Doctor of Philosophy, University of Akron, 2013, Counseling Psychology

Disparities in healthcare are a significant social problem affecting millions of racial and ethnic minorities in the United States. The sources of health disparities are many and range from institutional barriers, provider influences, and even patient factors (Smedley, et al., 2003). In comparison to research on provider contributions to health disparities, there is far less research on patient factors (Bird & Bogart, 2001; Smedley et al., 2003). The purpose of this study was to further examine patient-level factors which may be related to disparities in health care. Specifically, this study focused on how medical mistrust, perceived racial discrimination, and perceived health care specific discrimination were related to African Americans’ intentions to seek medical help. A primary purpose of this study was to better understand how medical mistrust relates to intentions to seek help. African Americans’ health care behavior was examined within the theoretical framework of the Behavioral Model for Vulnerable Populations (BVMP), in which, medical mistrust functions as a predisposing factor in the process of health services use (Gelberg, Andersen, & Leake, 2000). In addition to using the structure of the BMVP to examine the variables of interest, multiple additional explanatory models were utilized to gain a better understanding how these variables of interest relate to one another, and to determine if medical mistrust may function as a mediator between experiences of discrimination and intentions to seek medical help. The sample included 322 participants who identified as Black/African American. Participants completed an anonymous survey which included demographic questions and 46-items assessing the constructs of perceived racial discrimination, perceived health specific racial discrimination, mistrust of the medical system, and intentions to seek medical help. Consistent with hypotheses, perceived racial discrimination, perceived health care s (open full item for complete abstract)

Committee: Suzette Speight Dr. (Advisor); John Queener Dr. (Advisor); Ingrid Weigold Dr. (Committee Member); Dawn Johnson Dr. (Committee Member); Kevin Kaut Dr. (Committee Member) Subjects: African Americans; Counseling Psychology; Health Care; Psychology

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2024, Health Programs

This study examined the representation of racial minorities in the demographic subpopulation of Hospital Consumers Assessment of Healthcare Providers and Services (HCAHPS) survey respondents. These survey scores are the basis for a substantial portion of financial compensation from the Centers for Medicare and Medicaid Services; they are used to drive the process improvement of patient-centered care. Considerable previous research has focused on factors that affect HCAHPS scores and made adjustments to the scores of many other demographic factors. However, none has focused specifically on race and representativeness, which is needed to ensure benefits for all health care consumers. Reliance on this mechanism as the single measure of patient experience on which financial decisions are made and improvement efforts are centered may be a further example of systemic racism in a system with an established history of racism. This study examined the use of a representative sample from a social justice perspective utilizing Rawls' framework from A Theory of Justice. Following the logic of this work, most people would not choose failing to hear diverse patient voices at a representative rate when blinded to their own identity, as this would not represent the choice most likely to result in patient-centered care for all health care consumers. This mixed-method, convergent parallel design study compared the sample of patients returning HCAHPS surveys, the inpatient population, and contextualized those results with semi-structured interviews with patient experience professionals to provide context to the need for a representative sample.

Committee: Alyncia Bowen (Committee Chair); Lori Salgado (Committee Member); Bora Pajo (Committee Member) Subjects: Health Care; Health Care Management; Public Health; Public Policy

MS, University of Cincinnati, 2023, Medicine: Clinical and Translational Research

Objective: We assessed for inequities in continuity of care, using the Usual Provider Continuity Index (UPC – the proportion of visits with the provider the patient saw most frequently out of all visits), in a set of large pediatric academic clinics. Methods: We conducted a retrospective cohort study. Patients 12-24 months seen at 3 pediatric academic primary care clinics for any visit October 1-31, 2021 were included. We then reviewed continuity for these patients in the preceding 12 months. Outcomes included each patient's UPC for all visits, and a modified UPC for well child checks only (UPC Well). Covariates included race, ethnicity, insurance, clinic site, age, sex, care management, or seeing a social worker. We evaluated for differences in outcomes using bivariate analyses and multivariable regression models. Results: Our cohort included 356 patients (74% Black, 5% Hispanic, 85% Medicaid, 52% female, median age 15.8 months). The median UPC was 0.33 and median UPC Well was 0.40. Black patients had significantly lower median values for UPC (0.33 Black vs 0.40 non-Black, p<0.0001) and UPC Well (0.33 Black vs 0.50 non-Black, p<0.0001). There were similar inequities in continuity rates by insurance and clinic site. In multivariable models, clinic site was the only variable significantly associated with continuity. Conclusions: Clinic sites serving higher percentages of Black patients had lower rates of continuity. We believe structural racism contributes to these inequities. This analytic approach can be used to inform family-engaged, co-produced improvements in clinic processes, and to address structural factors influencing likelihood of continuity.

Committee: Patrick Ryan Ph.D. (Committee Chair); Shelley Ehrlich M.D. (Committee Member); Andrew Beck M.D. (Committee Member) Subjects: Medicine