)

16. Factor 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.

17. Factor 2: Care Through Relationships • 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)

18. Factor 2: Care Through Relationships • 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)

19. Factor 2: Care Through Relationships • 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.

20. Factor 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)

21. Factor 3: Care for Each Other • Most Unlike Me Statements • 1.* My family isreluctant to obtain early treatment for illness because care is provided by white and wealthymedical 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 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.

23. Discussion • 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

24. Implications for Future Research • 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.

25. 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