Racial differences in health-related beliefs, attitudes, and experiences of VA cardiac patients: scale development and application.
OBJECTIVE
To deternine whether there are racial differences in patients' health-related attitudes, beliefs, and experiences regarding invasive cardiac procedures, and to develop psychometrically and conceptually valid scales and single items to assess these dimensions.


METHODS
A survey was designed and administered to 854 white and black patients with ischemic heart disease at five VA medical centers. Patients were queried about the domains proposed to be important to treatment decision making by the Health Decision Model: sociodemographic characteristics, social interactions, health care experiences, patient preferences for care, knowledge about diseases and potential treatments, and health beliefs. Using multitrait analysis, the psychometric properties of scales assessing these domains were examined. It was then assessed whether there were racial differences in scale or individual item scores using chi2 and t test analyses.


RESULTS
The analyses yielded eight psychometrically valid scales: disease severity, patient evaluation of physician's interpersonal style, patient evaluations of VA care, satisfaction with treatment decision making, perceived urgency of catheterization, vulnerability to catheterization, bodily impact of catheterization, and attitudes toward religion. There were only racial differences on mean scores for the latter scale. Individual item analyses indicated that black patients were less likely to have been encouraged by friends or family to have cardiac catheterization, and had less personal or familial experiences with this or other surgical procedures. In contrast to expectations, white patients were more likely to be skeptical of medical care.


CONCLUSIONS
The multiple dimensions of white and black patients' health-related attitudes, beliefs, and experiences were examined, and few differences were found. These results suggest that racial differences in patients' attitudes, beliefs, and experiences are not a likely source of racial disparities in cardiac care. Future research will examine the association of beliefs, attitudes and experiences with actual use of invasive cardiac procedures.
Kressin
Nancy R
NR
Center for Health Quality, Outcomes and Economic Research (a VA Health Services Research and Development National Center of Excellence), Bedford VA Medical Center, Massachusetts 01730, USA. nkressin@bu.edu
Clark
Jack A
JA
Whittle
Jeff
J
East
Mark
M
Peterson
Eric D
ED
Chang
Bei-Hung
BH
Rosen
Amy K
AK
Ren
Xinhua S
XS
Alley
Linda G
LG
Kroupa
Laura
L
Collins
Tracie C
TC
Petersen
Laura A
LA
D001741:Black or African American / Q000523:psychology*; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D016009:Chi-Square Distribution; D003657:Decision Making; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D006784:Hospitals, Teaching / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000208:ethnology / Q000628:therapy*; D017060:Patient Satisfaction / Q000208:ethnology*; D011594:Psychometrics; D011822:Race Relations; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000145:classification / Q000523:psychology*; D044465:White People / Q000523:psychology*