Abstract B87: Healthcare distrust, medical advocacy, and patient satisfaction: A mediation model for African American navigated patients
Authors: Molina Yamile , Calhoun Elizabeth A. , Barrios Nerida , Thompson Beti , Kim Seijeoung 
Published: May 2015

Background. African American women experience poorer breast cancer outcomes, partially due to delays in care. Recent efforts have sought to mitigate disparities through patient navigation. Given its growing popularity, research is warranted to understand patient satisfaction and improve service use, including understanding the contributions of neighborhood, socio-demographic, and psychosocial factors. These associations may be influenced by targeted outcomes of patient navigation, such as increased confidence in patients' ability to understand and act on health information and with healthcare staff (medical advocacy). Certain groups of women may perceive themselves to have greater medical advocacy as a result of navigation and consequently report greater satisfaction.

Purpose. The current study has two objectives: 1) to assess predictors of satisfaction in a group of African American women who received navigation services; and 2) to assess the mediating role of medical advocacy.

Methods. This study includes 877 African American women who were referred for diagnostic mammograms and were identified by trained Patient Navigators in the Patient Navigation in Medically Underserved Areas Project associated with the University of Illinois-Chicago's Center for Population Health and Health Disparities. Consenting women completed socio-demographic information and the Health Care Distrust Scale (Cronbach's α = 0.60). Prior to appointments, navigators utilized a “teach back” method to ensure comprehension for their upcoming breast health care exams and to recommend patients contact health care staff for further information as needed. After the appointment, participants completed questionnaires regarding medical advocacy (Cronbach's α = 0.84) and patient satisfaction (Cronbach's α = 0.94). Addresses abstracted from electronic medical records were matched to census tract data from the American Community Survey 2005-2009. We conducted HLM models to identify predictors and Preacher and Hayes and Sobel methods to test mediation models.

Results. There was substantial variation in patient satisfaction (Range: 34-140). Neighborhood factors (racial/ethnic composition, poverty) were not associated with patient satisfaction. Patient satisfaction was associated with age (B = -0.11, 95%CI [-0.19, -0.03], p = .008) and education (B = 0.61, 95%CI [0.002, 1.22], p =.05), but not with income, insurance status, self-rated health, medical home, or type of mammogram recommended. Lower satisfaction was also reported by women with higher levels of healthcare distrust, B = -0.64, 95%CI [-0.85, -0.43], p &lt;.0001. Mediation models revealed medical advocacy partially mediated relationships between healthcare distrust and satisfaction (15% Mediated Effect, Z = -3.55, p = .0004), but not education or age effects. Women with higher levels of healthcare distrust reported lower levels of perceived medical advocacy, which resulted in lower patient satisfaction.

Conclusions: Evidence suggests variation in satisfaction with navigation services among African American women that relate to age, education, and healthcare distrust. Refinement of patient navigation systems should target intrapersonal components related to medical advocacy, especially among women with higher levels of healthcare distrust. Future research should further characterize socio-demographic differences in satisfaction as well as assess the impact of satisfaction on subsequent healthcare utilization.

Citation Format: Yamile Molina, Elizabeth A. Calhoun, Nerida Barrios, Beti Thompson, Seijeoung Kim. Healthcare distrust, medical advocacy, and patient satisfaction: A mediation model for African American navigated patients. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B87. doi:10.1158/1538-7755.DISP13-B87