title: Perceptions of negative health-care experiences and self-reported health behavior change in three racial and ethnic groups.
abstract: Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups.
  
  
  
  We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups.
  
  
  
  More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor's degree or above (OR: 2.95, 95%CI: 1.01-8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11-3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66-7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported 'sometimes/always' changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change.
  
  
  
  Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the perception of a previous negative experience may influence subsequent health-care-seeking behaviors.
authors.affiliation: a Department of Medicine , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Schwei
authors.affiliation: b Institute for Health Research and Policy, University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Johnson
authors.affiliation: b Institute for Health Research and Policy, University of Illinois at Chicago , Chicago , IL , USA.
authors.forename: Alicia K
authors.initials: AK
authors.lastname: Matthews
authors.affiliation: c Departments of Medicine & Population Health Sciences , University of Wisconsin School of Medicine and Public Health , Madison , WI , USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D015438:Health Behavior / Q000208:ethnology*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D017058:Mexican Americans / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D017060:Patient Satisfaction / Q000208:ethnology*; D010465:Perception; D044469:Racial Groups / Q000523:psychology*; D057566:Self Report; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology
keywords: Negative health-care experience; health-care behaviors; race/ethnicity