Association of cancer worry and perceived risk with doctor avoidance: an analysis of information avoidance in a nationally representative US sample

Fear of receiving bad news about one’s health can lead people to avoid seeking out health information that, ironically, may be crucial for health maintenance. Using a nationally representative US sample, the present study examined whether perceived likelihood of developing cancer and worry about cancer were associated with reports of avoiding visits to one’s doctor, in respondents under and over age 50. Cancer worry, but not perceived risk of cancer, predicted doctor avoidance in respondents aged 50 and older, whereas the opposite pattern held for respondents under age 50. Moreover, in respondents aged 50 and older, cancer worry and perceived cancer risk interacted such that cancer worry was linked to doctor avoidance only when respondents also perceived a high likelihood of cancer. The latter result is consistent with the notion that worry may motivate information seeking when people expect information to dispel worry and information avoidance when the information is seen as highly likely to confirm one’s fears. Findings suggest a need for communication strategies that can influence worry and perceived risk differentially. Research should also assess the effectiveness of other behavioral strategies (e.g., automatic scheduling of appointments) as a means for reducing doctor avoidance.     

Barriers to medical care among adult blacks: what happens to the uninsured?

This article examines perceived barriers to the utilization of medical care among the uninsured in a national sample of adult (18 years and older) black Americans. Uninsured respondents were more likely to feel that it was difficult for them to receive medical care, and that they needed more care than they were obtaining. The uninsured in comparison with insured respondents were less likely to utilize private, office-based physicians. Insurance coverage, however, made no difference in hospital emergency room use for health care. The results suggest that the lack of health insurance places large numbers of blacks at a severe disadvantage in obtaining needed health care.     

Health care disparities and language use at home among latino,asian american,and american indian adolescents: Findings from the california health interview survey

Using the 2001 California Health Interview Survey, this study compared health status, medical insurance, and having a usual source of care for 2,230 ethnic minority adolescents based on language use at home: Group 1, English only; Group 2, both English and another language; and Group 3, exclusively another language. Adjusting for demographic variables, adolescents in Group 3 were more likely to report fair or poor health (OR=2.37, p=.012) and to not have medical insurance (OR=4.61, p<.001) compared to adolescents in Group 1. Young adolescents in Group 3 were more likely to have no usual source of care (OR=4.07, p=.029). Interventions need to consider language barriers in the context of an adolescent's age. © 2007 Wiley Periodicals, Inc.     

Assessment of perceived barriers in self-care of insulinrequiring diabetic patients

To gain more insight into perceived barriers in the self-management of insulin-treated diabetic patients, a cross-sectional study was conducted at our outpatient clinic. The Barriers in Diabetes Questionnaire (BDQ), consisting of three subscales, was completed by 240 patients (type I and II). Additional background information and medical data were gathered. Mean BDQ scores indicated that most barriers relate to ‘self-regulation in specific situations’. No significant relationships were found between BDQ subscale-scores on the one hand and age, sex, educational level, type or duration of diabetes on the other. Patients with a higher HbA1c showed significantly higher scores on two of the three subscales. A significant negative correlation was found between patients' subjective evaluation of their health status and their BDQ-scores. It is concluded that the BDQ can be a valuable assessment tool for health care providers to tailor diabetes education and care to the patients' individual needs.     

Perceived access to health care and its influence on the prevalence of behavioral risks among urban African Americans

INTRODUCTION: Individuals who have difficulty gaining access to health care may delay seeking and obtaining treatment, underutilize preventive health care services, and may have a high prevalence of chronic disease risks. This report examines participant perception of the level of difficulty encountered when obtaining medical care and its influence on the prevalence of chronic disease behavioral risks among urban African Americans. RESULTS: We found a significantly higher prevalence of current cigarette smoking and alcohol consumption among African Americans who reported that they experienced difficulty in obtaining medical care than among those who did not. Compared to those who experienced no difficulty obtaining care, participants who perceived a high level of difficulty in obtaining care were less likely to have had a physical exam in the past year and to have seen the same doctor when services were obtained. CONCLUSION: The perception of a high level of difficulty obtaining health care may be associated with a higher prevalence of behavioral risks for chronic disease. The limited data suggest a need to more closely examine the perception of health care accessibility and its relationship to health services utilization and the prevalence of chronic disease behavioral risks.     

Assessing the significance of health information seeking in chronic condition management

ObjectiveTo examine the relationship between health information seeking and confidence in performing self-management activities, and to assess the influence of predisposing, enabling, and perceive need factors on confidence to perform self-management activities among adults with chronic conditions.MethodsThe sample included 6724 adults from the 2007 Health Tracking Household Survey who were ≥18 years with a chronic condition. Binary logistic regression examined the relationship between health information seeking, predisposing, enabling, and perceive need factors and confidence in performing three self-management activities; prevent symptoms, tell doctor concerns, and know when to get medical care.ResultsAnalyses indicated that 63.7% of adults sought health information. Rural residents who sought health information had 50% (95% CI: 0.28–0.89) lower odds of being confident to tell doctor concerns compared to urban residents who did not seek health information.ConclusionThe relationship between health information seeking and confidence to perform self-management varies by self-management activity. Rurality, education level, having a usual source of care, and perceived health status strongly predict confidence to perform self-management activities.Practice implicationsSelf-management strategies should incorporate health information seeking behavior that will enhance confidence to perform specific self-management activities, and should incorporate predisposing, enabling, and perceive need factors.     

Relationship between health beliefs and psychological variables in diabetic patients

The present paper is focused on the relationship between psychological variables and health beliefs in 93 diabetic men. A Diabetes Health Belief Scale was used to assess general health motivation, treatment beneficial, severity, susceptibility, psychological barriers, cues to action, and structural elements. The psychological variables included two measures of locus of control, depression, somatization, interpersonal sensitivity, obsessive—compulsiveness, anxiety, self-esteem, and attitudes toward diabetes, doctor, and medical care. Ten of the 11 psychological variables were correlated with various aspects of health beliefs. This indicates the extent to which the health beliefs are enmeshed with the psychological dynamics of the person. It would seem important to take such a psychological profile into consideration when attempting to understand and even alter the health beliefs.     

Medical ethics in sub-Sahara Africa: closing the gaps

Background

Health care providers are expected to have the skills and knowledge relevant to their field and should also be familiar with the ethical and legal expectations that arise out of the standard practices.

Objectives

To elucidate the practice of the health care providers in relation to healthcare ethics in Nigeria.

Methods

A self-administered structured questionnaire was devised and distributed to staff of two tertiary health care facilities in Northern Nigeria. The questionnaire comprised of detailed questions regarding day-to-day aspects of Medical ethical issues.

Results

A total of 307(76.2%) out of 403 health care providers responded to the questionnaire. The median age of the respondents was 34 years. More than half 168(54.7%) of the respondents disagreed as to whether “Ethical conduct is important only to avoid legal action. Many respondents 135 (44.0%) agreed to adhering to “patient''s wishes”, on the other hand over two-third of the respondents 211 (68.7%) agreed that “doctor should do what is best” irrespective of the patient''s opinion. There were significant differences (p<0.05) between the perception of physicians and non-physicians on many ethical issues.

Conclusion

This study has shown gap in knowledge and practice of healthcare ethics among health care providers. There is a need for periodic education on clinical ethics in our hospitals.     

Depressive symptoms and close relationships during the transition to adulthood: perspectives from dysphoric women, their best friends, and their romantic partners

Late adolescent women's depressive symptoms and interpersonal functioning were assessed using reports from participants, their best friends, and their romantic partners. As predicted, the associations between relationship dysfunction and dysphoria were stronger in romantic relationships than in friendships. Unlike friends, romantic partners perceived dysphoric women as having poorer social skills. Romantic partners also reported providing less emotional support to dysphoric women, whereas friends reported providing more. Finally, romantic partners of dysphoric women had more Cluster A (odd-eccentric) personality disorder symptoms; these symptoms mediated the relation between women's depression and partners' nonsupportiveness. The findings suggest that dysphoric women may find themselves in emotionally nonsupportive romantic relationships because they have paired (through assortative pairing or mutual influence) with symptomatic partners.     

Exploring differences in trust in doctors among African American men and women

ObjectivesLow trust in doctors may partially account for African Americans' adverse health outcomes. Understanding the drivers of low trust can guide health care policy to improve trust and delivery of health care for African Americans. This study examines gender differences in trust in doctors among African Americans and explores factors differentially associated with low level trust for men vs women.Methodsand Measures: Cross-sectional analysis of 3649 African Americans using data from the 2003-2004 Community Tracking Study Household Survey, including 4 items measuring trust in doctors (range, 1 = lowest trust and 5 = highest trust). Items were assessed separately and as an index measure. Linear regression analyses adjusted for multiple con-founders and accounted for complex data sampling.ResultsOverall, men were less trusting of doctors than women. However, men differed from women only on 2 trust measures: "doctor influenced by insurance rules" (adjusted mean scores = 2.48 for men and 2.79 for women, p = .001) and "doctor performs unnecessary tests" (adjusted mean score = 4.00 for men and 4.28 for women, p = .010). Common correlates of low trust in men and women included less than high school education, age of at least 65 years, and having no usual source of care. Unique correlates of lower trust for men included rural living and no doctor visit in the preceding year. Unique correlates for women included low income and poorer health status.ConclusionsThere are differential predictors of low trust among African American men vs women, underscoring the need for gender-based and health care system-level approaches to improve African Americans' trust and health outcomes.     

Barriers to oral health care utilization in Ibadan,South West Nigeria

Background

Barriers to oral health utilization are many, but those that are significant for our environment are not yet clear. The current study was designed to identify and graduate the barriers to receipt of oral health care among a cross-section of patients attending our centre. We also investigated the influence of socio demographic factors on the highly rated barriers.

Methods

This cross-sectional study was conducted among patients visiting UCH, Ibadan using a self-administered questionnaire. Socio-demographic variables and oral health care seeking behaviour were requested and in addition, the respondents were asked to rank 11 listed barriers to receipt of oral health care and any other barriers they may think of in order of strength. Factor analysis was employed in order to identify four factors with the highest loading. The mean scores were compared using t-test and one-way ANOVA and the level of significance was set at 0.05

Results

Only 400 questionnaires were properly filled (84.9%) out of the 471 that were administered. The mean age of these participants was 37.85±15.38 years. Most of the respondents (55.8%) consulted the dentists only when there was pain while 109(27.3%) had never visited the dentist. Fear of dental injection, cost of treatment, feeling of insecurity when the dentist is operating and disturbing noise from dental drill were the major barriers. There was a statistically significant association between age groups and feeling of insecurity (p=006).

Conclusion

The major barriers to oral health care utilization among our patients were fear related.     

Prostate cancer: perceptions of African-American males.

The purpose of this study was to determine black adult males'' knowledge and perceptions of prostate cancer by using the Health Belief Model. The subjects were obtained by randomly approaching males in churches, housing projects, inner-city health clinics, and inner-city shopping centers in seven major Ohio cities. A total of 290 black males responded to the survey (58% usable response rate). The mean age of respondents was 60 years (standard deviation = 13.8). Subjects often did not identify trouble urinating, pain urinating, or blood in the urine as possible signs of prostate cancer. Less than half of the subjects knew at what age one should start to have prostate examinations. Forty percent did not believe they were more likely than most men to develop prostate cancer. Almost 60% did not know black men were more likely than white men to develop prostate cancer, whereas 45% thought that if they had prostate cancer it would kill them, and another 28% were not certain. The vast majority of respondents did not perceive any barriers to having their prostate checked, yet 19% identified cost of the examination as a potential barrier. Approximately 10% to 20% of the respondents were unsure of or did not agree with the benefits of a prostate examination. Analysis of the effects of age, education level, and income levels on the Health Belief Model variables found level of education had the most significant effect followed by level of income.     

SEEKING HELP FOR PSYCHOLOGICAL DISTRESS IN URBAN CHINA

Based on data gathered through a household survey of 1,474 urban residents in Beijing, this study examines Chinese help‐seeking behaviors in times of psychological distress and perceived barriers to seeking professional help. The results demonstrate that most respondents rely on informal means of seeking help whereas mental health and medical services are underused. The Internet has become a preferred alternative help‐seeking approach, particularly among the young educated migrant population. Respondents with higher socioeconomic status are more likely to utilize professional services. The tendency to seek help informally is associated with refusal to recognize the need of professional help, whereas embarrassment and stigma are significant factors in the use of alternative services, particularly the Internet. In addition to showing a general lack of trust in professional mental health services, the more psychologically distressed subgroup also expressed concerns about the affordability of professional treatment.     

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators

Background

While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not.

Method

This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help.

Results

Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO.

Conclusion

Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.     

Patient Perspectives on Online Health Information and Communication With Doctors: A Qualitative Study of Patients 50 Years Old and Over

Background

As health care systems around the world shift toward models that emphasize self-care management, there is increasing pressure for patients to obtain health information online. It is critical that patients are able to identify potential problems with using the Internet to diagnose and treat a health issue and that they feel comfortable communicating with their doctor about the health information they acquire from the Internet.

Objective

Our aim was to examine patient-identified (1) problems with using the Internet to identify and treat a health issue, (2) barriers to communication with a doctor about online health information seeking, and (3) facilitators of communication with a doctor about patient searches for health information on the Internet.

Methods

For this qualitative exploratory study, semistructured interviews were conducted with a sample of 56 adults age 50 years old and over. General concerns regarding use of the Internet to diagnose and treat a health issue were examined separately for participants based on whether they had ever discussed health information obtained through the Internet with a doctor. Discussions about barriers to and facilitators of communication about patient searches for health information on the Internet with a doctor were analyzed using thematic analysis.

Results

Six higher-level general concerns emerged: (1) limitations in own ability, (2) credibility/limitations of online information, (3) anxiety, (4) time consumption, (5) conflict, and (6) non-physical harm. The most prevalent concern raised by participants who communicated with a doctor about their online health information seeking related to the credibility or limitations in online information. Participants who had never communicated with a doctor about their online health information seeking most commonly reported concerns about non-physical harm. Four barriers to communication emerged: (1) concerns about embarrassment, (2) concerns that the doctor doesn’t want to hear about it, (3) belief that there is no need to bring it up, and (4) forgetting to bring it up. Facilitators of communication included: (1) having a family member present at doctor visits, (2) doctor-initiated inquiries, and (3) encountering an advertisement that suggested talking with a doctor.

Conclusions

Overall, participants displayed awareness of potential problems related to online health information seeking. Findings from this study point to a set of barriers as well as facilitators of communication about online health information seeking between patients and doctors. This study highlights the need for enhanced patient communication skills, eHealth literacy assessments that are accompanied by targeted resources pointing individuals to high-quality credible online health information, and the need to remind patients of the importance of consulting a medical professional when they use online health resources to diagnose and treat a health issue.     

Self-evaluated health status and beer drinking behaviour among South Africans

A two stage instrumental variables probit model that postulates a simultaneous relationship between an individual's perceived health status and whether or not to drink beer is estimated using data from the South African National Household Survey of Health Inequalities. The results show a statistically significant negative relationship between individual decision to drink beer and health status. Thus, any policies geared at boosting perceived health status are likely to reduce the prevalence of beer drinking. Similarly, any policy interventions that are effective in discouraging beer drinking would improve individuals health status. Other results are that: beer drinking and cigarette smoking are complements; there is a positive relationship between individuals monthly income and his/her health status; the population groups which were politically, socially and economically deprived by a series of apartheid governments are more likely to abuse beer than their white counterparts; and there is a n-shaped relationship between individuals age and beer consumption. There is need for epidemiological research to evaluate the effectiveness of health education, fiscal and regulatory interventions in modifying alcohol use behaviour.     

Psychosocial aspects of antiretroviral medication use among HIV patients

This study examines variables related to alteration of antiretroviral medication regimens by HIV infected persons, independent of medical advice. Perceived severity, susceptibility, benefits/barriers, cues to action, and locus of control were included in the analyses. Of 99 subjects, 37 reported discontinuing antiretrovirals on their own initiative and 36 subjects (‘fiddlers’) reported recent alterations in their medication regimens. Subjects who reported greater perceived barriers and pessimism and less faith in the ability of antiretrovirals to protect them from AIDS related illness were more likely to discontinue drug therapy. Fiddlers were more pessimistic and perceived more barriers to drug therapy than compliers, who believed more in the benefits of antiretrovirals. Fiddlers were significantly more internally oriented than were discontinuers. Compliers were the most optimistic about the effect of antiretrovirals. Even though compliers were more symptomatic than discontinuers, they reported their health status to be better than did discontinuers.     

Clinical decision-making: Patients' preferences and experiences

OBJECTIVE: To determine the congruence between patients' preferred style of clinical decision-making and the style they usually experienced and whether this congruence was associated with socio-economic status and/or the perceived quality of care provided by the respondent's regular doctor. METHODS: Cross-sectional survey of the American public using computer-assisted telephone interviewing. RESULTS: Three thousand two hundred and nine interviews were completed (completion rate 72%). Sixty-two percent of respondents preferred shared decision-making, 28% preferred consumerism and 9% preferred paternalism. Seventy percent experienced their preferred style of clinical decision-making. Experiencing the preferred style was associated with high income (OR, 1.59; 95% CI, 1.16-2.16) and having a regular doctor who was perceived as providing excellent or very good care (OR, 2.39; 95% CI, 1.83-3.11). CONCLUSION: Both socio-economic status and having a regular doctor whom the respondent rated highly are independently associated with patients experiencing their preferred style of clinical decision-making. PRACTICE IMPLICATIONS: Systems which promote continuity of care and the development of an on-going doctor-patient relationship may promote equity in health care, by helping patients experience their preferred style of clinical decision-making.     

Barriers to HIV/AIDS treatment and treatment adherence among African-American adults with disadvantaged education

African Americans are disproportionately affected by acquired immunodeficiency syndrome (AIDS). New treatments that slow the progression of human immunodeficiency virus (HIV) infection offer hope for individuals living with HIV/AIDS, but lack of access to care and poor treatment adherence remain significant obstacles to HIV treatment. This study investigated the association between education literacy to HIV treatment adherence and barriers to care among African Americans living with HIV/AIDS. A community-recruited sample of 85 African-American men and 53 women receiving HIV treatment completed measures of health literacy, health status, treatment adherence, emotional well-being, and barriers to care. Nearly one-third (29%) of the participants had < 12 years of education or were functionally illiterate, and those with low-education literacy were less likely to be adherent to HIV medications within the previous two days. Lower-education literacy also was related to reasons for missing medications and barriers to accessing medical care. Individuals of law-education literacy also were more emotionally distressed, lacked social support, and were less optimistic than those with higher education. These results indicate that education and health literacy are important factors in HIV-treatment adherence and access to medical care. Interventions are needed for improving treatment adherence among law-income minorities, and such interventions will need tailoring for individuals with limited reading ability.