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The Role of Perceived Discrimination and Perceived Cultural Competence in Predicting Use of Preventive Health Care Services

Chisolm, Deena Brown

Abstract Details

2003, Doctor of Philosophy, Ohio State University, Public Health.
Racial and ethnic disparities in health care utilization in the United States have been broadly documented. While some of these disparities can be attributed to socioeconomic factors, many studies have found that significant racial disparities remain even after control for variables including income, education, and insurance status. How race and ethnicity impact health utilization beyond socioeconomic factors is an expanding area of research. This study considers the role of two previously unexplored constructs, perceived discrimination and perceived cultural competence, in explaining use of ambulatory and preventive health care services. The data for this study are derived from the Commonwealth Fund 2001 Disparities in Health Care Quality Survey, a national survey including 6,722 people aged 18 and older. Blacks and Hispanics were over sampled to allow for meaningful subgroup analysis. This study employs logistic regression modeling to explain the use of nine ambulatory and preventive services: ambulatory care, physical examination, blood pressure screening, cholesterol screening, Pap testing, mammography, colon cancer screening, prostate cancer screening, and dental care. Independent variables for the model are be derived from the Anderson Behavioral Model for health care utilization using the categories of predisposing, enabling, and need variables. The analysis tests whether the addition of perceived discrimination and perceived cultural competence constructs to Andersen’s traditional predisposing variables decreases the significance of race and whether it improves of models. Analysis also explores whether access to a regular source of care mediates the association between health services use and racial perceptions. Findings support the hypothesis that the addition of perceived discrimination and perceived cultural competence measures to a behavioral model predicting service use significantly improves the fit of the model in four of the nine services studied and found that in selected services these variables explained some or all of the race effect that remained after control for socioeconomic variables. A mediating role for regular source of care was also supported in some services. This study provides policy makers with an enhanced understanding of the role of racial perceptions in health services us that can be used for informed policy development.
Dev Pathak (Advisor)
228 p.

Recommended Citations

Citations

  • Chisolm, D. B. (2003). The Role of Perceived Discrimination and Perceived Cultural Competence in Predicting Use of Preventive Health Care Services [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1052409673

    APA Style (7th edition)

  • Chisolm, Deena. The Role of Perceived Discrimination and Perceived Cultural Competence in Predicting Use of Preventive Health Care Services. 2003. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1052409673.

    MLA Style (8th edition)

  • Chisolm, Deena. "The Role of Perceived Discrimination and Perceived Cultural Competence in Predicting Use of Preventive Health Care Services." Doctoral dissertation, Ohio State University, 2003. http://rave.ohiolink.edu/etdc/view?acc_num=osu1052409673

    Chicago Manual of Style (17th edition)