title: The influence of mistrust, racism, religious participation, and access to care on patient satisfaction for African American men: the North Carolina-Louisiana Prostate Cancer Project.
abstract: OBJECTIVE
  The purpose of this study was to explore whether a particular combination of individual characteristics influences patient satisfaction with the health care system among a sample of African American men in North Carolina with prostate cancer. Patient satisfaction may be relevant for improving African American men's use of regular care, thus improving the early detection of prostate cancer and attenuating racial disparities in prostate cancer outcomes.
  
  
  METHODS
  This descriptive correlation study examined relationships of individual characteristics that influence patient satisfaction using data from 505 African American men from North Carolina, who prospectively enrolled in the North Carolina-Louisiana Prostate Cancer Project from September 2004 to November 2007. Analyses consisted of univariate statistics, bivariate analysis, and multiple regression analysis.
  
  
  RESULTS
  The variables selected for the final model were: participation in religious activities, mistrust, racism, and perceived access to care. In this study, both cultural variables, mistrust (p=<.0001, F=95.58) and racism (p=<.002, F=5.59), were significantly negatively associated with patient satisfaction and accounted for the majority of the variability represented by individual characteristics.
  
  
  CONCLUSIONS
  Mistrust and racism are cultural factors that are extremely important and have been negatively associated with patient satisfaction and decreased desires to utilize health care services for African American men. To overcome barriers in seeking health care services, health care providers need to implement a patient-centered approach by creating a clinical environment that demonstrates cultural competence and eliminating policies, procedures, processes, or personnel that foster mistrust and racism.
authors.affiliation: US Army, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA. angelo.moore@us.army.mil
authors.forename: Angelo D
authors.initials: AD
authors.lastname: Moore
authors.forename: Jill B
authors.initials: JB
authors.lastname: Hamilton
authors.forename: George J
authors.initials: GJ
authors.lastname: Knafl
authors.forename: P A
authors.initials: PA
authors.lastname: Godley
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Jeannette T
authors.initials: JT
authors.lastname: Bensen
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.forename: Merle
authors.initials: M
authors.lastname: Mishel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology* / Q000523:psychology; D000368:Aged; D003469:Culture; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D017060:Patient Satisfaction; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000523:psychology; D063505:Racism