title: Predictors and Consequences of Negative Patient-Provider Interactions Among a Sample of African American Sexual Minority Women.
abstract: OBJECTIVE
  Using Andersen's Behavioral Model of Health Services Utilization, we examined the associations between negative experience in a health care setting and subsequent reductions in health care utilization among African American sexual minority women (SMW).
  
  
  METHODS
  The data were collected as part of a larger study exploring health and health care experiences of a volunteer sample of African American SMW (n=226). We examined predisposing, enabling, and need factors as predictors of a negative experience and changes in health care utilization.
  
  
  RESULTS
  More than one-third of the sample reported a negative health care experience in the past 5-years. One fourth of those reporting a negative experience attributed it to discrimination including race/ethnicity (70.4%), gender (58.2%), and sexual orientation (46.2%). (The categories were not mutually exclusive). Reduction in health care utilization (i.e., didn't see a doctor next time when they were ill) following the negative experience was common (34%). Predisposing (younger age), enabling (lack of insurance, part-time employment, and no regular provider), and need factors (living with a chronic illness) predicted experiencing a negative event. In multivariate analysis, health care factors (quality of health care, negative experience due to discrimination) and patient factors (passive coping response) were factors associated with reduced health care utilization.
  
  
  CONCLUSIONS
  Problems in the patient-provider relationship were a significant factor in decreasing healthcare use among SMW. Anderson's model helped to inform our understanding of who might be at risk of experiencing a negative experience but not subsequent changes in health care utilization. Modifiable variables related to the health care environment and patient coping responses predicted changes in health care use.
authors.affiliation: 1 Department of Health Systems Management, College of Health Sciences, Rush University , Chicago, Illinois.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Li
authors.affiliation: 2 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Matthews
authors.affiliation: 2 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Frances
authors.initials: F
authors.lastname: Aranda
authors.affiliation: 3 Department of Biology, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Chirag
authors.initials: C
authors.lastname: Patel
authors.affiliation: 3 Department of Biology, University of Illinois at Chicago , Chicago, Illinois.
authors.forename: Maharshi
authors.initials: M
authors.lastname: Patel
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D001727:Bisexuality / Q000208:ethnology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D018452:Homosexuality, Female / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D011369:Professional-Patient Relations; D011787:Quality of Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012307:Risk Factors; D063508:Social Discrimination / Q000523:psychology; D014481:United States; D055815:Young Adult
keywords: African American; health care utilization; lesbian and bisexual women (LB); patient-provider interactions