The Influence of Contextual Characteristics, Individual Characteristics, and Health Behaviors on Patient Satisfaction for African American Men Treated for Prostate Cancer in North Carolina

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  • March 22, 2019
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  • Moore, Angelo D.
    • Affiliation: School of Nursing
Abstract
  • Patient satisfaction is an outcome of health services utilization; however, health services utilization can be predicated by contextual characteristics, individual characteristics, and health behaviors (Andersen, 2008). Since prostate cancer is one of the medical conditions that disproportionately affects the mortality of African American men (AAM) in North Carolina, it is imperative to evaluate the factors or combination of factors that influence patient satisfaction for AAM diagnosed and treated for prostate cancer. A modified version of Andersen's Behavioral Model for Health Services Use was used to guide this study (Andersen, 2008). The model has four domains: contextual characteristics, individual characteristics, health behaviors, and health outcomes. The purpose of this study was to determine the strength of particular or combinations of contextual characteristics, individual characteristics, and health behaviors to predict patient satisfaction in AAM from North Carolina treated for prostate cancer. This descriptive, correlational study was a secondary data analysis of cross-sectional data of approximately 505 African American men from North Carolina treated for prostate cancer. Data in this study were obtained from Project 1 (Racial differences in prostate cancer screening and care-seeking behaviors: P.I. Paul Godley) and Project 2 (Cultural and demographic predictors of interaction with the health care system and prostate cancer aggressiveness: P.I. Merle Mishel) of the North Carolina-Louisiana Prostate Cancer Project (PCaP) supported by Department of Defense Grant DAMD 17-03-2-0052: P.I. James Mohler. The data were collected from September 2004 to November 2007. A model was proposed and tested to determine statistically significant relationships among the three domains of health service utilization (contextual characteristics, individual characteristics, and health behaviors) and patient satisfaction. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression using forward selection, backward elimination, and stepwise procedures. Finally, hierarchical regression was used to assess and analyze nested data. The variables selected for the final model were: percentage with less than a high school degree, participation in religious activities, mistrust, racism, perceived access to care, patient-provider communication, interpersonal treatment, and communications. Together, these variables accounted for 51% (p = <.0001) of the variability in patient satisfaction. This study identified that interpersonal treatment and mistrust were the two most important predictors fo patient satisfaction for men in this study. While contextual characteristics (p = .003, F = 13.36) accounted for only 2% of the variability, individual characteristics (p = <.001, F = 32.63) added 27% more, and health behaviors (p = <.001, F = 51.6) added an additional 22%. Patient-controlled variables (individual characteristics) and health care provider-controlled variables (health behaviors) are similar in the amount of explained variability in patient satisfaction. The study also provided evidence for the need to look at cultural factors of mistrust and racism when considering individual characteristics. Patient satisfaction can inform us of future health care utilization.
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  • ... in partial fulfillment of the requirements for the degree Doctorate of Philosophy in the School of Nursing.
Advisor
  • Mishel, Merle H.
Degree granting institution
  • University of North Carolina at Chapel Hill
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