1. Racial/Ethnic Differences in the Use of Health Information to Self-Advocate During the Medical Encounter: Is Having Health Information Enough? Jacqueline C. Wiltshire, MPH PhD Kate Cronin, MPH Gloria E. Sarto, MD PHD University of Wisconsin Medical School Center for Women’s Health Research Madison, Wisconsin 28 June 2005

2. Importance Patients who self-advocate gain maximum benefit from the medical encounter (Brashers et al 1999; Marelich & Murphy; Walsh-Burke & Marcusen, 1999) Cornerstone in cancer survivorship (Walsh-Burke et al 1999) Essential for chronic disease management & survivorship (Brashers et al, 1999; Courts et al 2004; Schaefer 1999) Changing health care climate Necessary skill for all health care consumers (Naumann & Vessey, 2002; Steinberg et al 2002)

3. Gaps in Literature Increasing numbers of people are accessing health information, little is known about whether and how they use this health information to advocate during the medical encounter It is also unclear how self-advocacy differs among different racial and ethnic groups

4. Objectives To examine whether race/ethnicity and obtaining health information are associated with self-advocacy

5. Data and Analytic Sample 2000-2001 Household Component of the Community Tracking Study (CTS) Nationally representative study to track changes in the health care system and their effects on people Target Population: Civilian, non-institutionalized adult population in the contiguous U.S. (n=59, 725) Analytic Sample 7,419 women aged 45-64 who had at least 1 provider visit in the preceding 12 months

6. Dependent Variables Health information mentioned to the physician by the patient Physician used imparted health information to order tests, procedures, or prescriptions

7. Main Explanatory Variables Health Information 1.Internet 2.Friends 3.TV or Radio 4.Books/magazine/other source 5.Health care professional/health care organization Frequency of sources 1, 2, 3+ sources Race/Ethnicity 1.White 2.African American (AA) 3.Hispanic

8. Control Variables Age Marital status Rural living Education Employment Federal Poverty Level Insurance Usual source of care Perceived Health Status HMO Enrollment

9. Analysis Descriptives (frequencies) Binomial logistic regression (SUDAAN) Account for complex survey design “SUBPOPN” statement in SUDAAN was used to select analytic sample Odds ratios and 95% confidence intervals

10. Selected Characteristics of Respondents

12. Main Explanatory Variables

13. Dependent Variables  Mentioned Info to Physician  Physician Ordered Tests Of the 28% who mentioned information to the physician n=1079), 48.7% perceived that they got tests ordered

14. *Multivariate-adjusted % Characteristic White (n=3113) AA (n=342) Hispanic (n=215) Sources of Health Info Internet Friends TV or Radio Books/magazine/other source Health care profs & orgs All Health Info Combined 45.8 49.2 29.3 68.9 5.1 50.0 31.0 b 44.6 34.0 75.0 b 4.5 40.4 b 35.0 c 45.2 38.5 70.2 7.7 47.2 Frequency of Health Info 1 2 3 38.3 32.1 29.6 43.8 30.0 26.0 41.9 30.6 27.4 Self-Advocacy Mentioned Info to Physician Physician Ordered Tests 29.3 46.7 19.2 b 49.2 27.0 64.3 Among those who sought health information, frequency of sources, and self-advocacy by race/ethnicity *Adjusted for age, marital status, rural living, education, employment status, poverty level, usual source of care, health insurance, HMO status, and health status.

17. Summary Midlife women with health information are more likely to self-advocate than those without health information Self-advocacy differs by race/ethnicity African Americans less likely to obtain health information & less likely to advocate during the medical encounter

18. Limitations  Cross-sectional design limits causal conclusions  Relatively high socioeconomic status Self-reported data – recall bias Cannot distinguish primary source of health information Omitted variables that may confound or mediate the observed relationships Patients attitudes (assertiveness, role perceptions) Situational factors (chronic conditions, type of illness, length of time with physician)

19. Conclusions While obtaining health information is associated with self-advocacy, this may not be enough among minority women, especially African Americans Future research needed to examine Factors that impede the ability of African American women to self-advocate Impact on unequal treatment

20. Thank You Lyn Bromley Center for the Study of Cultural Diversity in Health Care (UW Medical School)