title: Financial hardship, unmet medical need, and health self-efficacy among African American men.
abstract: BACKGROUND
  Health self-efficacy (the confidence to take care of one's health) is a key component in ensuring that individuals are active partners in their health and health care. The purpose of this study was to determine the association between financial hardship and health self-efficacy among African American men and to determine if unmet medical need due to cost potentially mediates this association.
  
  
  METHODS
  Cross-sectional analysis was conducted using data from a convenience sample of African American men who attended a 1-day annual community health fair in Northeast Ohio (N = 279). Modified Poisson regression models were estimated to obtain the relative risk of reporting low health self-efficacy. After adjusting for sociodemographic characteristics, those reporting financial hardship were 2.91 times, RR = 2.91 (confidence interval [1.24, 6.83]; p < .05), more likely to report low health self-efficacy. When unmet medical need due to cost was added to the model, the association between financial hardship and low health self-efficacy was no longer statistically significant.
  
  
  CONCLUSIONS
  Our results suggest that the association between financial hardship and health self-efficacy can be explained by unmet medical need due to cost. Possible intervention efforts among African American men with low financial resources should consider expanding clinical and community-based health assessments to capture financial hardship and unmet medical need due to cost as potential contributors to low health self-efficacy.
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA, USA Harvard School of Public Health, Boston, MA, USA reginald_tucker-seeley@dfci.harvard.edu.
authors.forename: Reginald D
authors.initials: RD
authors.lastname: Tucker-Seeley
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Mitchell
authors.affiliation: Wayne State University, Detroit, MI, USA.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Shires
authors.affiliation: The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Modlin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000208:ethnology* / Q000706:statistics & numerical data*; D000368:Aged; D003430:Cross-Sectional Studies; D015438:Health Behavior; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012959:Socioeconomic Factors
keywords: African American men; financial hardship; health self-efficacy; unmet medical need