title: A qualitative study of factors underlying decision making for joint replacement among African Americans and Latinos with osteoarthritis.
abstract: To support patients in making decisions that align with their unique cultural beliefs, an understanding of factors underlying patient preferences is needed. We sought to identify psychosocial factors that influenced decision making among African-American and Hispanic patients referred for knee or hip arthroplasty. Thirty-six participants deciding on surgery were interviewed. Responses were audio-taped, transcribed, and read. Codes were assigned to the raw data and then clustered into categories that were analyzed to yield overarching themes. This process was repeated independently by two corroborators. Six categories described the mental calculations made in patients' decision-making processes: 1) self-assessment of fit for surgery based on age and comorbidity, 2) research and development of mental report cards of their surgeons, 3) reliving of social network experiences, 4) reliance on faith and spirituality for guidance, 5) acknowledgment of fear and anxiety, and 6) setting expectations for recovery. This study advanced the understanding of how decisions about joint replacement are constructed and identified cultural levers that can be targeted for intervention. Developing culturally tailored health information that addresses some of our findings and disseminating messages through social networks may reduce the underutilization of joint replacement among racial and ethnic minority populations.
authors.affiliation: Hospital for Special Surgery, New York, New York.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Parks
authors.affiliation: University of Illinois at Chicago, School of Public Health, Chicago, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hebert-Beirne
authors.affiliation: Maimonides Medical Center, Brooklyn, New York.
authors.forename: Mary
authors.initials: M
authors.lastname: Rojas
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Leah
authors.initials: L
authors.lastname: Tuzzio
authors.affiliation: University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Nelson
authors.affiliation: Center of Excellence in Disparities Research, Weill Cornell Medical College, New York, New York.
authors.forename: Carla
authors.initials: C
authors.lastname: Boutin-Foster
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D001007:Anxiety / Q000523:psychology; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001294:Attitude to Health; D002983:Clinical Competence; D015897:Comorbidity; D054521:Cultural Competency; D003657:Decision Making; D005239:Fear / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D010003:Osteoarthritis / Q000208:ethnology / Q000601:surgery*; D036301:Qualitative Research; D012067:Religion; D012647:Self-Assessment; D012944:Social Support; D029181:Spirituality