Reducing Racial Disparities in Health Services Use: Exploring the Role of Racial Equity Training for Nurse Navigators and Improved Measurement of Trust in Health Care

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  • Richmond, Jennifer
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Background. Black patients are less likely than White patients to receive treatment for lung cancer, the leading cause of cancer death in the U.S. Mistrust of health care providers and systems contributes to disparities in several health services use outcomes, including receipt of lung cancer treatment. Little is known about effective trust-related interventions, in part, because trust is hard to measure. This dissertation explored two areas for reducing health services use disparities: 1) evaluating an intervention to increase equitable receipt of lung cancer treatment and 2) improving trust measurement. Study 1. Nurse navigators trained to help patients overcome barriers to receiving lung cancer surgery may reduce treatment disparities, especially if they receive racial equity training (RET). RET offers a foundation for understanding barriers like medical mistrust that may be affected by patient experiences with racism. Yet, little is known about whether navigator RET increases lung cancer surgery receipt. Study 1 explored this gap using data from a trial where patients with early stage lung cancer were randomized to groups paired with navigators who did or did not receive RET (n=229). Results suggest that RET was not associated with the primary outcome. Study 2. Systematic reviews suggest the need to develop updated trust measures that are multidimensional and pilot tested using qualitative methods. In Study 2, I developed three trust measures: the Trust in My Doctor (T-MD), Trust in Doctors in General (T-DiG), and Trust in the Health Care System (T-HCS) scales. After obtaining expert feedback and conducting cognitive interviews (n=21), I used an online survey (n=801) to assess scale reliability and validity. Confirmatory factor analysis suggested acceptable model fit for second order latent factor models for each scale. Each scale required an 8th grade reading level or less, was significantly correlated with existing trust measures and perceived racism in health care, and was associated with health services use. Conclusions. Future studies should explore how RET is associated with other outcomes that affect health services use (e.g., trust in doctors). In such studies where trust is the main outcome, the T-MD, T-DiG, and T-HCS are measurement options with sound psychometric properties.
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Advisor
  • Ribisl, Kurt M
  • Boynton, Marcella
  • Muessig, Kathryn E
  • Cykert, Samuel
  • Ozawa, Sachiko
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2020
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