Hull APHA 2004 FINAL

Access to Medical Care and the Use of Faith-Based Healers in the Rural Southeast: 

Access to Medical Care and the Use of Faith-Based Healers in the Rural Southeast Sharon K. Hull, MD Timothy P. Daaleman, DO Samruddhi Thaker, MHA, MBBS Donald E. Pathman, MD, MPH University of North Carolina at Chapel Hill This study was supported by grants from The Robert Wood Johnson Foundation (#036829) The Health Resources and Services Administration (#T32-HP14001)

Background and Rationale: 

Background and Rationale 40% of people in the US use prayer for healing Prayer for healing is more common in the southeast Why do some patients use prayer for healing while others do not? This study does not address efficacy of faith-based healing (McCaffrey et al, 2004; Barnes et al, 2004)

Research Question: 

Research Question Hypothesis: Those who have difficulty accessing medical care are more likely to use faith-based healing (FBH). What is the relationship between access to medical care and the use of faith-based healers?

Primary Outcome – Use of Faith Based Healing (FBH): 

Primary Outcome – Use of Faith Based Healing (FBH) Dependent Variable Dichotomous (yes or no) response to the question, “In the past 12 months, have you been to see a healer who used prayer as their primary treatment method?

Methods: 

Methods RWJF Southern Rural Access Program Evaluation Eight states in southeastern US Random-digit dialed telephone survey, October 2002-July 2003 Eligibility: English- or Spanish-speaking adults ≥ 600 adults from each state, oversampling small counties

Analysis: 

Analysis 184 non-blacks and non-whites were eliminated Final analysis included 4680 subjects Four sets of variables related to access to medical care: Utilization of medical care Barriers to medical care Satisfaction with medical care Beliefs about medical care

Description of Population: 

Description of Population Overall response rate was 51% Population Demographics (N = 4879): Average age 50 yrs 33% male 51% employed 55% married <2% each of Native Americans, Asians, Native Hawaiians Response rates lower among African Americans Those with household incomes <$15,000 Males Those aged 18-39 years Weighting revised to adjust for oversampling and differential response rates Overall prevalence for use of FBH was 4.0%

Results – Differential Use of FBH by Demographic Characteristics: 

Results – Differential Use of FBH by Demographic Characteristics * Statistically significant (p<0.05) No significant differences in use of FBH by, income, education, employment status, or marital status. Demographic Characteristics of FBH Users (Odds Ratios adjusted for gender, income, employment status, health status and race)

Utilization and Barriers: 

Utilization and Barriers *Adjusted for gender, income, race, employment status, and health status

Satisfaction and Beliefs: 

Satisfaction and Beliefs *Adjusted for gender, income, race, employment status, and health status

Results – Stratified Analysis by Gender and Race: 

Results – Stratified Analysis by Gender and Race Adjusted OR for Use of FBH (Adjusted for income, employment status, health status and gender or race)

Limitations: 

Limitations Small number of FBH users (180) No measure of religiosity was included in the survey No questions were asked about the details or context of the faith-based healing interventions Does not include use of self-prayer or participation in prayer circles, which may be more common People may not be willing to talk about religious issues on the phone Cannot address Hispanics

Most Important Findings: 

Most Important Findings Only 4% of residents in the rural south reported that they had utilized FBH Those under age 65 are more likely to use FBH Those with fair or poor self-reported health status are more likely to use FBH Clear associations between use of FBH and the following access measures (original hypothesis) Break in health insurance coverage (Barriers) Foregone or delayed medical care within the past 12 months (Utilization) Belief that people should delay or avoid seeing physicians (Beliefs)

Implications: 

Implications Prevalence rate – if it’s this low, how important is the issue? Is the relationship between access to medical care and FBH a causal relationship? Implications of economic issues for women vs. men? How should we integrate faith-based healers with western medical care? Education of health care providers Incorporation of faith-related issues into patient encounters Inclusion as a cultural competency issue Utilization of this methodology to study reasons patients use other complementary/alternative therapies

Discussion: 

Discussion