Importance
Racial/Ethnic Differences in the Use of
Health Information to Self-Advocate
During the Medical Encounter: Is
Having Health Information Enough?
„
Patients who self-advocate gain maximum
benefit from the medical encounter (Brashers et al
1999; Marelich & Murphy; Walsh-Burke & Marcusen, 1999)
„
Cornerstone in cancer survivorship
(Walsh-Burke et al 1999)
Jacqueline C. Wiltshire, MPH PhD
Kate Cronin, MPH
Gloria E. Sarto, MD PHD
University of Wisconsin Medical School
Center for Women’s Health Research
Madison, Wisconsin
„
1999)
„
„
„
Increasing numbers of people are accessing
health information, little is known about
whether and how they use this health
information to advocate during the medical
encounter
Changing health care climate
„
Necessary skill for all health care consumers
(Naumann & Vessey, 2002; Steinberg et al 2002)
28 June 2005
Gaps in Literature
Essential for chronic disease management
& survivorship (Brashers et al, 1999; Courts et al 2004; Schaefer
Objectives
„
To examine whether race/ethnicity and
obtaining health information are
associated with self-advocacy
It is also unclear how self-advocacy differs
among different racial and ethnic groups
Data and Analytic Sample
Household Component of the
Community Tracking Study (CTS)
Dependent Variables
„ 2000-2001
„ Nationally
representative study to track changes in the
health care system and their effects on people
„ Target Population: Civilian, non-institutionalized adult
population in the contiguous U.S. (n=59, 725)
„ Analytic
„ 7,419
Sample
women aged 45-64 who had at least 1 provider visit
in the preceding 12 months
„
Health information mentioned to the
physician by the patient
„
Physician used imparted health
information to order tests,
procedures, or prescriptions
1
Main Explanatory Variables
Health Information
„
1. Internet
2. Friends
3. TV or Radio
4. Books/magazine/other
source
5. Health care
professional/health care
organization
„
Race/Ethnicity
1. White
2. African
American (AA)
3. Hispanic
Control Variables
Age
Marital status
Rural living
Education
Employment
Federal Poverty
Level
„
„
„
„
„
„
„
„
„
„
Insurance
Usual source of care
Perceived Health Status
HMO Enrollment
Frequency of sources
„
„
1, 2, 3+ sources
Analysis
„
„
Selected Characteristics of Respondents
70
Descriptives (frequencies)
Binomial logistic regression (SUDAAN)
„
„
„
62.8
60
50
40
Account for complex survey design
“SUBPOPN” statement in SUDAAN was
used to select analytic sample
Odds ratios and 95% confidence intervals
30
20.6
20.9
20
11.8
10
0
Age
(years)
Selected Characteristics of Respondents
59.8
53.5
Married
(%)
Rural
living (%)
< High
School
(%)
Main Explanatory Variables
Weighted % of Health Information/Sources
Weighted % of Race/Ethnicity
100
95.5
60
90
80
48.7
78
60
20
White
African American
Hispanic
70
39.4
20.8
1 Source
2 Sources
3+ Sources
50
80
40
Employed Poor/near(%)
poor (%)
39.0
40
31.8
60
29.1
% 30
50
%
7.3
40
20
30
0
Usual
Source of
Care (%)
Poor/Fair
Health
(%)
Uninsured
(%)
HMO (%)
20
12
8
10
10
0
0
Race/Ethnicity
All Info
Combined
Frequency
of Sources
2
Among those who sought health information, frequency
of sources, and self-advocacy by race/ethnicity
Dependent Variables
*Multivariate-adjusted %
ƒ Mentioned Info to Physician
ƒ Physician Ordered Tests
35
28.2%
30
25
20 17.3%
13.4%
15
10
8.3%
Of the 28% who mentioned
information to the physician
n=1079), 48.7% perceived
that they got tests ordered
5
0
Overall
Sample
(n=7419)
Sample with
Health Info
(n=3960)
a
Model 1 (N=7419)
95% CI p-value q-value
Sociodemographics
Race/Ethnicity
African American
0.52 (0.37-0.73) <0.001 0.001
Hispanic
0.79 (0.57-1.09) 0.156 0.223
White (reference)
Sought Health Information
Yes
4.76 (4.05-5.60) <0.001 0.001
No (reference)
Frequency of health sources
3
2
1 (reference)
Interactions
Race x Poverty Level
African American - Poor
African American - Near-poor
Hispanic - Poor
Hispanic - Near-poor
b
OR
Model 2 (N=3690)
95% CI p-value q-value
c
OR
Model 3 (N=3690)
95% CI p-value q-value
0.57 (0.40-0.83) 0.004 0.013
0.92 (0.64-1.32) 0.647 0.715
0.68 (0.48-0.94) 0.022 0.072
0.92 (0.63-1.33) 0.653 0.742
2.24 (1.86-2.69) <0.001 0.001
1.41 (1.15-1.73) 0.001 0.004
2.24 (1.86-2.70) <0.001 0.001
1.40 (1.14-1.71) 0.001 0.005
0.72
0.39
1.35
0.59
(0.26-2.00)
(0.16-0.96)
(0.44-4.16)
(0.23-1.52)
0.534
0.041
0.600
0.275
0.668
0.094
0.714
0.382
Summary
„
Midlife women with health information are
more likely to self-advocate than those
without health information
„
Self-advocacy differs by race/ethnicity
„
White
(n=3113)
AA
(n=342)
Hispanic
(n=215)
45.8
49.2
29.3
68.9
31.0b
44.6
34.0
75.0b
35.0c
45.2
38.5
70.2
5.1
50.0
4.5
40.4b
7.7
47.2
38.3
32.1
29.6
43.8
30.0
26.0
41.9
30.6
27.4
29.3
46.7
19.2b
49.2
27.0
64.3
*Adjusted for age, marital status, rural living, education, employment status, poverty level, usual source
of care, health insurance, HMO status, and health status.
Binomial Logistic Regression Models of Mentioned Health Information to Doctor
OR
Characteristic
Sources of Health Info
Internet
Friends
TV or Radio
Books/magazine/other
source
Health care profs & orgs
All Health Info Combined
Frequency of Health Info
1
2
3
Self-Advocacy
Mentioned Info to Physician
Physician Ordered Tests
African Americans less likely to obtain health
information & less likely to advocate during the
medical encounter
Binomial Logistic Regression Model of Doctor Used Health Information to Order Tests
a
b
Model 1 (N=1079)
OR 95% CI p-valueq-value
Sociodemographics
Race/Ethnicity
African American
Hispanic
White (reference)
Freqency of Health Information
3
2
1 (reference)
1.11 (0.62-1.97) 0.721 0.831
2.15 (1.10-4.20) 0.025 0.131
0.75 (0.53-1.05) 0.095 0.307
0.69 (0.49-0.95) 0.024 0.131
Limitations
ƒ Cross-sectional design limits causal conclusions
ƒ Relatively high socioeconomic status
„ Self-reported data – recall bias
„ Cannot distinguish primary source of health
information
„ Omitted variables that may confound or mediate
the observed relationships
„
„
Patients attitudes (assertiveness, role perceptions)
Situational factors (chronic conditions, type of
illness, length of time with physician)
3
Conclusions
„
„
While obtaining health information is
associated with self-advocacy, this may not
be enough among minority women, especially
African Americans
Thank You
„
Lyn Bromley
„
Center for the Study of Cultural
Diversity in Health Care (UW Medical
School)
Future research needed to examine
„
„
Factors that impede the ability of African
American women to self-advocate
Impact on unequal treatment
4