Religious influences on trust in physicians and the health care system

A model of contributors to a trusting patient-physician relationship: a critical review using a systematic search strategy

BACKGROUND

The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model.

METHODS

A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable.

RESULTS

Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services.

DISCUSSION

Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship.

Associations Between Religiosity and Medical Mistrust: An Age-Stratified Analysis of Survey Data from Black Adults in Chicago

Medical mistrust is associated with poor health outcomes, ineffective disease management, lower utilization of preventive care, and lack of engagement in research. Mistrust of healthcare systems, providers, and institutions may be driven by previous negative experiences and discrimination, especially among communities of color, but religiosity may also influence the degree to which individuals develop trust with the healthcare system. The Black community has a particularly deep history of strong religious communities, and has been shown to have a stronger relationship with religion than any other racial or ethnic group. In order to address poor health outcomes in communities of color, it is important to understand the drivers of medical mistrust, which may include one's sense of religiosity. The current study used data from a cross-sectional survey of 537 Black individuals living in Chicago to understand the relationship between religiosity and medical mistrust, and how this differs by age group. Descriptive statistics were used to summarize data for our sample. Adjusted stratified linear regressions, including an interaction variable for age group and religiosity, were used to model the association between religiosity and medical mistrust for younger and older people. The results show a statistically significant relationship for younger individuals. Our findings provide evidence for the central role the faith-based community may play in shaping young peoples' perceptions of medical institutions.

Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study

Background

Mass vaccination against Covid-19 has been recognised as the most effective strategy for overcoming the pandemic emergency and remains crucial in the ongoing efforts to mitigate the impact of the virus. The present study aimed to test the efficacy of an extended Theory of Planned Behaviour (TPB) model in predicting vaccination intention in three different phases of the pandemic. Understanding how psychological drivers of vaccine acceptance may have changed throughout the pandemic is essential for informing public health strategies and addressing vaccine hesitancy, even in the current post-pandemic context.

Methods

Using a repeated cross-sectional survey, we tested the hypothesised extended TPB model (intention, attitude, subjective norms, perceived behavioural control, anticipated affective reactions, risk perception, trust in science, trust in institutions and religiosity) across three independent samples: before (T1: November-December 2020; N = 657), during (T2: March-May 2021; N = 818), and after (T3: February-March 2022; N = 605) the start of the vaccination campaign in Italy.

Results

Results indicated significant differences between the time points in all investigated variables, pointing to a general trend of improvement in vaccine acceptability levels at T2 compared to T1, and a worsening at T3 compared to the other two time points. Interestingly, net of these differences, a multi-group Structural Equation Modeling analysis supported the invariance, across time, of the structural relationships examined within the extended TPB.

Conclusion

Findings demonstrated the efficacy of the TPB in predicting Covid-19 vaccination intention at different stages of the pandemic, suggesting that the model, in its extended version, represents a valuable framework for designing interventions aimed at promoting vaccine acceptance.

Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study

Background

A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption.

Objective

We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors.

Methods

A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death.

Results

Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life.

Conclusions

The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.

Patients' Positions on the Degree of Trust to be Placed in Physicians

Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.

Spiritual and religious perspectives in persons with visual impairment due to age-related macular degeneration

Introduction

Age-related macular degeneration (AMD) is one of the global leading causes of severe vision loss. Patients suffering from AMD face complex spiritual and mental challenges that have an impact on the course of their disease, their quality of life, and their relationship with their surroundings.

Methods

A survey was carried out using a 21-item questionnaire between August 2020 and June 2021 among 117 patients from different countries to investigate how spirituality, religion, and their way of practicing them affected the experiences and daily lives of patients suffering from AMD, and whether it helped them cope with the disease.

Results

Our study concluded that spirituality and religion are important factors that facilitate patients' ability to cope with a progressive degenerative disease such as AMD. Patients who are religious are more at peace with having AMD. Practices that contribute to patients being at peace in accepting the disease are regular prayers or meditation. Spirituality and religion are important components that promote a healthier and happier emotional state and mental wellbeing. In particular, by believing that death is not the end, patients feel more hopeful, which helps in their adjustment to a seemingly hopeless health condition. A significant number of AMD patients desire to talk about God with the medical staff. The profile of such patients could be those believing in a higher power, praying often, participating in religious services, being worried about the loss of vision, and needing assistance in daily life.

Discussion

An interdisciplinary and multidimensional team of medical health professionals including mental health workers and chaplains can be of great value in managing persons with AMD.

Correlation between religion, spirituality and perception of healthcare services utilisation in Poland during COVID-19 pandemic

Background

The worldwide transmission of SARS CoV-2 caused the COVID-19 pandemic and had an impact on healthcare provision. The disruption of reliance on the health system during the COVID-19 pandemic posed a clear threat to public trust. Religiosity, like spirituality, is believed to have a positive influence on people's lives, enabling them to cope with illness, stress, and sudden life changes. In practice, although the terms religiosity and spirituality have similar meanings and are related, they are not identical concepts. The aim of this study is to compare the perceptions of the accessibility and quality of healthcare services provided before and during the COVID-19 pandemic in Poland by religious/spiritual people compared to those for whom religion and spirituality have little or no importance in their lives.

Methodology

This cross-sectional study was based on the authors' questionnaire, carried out during the third wave of the COVID-19 pandemic in Poland. Participants in the study were people living in various regions of Poland over 18 who were willing to complete the questionnaire voluntarily. The number of people sampled was two hundred and sixty-four. Convenience sampling method was used for this study. Statistical calculations were performed using Statistica 13 software from TIBCO and PQStat from PQStat Software and were based on the Kruskal-Wallis test, multiple regression model, the chi2 test of independence or the Mann-Whitney test. The result was considered statistically significant when p < α. The significance level was taken as α = 0.05.

Results

Two hundred and sixty-three respondents answered the questionnaire. Among them, 181 (69%) were women, and 82 (31%) were men. It was shown that religion is more important for women than for men and women who report a high role of religion in their lives rated the quality of healthcare services better before and during the COVID-19 pandemic. It was also concluded that religious people for whom religion played a major role and those who were helped by spiritual life rated accessibility and quality higher both before and during the pandemic.

Conclusions

Religious/spiritual people, through their more positive attitudes towards the world, were thought to rate access and quality of healthcare services better. Regardless of religious affiliation, the help of spiritual life during the pandemic or the importance of religion in life in all respondents, perception of healthcare services utilisation were decreased by the pandemic. This prompts thoughts on the implementation of spiritual assistance as a supportive measure to mitigate the effects of the pandemic.

Trust in Medicine as a Factor Conditioning Behaviors Recommended by Healthcare Experts during the COVID-19 Pandemic in Poland

OBJECTIVE

Due to the COVID-19 pandemic, public health experts have faced the challenge of convincing people to change their everyday habits. This study aims to evaluate the impact of trust in medicine on Polish citizens' adherence to recommended behaviors.

METHODS

An online survey was conducted on a quota sample of adult Poles (n = 1072) during the second wave of COVID-19.

RESULTS

The trust-in-medicine index was created from statements relating to trust in healthcare professionals, vaccines, and medicines. This index showed that 27.1% of respondents expressed low trust, 36.7% expressed moderate trust, and 36.3% expressed high trust. The recommended behavior index was created from nine statements. This index showed that 15.8% of respondents had low adherence, 38.2% had moderate adherence, and 46.0% had high adherence to the healthcare experts' recommendations. One-way analysis of variance showed that people with a high trust had significantly higher scores on the recommended behavior index when compared to people with a moderate or low trust.

CONCLUSIONS

This study suggests that those responsible for health policy should put more effort into building trust not only in health professionals, but also in pharmaceutical companies. We also determined the socio-demographic features of people to whom such actions of trust building should be directed.

Community Boosts Immunity? Exploring the Relationship Between Social Capital and COVID-19 Social Distancing

The early stages of the COVID-19 pandemic required a dramatic change in social practices, including distancing from social settings, to limit its spread. While social capital has considerable potential in facilitating the adoption of these norms, it also comes with considerable limitations that potentially undermine its effectiveness. We draw upon recently released mobility data from Google, network data from Facebook, and demographic data from the 2018 American Community Survey to determine how both organizational and networked measures of social capital relate to different forms of distancing. In addition, we employ geographically weighted regression to identify how these relationships vary across the nation. Findings indicate that while both forms of social capital can positively relate to distancing, the impacts are spatially inconsistent and, in some locations, social capital can discourage distancing. In sum, more policy efforts are needed to address not only low-social capital, but also unhelpful social capital.

Examining the association between religiosity and medical mistrust among churchgoing Latinos in Long Beach, CA

Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and potentially high mistrust. In-person, self-administered surveys were collected among 767 adult Latinos attending three Latino churches (one Catholic and two Pentecostal) in Long Beach, CA. Measures included a previously validated 12-item medical mistrust scale, religiosity (religious denomination, length and frequency of attendance, and number of groups or ministries involved in), health care access, and sociodemographic factors. Medical mistrust score was 2.47 (standard deviation [SD] = 0.77; range 1-5). Almost two-thirds of participants (62%) attended religious services frequently (once a week or more), and the majority attended a Catholic church (80%). About half of the participants had attended their church for ≥5 years (50%) and participated in one to two church groups or ministries (53%). Multivariable analyses show that Pentecostal church congregation and those identifying as Mexican/Chicano were negatively associated with medical mistrust. On the contrary, participating in church groups or ministries and having an immigrant parent were positively associated with medical mistrust. Our findings suggest that church-based health initiatives should consider church denomination, length of attendance, participation in groups or ministries, and ethnic differences to address medical mistrust issues among Latino congregants.

Understanding the psychosocial determinants of Italian parents' intentions not to vaccinate their children: an extended theory of planned behaviour model

OBJECTIVE

This study aimed to identify the psychosocial factors involved in Italian parents' intentions not to vaccinate their children. For this purpose, we used an extended version of the Theory of Planned Behaviour, which included both proximal and distal factors influencing intention not to vaccinate children.

DESIGN

Participants included 447 Italian parents, each completed an online questionnaire, which measured intention not to vaccinate children, attitude toward not vaccinating, subjective norms, perceived behavioural control, anticipated regret, negative attitude toward vaccines, risk perception, trust in healthcare institutions, trust in science and religious morality.

RESULTS

Results showed that attitude toward not vaccinating was strongly associated with intention not to vaccinate children. Furthermore, attitude toward not vaccinating was associated with negative attitude toward vaccines, which in turn was affected by all the distal factors considered (risk perception, trust in healthcare institutions, trust in science, religious morality). Finally, negative attitude toward vaccines fully mediated the effect of the distal factors on attitude toward not vaccinating children.

CONCLUSION

These findings provide support for the validity of the proposed extended TPB model in explaining parents' intention not to vaccinate children. Theoretical and practical implications, in terms of understanding and promoting vaccination behaviour, are discussed.

Trust in physicians among patients with head and neck cancer before and after treatment

BACKGROUND

Little is known about physician trust in patients with head and neck cancer. This study's aim is to evaluate trust pre- and post-treatment.

METHODS

A study was conducted of 50 patients with head and neck cancer at a tertiary referral center. Surveys administered before and after treatment included several validated survey tools including the Trust in Oncologist Scale Short Form.

RESULTS

There was an increase in overall trust scores (p < 0.001). Female patients (p = 0.034) and those who received chemotherapy (p = 0.001) were less trusting post-treatment. Patients with more comorbidities (p = 0.045) and progression of disease (p = 0.029) had higher final trust than those without. Patients with high initial distress scores showed a decrease in trust (p = 0.023).

CONCLUSIONS

Patients with head and neck cancer trust their surgeon more after completion of treatment, with specific characteristics having a variable impact on trust scores.

Beyond political affiliation: an examination of the relationships between social factors and perceptions of and responses to COVID-19

A significant challenge in the United States’ response to COVID-19 continues to be wide variation in the extent to which individuals believe the virus is a credible health threat and are willing to undertake measures to protect personal and public health. In this study, data were collected from a national sample of 1141 participants from the United States to examine how beliefs and behavioral responses to COVID-19 have been shaped by sociopolitical characteristics. The relationships between social predictors; perceived severity, knowledge, and fear of the virus; and health behaviors were tested using path analysis. Social characteristics significantly predicted perceived severity, knowledge, and fear, as well as health behaviors, even after controlling for an objective indicator of the risk of contracting the virus. Our findings suggest that perceptions and knowledge of the virus, especially believing that the virus poses a serious threat to one’s individual health, are important determinants of behavior, but also that perceptions and knowledge are strongly driven by social and cultural factors above and beyond political affiliation.

Religious Affiliations Influence Health-Related and General Decision Making: A Brazilian Nationwide Survey

Approximately 90% of the world's population is involved in some spiritual/religious practice, and this dimension has a relevant role in life. Many studies demonstrate the associations between spirituality/religiosity (S/R), and physical, mental, and social health. Systematic reviews have indicated positive associations; however, the mechanisms behind religious coping are not fully understood. The present study aimed to examine the role of religious affiliation in general (ordinary) and health-related decisions. A nationwide, population-based, cross-sectional study was conducted in Brazil using a self-administered online survey. How much religious affiliation influences decision making was investigated. A total of 1133 participants were included, who were classified as Catholics (43.9%), Evangelicals (18.7%), spiritualists (12.8%), non-religious (11.9%), and others (12.7%). Most participants (66.5%) believed that their religious affiliations had moderate to high influences on their decisions. Participants rated the influence as high in marriage (62.7%), in donations (60.1%), in volunteering (55%), in friendships (53.9%), and in work (50.5%). Concerning health-related decisions, the influence was rated as high in drug use (45.2%), in accepting medical recommendations (45%), and in smoking (43.2%). The influence of religious affiliation on general decision making was significantly correlated for dietary restrictions (r = 0.462), alcohol consumption (r = 0.458), drug use (r = 0.441), tobacco consumption (r = 0.456), and refusal of medical recommendations (r = 0.314). Improving the understanding of how a patient's beliefs, practices, and experiences affect their health may help healthcare practitioners to take into account religious considerations, not only regarding influences on habits but also regarding adherence to medical treatment advice.

Associations between social capital and trust in general practitioners among the elderly people: Empirical evidence from China

Elderly individuals' trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients' trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals' trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China.

Forty years after Alma-Ata: how people trust primary health care?

BACKGROUND

Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma-Ata declaration. However, after forty years, it needs to be more trustful to achieve its predefined objectives. Public trust in PHC is one of the neglected issues in the context. The aim of this study is to evaluate public trust in PHC in Iran.

METHODS

The present investigation is a household survey conducted in East Azerbaijan Province, Iran. Two-stage cluster sampling method with Probability Proportional to Size (PPS) approach was used. Totally, 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of Socio-Economic Status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA software (version 15) through descriptive statistics and linear regression.

RESULTS

The mean ± SD age of the participants was 41.2 ± 15.1 and most (53.7%) were female. Mean score of PHC trust was 56.9 ± 24.7 (out of 100). It was significantly different between residents of Tabriz (the capital of province) and other cities in the province (p < 0.001). Linear regression showed that younger age, gender, insurance type, being married, and households higher socio-economic status had a significant positive effect on PHC trust level with R² = 0.14383.

CONCLUSIONS

Public trust in PHC system in Iran needs to be improved. Individual variables had a small but key role in trust level. PHC trust cannot be only affected by individual's variables and experiences but also by health system and health providers' characteristics and public context in which PHC system exists. PHC trust level could be used as a public indicator in health systems especially in Low and Middle Income Countries (LMIC) to contribute in system strengthening policies at the national and international levels.

Religion and Use of Institutional Child Delivery Services: Individual and Contextual Pathways in Mozambique

CONTEXT

Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the use of such services have not been well examined and remain poorly understood.

METHODS

The relationship between religious affiliation and delivery in a health facility was explored using data from a household survey of 1,297 women aged 18-50 and a census of 825 religious congregations, both conducted in a predominantly Christian district in Mozambique in 2008. Multilevel logistic regression analyses were conducted to predict the likelihood of recent institutional delivery according to both individual religious affiliation and the concentration of religious congregations of certain denominations in the community of residence.

RESULTS

Approximately 63% of deliveries occurred in a health facility. The odds of such deliveries were lower among women who belonged to Apostolic churches or had no religious affiliation than among members of Catholic or mainline Protestant churches, net of other factors (odds ratios, 0.5 and 0.6, respectively). In addition, regardless of a woman's religion, the odds that she had an institutional delivery increased by 9% for each additional Catholic or mainline Protestant congregation in her community of residence (1.1).

CONCLUSIONS

Organized religion is associated with critical health outcomes in Mozambique and, potentially, in other Sub-Saharan African contexts. Policymakers should consider designing programs and interventions that promote the use of institutional delivery services among members of religious groups characterized by low use of these services and in areas where such religious groups have a strong presence.

Pediatric Palliative Care in the Multicultural Context: Findings From a Workshop Conference

CONTEXT

In our increasingly multicultural society, providing sensitive and respectful pediatric palliative care is vital.

OBJECTIVES

We held a one-day workshop conference with stakeholders and pediatric clinicians to identify suggestions for navigating conflict when cultural differences are present and for informing standard care delivery.

METHODS

Participants explored cases in one of four workshops focused on differences based on race/ethnicity, economic disparity, religion/spirituality, or family values. Each workshop was facilitated by two authors; separate transcriptionists recorded workshop discussions in real time. We used content analyses to qualitatively evaluate the texts and generate recommendations.

RESULTS

Participants included 142 individuals representing over six unique disciplines, 25 of the U.S., and three nations. Although the conference focused on pediatric palliative care, findings were broadly generalizable to most medical settings. Participants identified key reasons cultural differences may create tension and then provided frameworks for communication, training, and clinical care. Specifically, recommendations included phrases to navigate emotional conflict, broken trust, unfamiliar family values, and conflict. Suggested approaches to training and clinical care included the development of core competencies in communication, history taking, needs assessment, and emotional intelligence. Important opportunities for scholarship included qualitative studies exploring diverse patient and family experiences, quantitative studies examining health disparities, and randomized clinical trials testing interventions designed to improve community partnerships, communication, or child health outcomes.

CONCLUSION

Taken together, findings provide a foundation for collaboration between patients, families, and clinicians of all cultures.

Quality of Communication and Trust in Patients With Serious Illness: An Exploratory Study of the Relationships of Race/Ethnicity, Socioeconomic Status, and Religiosity

CONTEXT

Better understanding of clinicians' skill communicating with their patients and of patients' trust in clinicians is necessary to develop culturally sensitive palliative care interventions. Race/ethnicity, socioeconomic status, and religiosity have been documented as factors influencing quality of communication and trust.

OBJECTIVES

The objective of this study was to explore associations of seriously ill patients' race/ethnicity, socioeconomic status, and religiosity with patients' ratings of the quality of clinicians' communication and trust in clinicians.

METHODS

An observational analysis was performed using baseline data from a multicenter cluster-randomized trial of a communication intervention. We enrolled consecutive patients with chronic, life-limiting illnesses (n = 537) cared for by primary and specialty care clinicians (n = 128) between 2014 and 2016 in outpatient clinics in Seattle, Washington. We assessed patient demographics (age, gender, race/ethnicity, education, income, and self-rated health status), Duke University Religion Index, Quality of Communication Scale, and Wake Forest Physician Trust Scale. We used probit and linear regression and path analyses to examine associations.

RESULTS

Patients providing higher ratings of clinician communication included those belonging to racial/ethnic minority groups (P = 0.001), those with lower income (P = 0.008), and those with high religiosity/spirituality (P = 0.004). Higher trust in clinicians was associated with minority status (P = 0.018), lower education (P = 0.019), and clinician skill in communication (P < 0.001).

CONCLUSION

Contrary to prior studies, racial/ethnic minorities and patients with lower income rated communication higher and reported higher trust in their clinicians than white and higher income patients. More research is needed to identify and understand factors associated with quality communication and trust between seriously ill patients and clinicians to guide development of patient-centered palliative care communication interventions.

Factors affecting trust in healthcare among middle-aged to older Korean American women

Background

Predictors of trust in healthcare providers and the healthcare system have never been studied in Korean Americans (KA) despite the fact that trust plays an important role in health behaviors. The purpose of this study is to examine factors influencing trust in the healthcare system and providers among KA women.

Methods

Data were collected in 196 KA women examining the effects of perceived discrimination and trust on breast cancer screening in the Chicago metropolitan area. Path analysis was used to identify factors influencing trust in the healthcare system and providers.

Results

Acculturation was positively related to trust in healthcare providers (β = .15, p =. 002), and discrimination in the healthcare system was inversely related to trust in healthcare providers (β = −.60, p <. 001). Length of stay in the US was inversely related to distrust in the healthcare system (β = −.14, p <. 001), and discrimination in healthcare was positively related to distrust in the healthcare system (β = .60, p <. 001). Trust in healthcare providers and distrust in the healthcare system were moderately correlated (r = .51, p < .001).

Conclusion

Higher levels of acculturation and lower levels of perceived discrimination were identified as predictors of higher levels of trust in healthcare providers. A shorter stay in the US and higher levels of discrimination were identified as predictors of higher levels of distrust in the healthcare system. Perceived discrimination is a target for interventions to enhance trust in the healthcare system, and therefore reduce healthcare disparities in KAs.

Religious Involvement and Marijuana Use for Medical and Recreational Purposes

In this article, we use data from the 2016 National Survey on Drug Use and Health (NSDUH) to examine the association between religious involvement and marijuana use for medical and recreational purposes in U.S. adults (N = 41,517). We also consider whether the association between religious involvement and marijuana use varies according to personal health status. Our results show that adults who attend religious services more frequently and hold more salient religious beliefs tend to exhibit lower rates of medical and recreational marijuana use. We also find that these “protective effects” are less pronounced for adults in poor health. Although our findings confirm previous studies of recreational marijuana use, we are the first to examine the association between religious involvement and medical marijuana use. Our moderation analyses suggest that the morality and social control functions of religious involvement may be offset under the conditions of poor health.

Spiritual/Religious Beliefs & Medication Adherence in Black Women with Hypertension

Black women have the highest rate of hypertension (HTN) in the U.S. and perhaps the world. Because they are deemed the most religiously devout group in the U.S., it is plausible that faithfulness to spiritual/religious practices may yield more adherence to HTN medication regimens. This study examined spiritual/religious beliefs in relation to antihypertensive medication adherence in Black women with HTN. Although results showed no association between beliefs and adherence, women who developed trusting relationships with their healthcare provider were more likely to be adherent to their medications.

End-of-Life Decision Making and Communication of Bereaved Family Members of African Americans with Serious Illness

OBJECTIVE

The study objective was to examine factors that influence African American (AA) family members' end-of-life care decision outcomes for a relative who recently died from serious illness.

METHODS

A cross-sectional descriptive study design was used. Binary logistic and linear regressions were used to identify factors associated with decision regret and decisional conflict. Forty-nine bereaved AA family members of AA decedents with serious illness who died two to six months prior to enrollment were recruited from the palliative care program in a safety net hospital and a metropolitan church in the Midwest. Measurements used were the Decisional Conflict, Decision Regret, Beliefs and Values, and Quality of Communication scales.

RESULTS

Family members who reported higher quality of communication with health care providers had lower decisional conflict. Family members of decedents who received comfort-focused care (CFC) had significantly less decision regret than family members of those who received life-prolonging treatment (LPT). Family members who reported stronger beliefs and values had higher quality of communication with providers and lower decisional conflict.

CONCLUSIONS

This research adds to a small body of literature on correlates of end-of-life decision outcomes among AAs. Although AAs' preference for aggressive end-of-life care is well-documented, we found that receipt of CFC was associated with less decision regret. To reduce decisional conflict and decision regret at the end of life, future studies should identify strategies to improve family member-provider communication, while considering relevant family member and decedent characteristics.

Determining the spatial heterogeneity underlying racial and ethnic differences in timely mammography screening

BACKGROUND

The leading cause of cancer death for women worldwide continues to be breast cancer. Early detection through timely mammography has been recognized to increase the probability of survival. While mammography rates have risen for many women in recent years, disparities in screening along racial/ethnic lines persist across nations. In this paper, we argue that the role of local context, as identified through spatial heterogeneity, is an unexplored dynamic which explains some of the gaps in mammography utilization by race/ethnicity.

METHODS

We apply geographically weighted regression methods to responses from the 2008 Public Health Corporations' Southeastern Household Health Survey, to examine the spatial heterogeneity in mammograms in the Philadelphia metropolitan area.

RESULTS

We find first aspatially that minority identity, in fact, increases the odds of a timely mammogram: 74% for non-Hispanic Blacks and 80% for Hispanic/Latinas. However, the geographically weighted regression confirms the relation of race/ethnicity to mammograms varies by space. Notably, the coefficients for Hispanic/Latinas are only significant in portions of the region. In other words, the increased odds of a timely mammography we found are not constant spatially. Other key variables that are known to influence timely screening, such as the source of healthcare and social capital, measured as community connection, also vary by space.

CONCLUSIONS

These results have ramifications globally, demonstrating that the influence of individual characteristics which motivate, or inhibit, cancer screening may not be constant across space. This inconsistency calls for healthcare practitioners and outreach services to be mindful of the local context in their planning and resource allocation efforts.

Support for immigration reduction and physician distrust in the United States

Objectives:

Health research indicates that physician trust in the United States has declined over the last 50 years. Paralleling this trend is a decline in social capital, with researchers finding a negative relationship between immigration-based diversity and social capital. This article examines whether physician distrust is also tied to immigration-based diversity and declining social capital.

Methods:

Data come from the 2012 General Social Survey, one of the gold standards of US public opinion surveys, using a national probability sample of 1080 adult US respondents. Key measures included support for reducing levels of immigration to the United States and multiple measures of physician trust.

Results:

The results of ordinary least squares regressions, using survey weights, indicate that support for reducing immigration is positively linked to physician distrust, bringing physician distrust into the orbit of research on diversity and declining social capital. Models controlled for age, education, income, gender, race, nativity, conservatism, unemployed status, lack of health insurance, and self-rated health. Furthermore, analyses of a subset of respondents reveal that measures of general trust and some forms of institutional trust do not explain away the association between support for immigration reduction and physician distrust, though confidence in science as an institution appears relevant.

Conclusion:

Consistent with diversity and social capital research, this article finds that an immigration attitude predicts physician distrust. Physician distrust may not be linked just to physician–patient interactions, the structure of the health care system, or health policies, but could also be tied to declining social trust in general.

Religion, Judaism, and the challenge of maintaining an adequately immunized population

A slow but steady trend to decline routine immunization has evolved over the past few decades, despite its pivotal role in staving off life-threatening communicable diseases. Religious beliefs are among the reasons given for exemptions. In the context of an overview of various religious approaches to this issue, this article addresses the Jewish religious obligation to immunize. The latter is nested in the more general obligation to take responsibility for one's health as it is essential to living a morally productive life. Furthermore, the individual's responsibility extends to supporting communal health by contributing to herd immunity. Judaism embraces evidence-based information regarding immunization safety and efficacy and holds the resulting professional guidelines to be religiously binding. From a Jewish perspective, government bodies need to weigh respect for individual autonomy to refrain from immunization against preserving public safety, such that waiving autonomy should be reserved for immediately life-threatening situations. Nurses' knowledge and understanding of the Jewish legal approach as explicated in this article and those of other religions in which similar principles apply (such as Islam and Christianity) can enrich their awareness of how revering God can go hand in hand with an obligation to prevent illness for the self and the community by immunizing.

Disaggregating ethnoracial disparities in physician trust

Past research yields mixed evidence regarding whether ethnoracial minorities trust physicians less than Whites. Using the 2002 and 2006 General Social Surveys, variegated ethnoracial differences in trust in physicians are identified by disaggregating a multidimensional physician trust scale. Compared to Whites, Blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are less likely than Whites to trust the fiduciary ethic, technical judgment, and interpersonal competence of doctors. Black-Latino differences in physician trust are a function of ethnoracial differences in parental nativity. The ways ethnoracial hierarchies are inscribed into power-imbalanced clinical exchanges are discussed.

Patient communication pattern scale: psychometric characteristics

BACKGROUND

In western societies, a shared decision-making model for doctor-patient relationships calling for open and collaborative communication is recommended. Research focuses mainly on the doctor's communication patterns, while research on patient communication patterns is rare. The purpose of this study was to develop a tool for evaluating patient's communication patterns - the Patient Communication Pattern Scale (PCPS).

METHODS

Interviews based on structured questionnaires were conducted with 251 cancer patients. In addition to the 14-item PCPS, the questionnaire included questions regarding education, religiosity and desirability of control in general and over one's own health in particular, for validating the scale.

RESULTS

The PCPS was found to be a valid and reliable tool for evaluating patients' communication patterns. Confirmatory factor analysis supported the PCPS designed structure of five facets: (1) Information, (2) Clarification, (3) Initiation, (4) Preferences and (5) Emotions.

CONCLUSION

The PCPS is a reliable scale for evaluating patient communication patterns. The use of this scale can assist in promoting related research and in developing interventions for enhancing open and collaborative doctor-patient communication.

"A remarkable experience of god, shaping us as a family": parents' use of faith following child's rare disease diagnosis

A child's chronic illness can lead parents to utilize different types of coping, including religious beliefs and practices. Previous studies have generally focused on life-shortening diagnoses. The present study explored parental use of faith when the diagnosis was not life-shortening, using grounded-theory qualitative methodology. Data were collected using semi-structured telephone interviews with N = 12 parents of children diagnosed with Neuroendocrine Hyperplasia of Infancy (NEHI); approximately 50% of the diagnosed population in the United States at the time of the interview. Participants used faith to cope and make meaning in five ways: parents believed NEHI happened for a reason; beliefs provided resilience; parents were sustained by faith communities; beliefs affected parents' behavior; and beliefs developed over time. The results suggest that chaplains develop means for universal screening for spiritual struggle; educating congregational clergy how to support families in which a child has a chronic illness; and assisting parents construct meaning of their experience.

Religious leaders' opinions and guidance towards oral health maintenance and promotion: a qualitative study

Religions emphasize the supreme value of life. However, potential or concrete conflicts of perception between dictates of faith and science often present an inescapable dilemma. The aim of this qualitative research was to examine the views of spiritual and religious leaders towards general and oral health issues. A total of 11 eminent Jewish spiritual and religious community leaders were purposively chosen. They were interviewed using a semi-structured questionnaire. The verbatim transcriptions of the interviews were analysed in the spirit of grounded theory, using qualitative data analysis software. Open, axial, and thematic coding served to build categories and themes. Analysis of participants' perspectives reflected that they, based upon Jewish theology, attributed high importance to primary prevention at both personal and community levels. Religious and orthodox people were depicted as being motivated towards maintaining oral health behaviours due to a sense of obligation to follow religious edicts, strong social support, and elevated perceived spiritual levels. We offer a theoretical model that can explain the potential high motivation among these communities towards implementing positive general and oral health behaviours. Religiosity may be regarded as an example of a psycho-social health determinant, encompassing spiritual belief ("psycho") and social support ("social") components.

Associations between patient-provider communication and socio-cultural factors in prostate cancer patients: a cross-sectional evaluation of racial differences

OBJECTIVE

To examine the association between socio-cultural factors and patient-provider communication and related racial differences.

METHODS

Data analysis included 1854 men with prostate cancer from a population-based study. Participants completed an assessment of communication variables, physician trust, perceived racism, religious beliefs, traditional health beliefs, and health literacy. A multi-group structural equation modeling approach was used to address the research aims.

RESULTS

Compared with African Americans, Caucasian Americans had significantly greater mean scores of interpersonal treatment (p<0.01), prostate cancer communication (p<0.001), and physician trust (p<0.001), but lower mean scores of religious beliefs, traditional health beliefs, and perceived racism (all p values <0.001). For both African and Caucasian Americans, better patient-provider communication was associated with more physician trust, less perceived racism, greater religious beliefs (all p-values <0.01), and at least high school education (p<0.05).

CONCLUSION

Socio-cultural factors are associated with patient-provider communication among men with cancer. No evidence supported associations differed by race.

PRACTICE IMPLICATION

To facilitate patient-provider communication during prostate cancer care, providers need to be aware of patient education levels, engage in behaviors that enhance trust, treat patients equally, respect religious beliefs, and reduce the difficulty level of the information.

Interventions for improving patients' trust in doctors and groups of doctors

BACKGROUND

Trust is a fundamental component of the patient-doctor relationship and is associated with increased satisfaction, adherence to treatment, and continuity of care. Our 2006 review found little evidence that interventions improve patients' trust in their doctor; therefore an updated search was required to find out if there is further evidence of the effects of interventions that may improve trust in doctors or groups of doctors.

OBJECTIVES

To update our earlier review assessing the effects of interventions intended to improve patients' trust in doctors or a group of doctors.

SEARCH METHODS

In 2003 we searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, EMBASE, Health Star, PsycINFO, CINAHL, LILACS, African Trials Register, African Health Anthology, Dissertation Abstracts International and the bibliographies of studies selected for inclusion. We also contacted researchers active in the field. We updated and re-ran the searches on available original databases (Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library issue 2, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), CINAHL (Ebsco)) as well as Proquest Dissertations and Current Contents for the period 2003 to 18 March 2013.

SELECTION CRITERIA

Randomised controlled trials (RCTs), quasi-randomised controlled trials, controlled before and after studies, and interrupted time series of interventions (informative, educational, behavioural, organisational) directed at doctors or patients (or carers) where trust was assessed as a primary or secondary outcome.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed the risk of bias of included studies. Where mentioned, we extracted data on adverse effects. We synthesised data narratively.

MAIN RESULTS

We included 10 randomised controlled trials (including 7 new trials) involving 11,063 patients. These studies were all undertaken in North America, and all but two involved primary care.  As expected, there was considerable heterogeneity between the studies.  Interventions were of three main types; three employed additional physician training, four were education for patients and three provided additional information about doctors in terms of financial incentives or consulting style. Additionally, several different measures of trust were employed.The studies gave conflicting results. Trials showing a small but statistically-significant increase in trust included: a trial of physician disclosure of financial incentives; a trial of providing choice of physician based on concordance between patient and physician beliefs about care; a trial of group visits for new inductees into a Health Maintenance Organisation; a trial of training oncologists in communication skills; and a trial of group visits for diabetic patients. However, trust was not affected in a subsequent larger trial of group visits for uninsured people with diabetes, nor with a decision aid for helping choose statins, another trial of disclosure of financial incentives or specifically training doctors to increase trust or cultural competence. There was no evidence of harm from any of the studies.

AUTHORS' CONCLUSIONS

Overall, there remains insufficient evidence to conclude that any intervention may increase or decrease trust in doctors. This may be due in part to the sensitivity of trust instruments, and a ceiling effect, as trust in doctors is generally high. It may be that current measures of trust are insufficiently sensitive. Further trials are required to explore the impact of doctors' specific training or the use of a patient-centred or decision-sharing approach on patients' trust, especially in the areas of healthcare provider choice, and induction into healthcare organisation. International trials would be of particular benefit. The review was constrained by the lack of consistency between trust measurements, timeframes and populations.

HPV vaccine decision-making and acceptance: does religion play a role?

We conducted a web-based survey among 476 white, Black, and Hispanic parents or caregivers with daughter(s) between the ages of 9-17 to better understand how religion influences HPV vaccine acceptance. Catholic parents were more likely than nonaffiliated parents to have already vaccinated their daughters (vs. being undecided) (OR = 3.26, 95% CI = 1.06, 10.06). Parents with frequent attendance at religious services were more likely than parents who do not attend services to have decided against vaccination (vs. being undecided) (OR = 2.92, 95% CI = 1.25, 6.84). Directions for research and implications for interventions are addressed.

"I honestly believe god keeps me healthy so i can take care of my child": parental use of faith related to treatment adherence

A limited number of studies address parental faith and its relationship to their children's health. Using cystic fibrosis as a disease exemplar in which religion/spirituality have been shown to play a role and parental health behaviors (adherence to their child's daily recommended home treatments) are important, this study explored whether parents with different levels of adherence would describe use of faith differently. Twenty-five interviews were completed and analyzed using grounded theory methodology. Some parents described no relationship between faith and treatment adherence. However, of those who did, higher-adherence parents believed God empowered them to care for their child and they used prayer to change themselves, while lower-adherence parents described trusting God to care for their child and used prayer to change God. Clinical implications for chaplains' differential engagement with parents are presented.

Relationship of adherence determinants and parental spirituality in cystic fibrosis

The course of cystic fibrosis (CF) progression in children is affected by parent adherence to treatment plans. The Theory of Reasoned Action (TRA) posits that intentions are the best behavioral predictors and that intentions reasonably follow from beliefs ("determinants"). Determinants are affected by multiple "background factors," including spirituality. This study's purpose was to understand whether two parental adherence determinants (attitude towards treatment and self-efficacy) were associated with spirituality (religious coping and sanctification of the body). We hypothesized that parents' attitudes toward treatment adherence are associated with these spiritual constructs. A convenience sample of parents of children with CF aged 3-12 years (n = 28) participated by completing surveys of adherence and spirituality during a regular outpatient clinic visit. Type and degree of religious coping was examined using principal component analysis. Adherence measures were compared based on religious coping styles and sanctification of the body using unpaired t-tests. Collaborative religious coping was associated with higher self-efficacy for completing airway clearance (M = 1070.8; SD = 35.8; P = 0.012), for completing aerosolized medication administration (M = 1077.1; SD = 37.4; P = 0.018), and for attitude towards treatment utility (M = 38.8; SD = 2.36; P = 0.038). Parents who attributed sacred qualities to their child's body (e.g., "blessed" or "miraculous") had higher mean scores for self-efficacy (airway clearance, M = 1058.6; SD = 37.7; P = 0.023; aerosols M = 1070.8; SD = 41.6; P = 0.020). Parents for whom God was manifested in their child's body (e.g., "My child's body is created in God's image") had higher mean scores for self-efficacy for airway clearance (M = 1056.4; SD = 59.0; P = 0.039), aerosolized medications (M = 1068.8; SD = 42.6; P = 0.033) and treatment utility (M = 38.8; SD = 2.4; P = 0.025). Spiritual constructs show promising significance and are currently undervalued in chronic disease management.

Religion and preventive service use: do congregational support and religious beliefs explain the relationship between attendance and utilization?

Religious individuals are more likely to engage in healthy practices, including using preventive services; however, the underlying mechanisms have not been adequately explored. To begin addressing this, the current study examines the association between religious attendance, four aspects of congregational support, two health-related religious beliefs, and the use of preventive services (cholesterol screening, flu shot, and colonoscopy) among a national sample of Presbyterian adults (n = 1,076). The findings show that two aspects of congregational support are relevant to these types of behavioral health. First, church-based health activities are significantly related to the use of cholesterol screenings and flu shots (OR = 1.13, P < .05; OR = 1.10, P < .05, respectively). Second, discussing health-related issues with fellow church members is also significantly associated with reporting a cholesterol screening (OR = 1.15, P < .05), as well as moderately predictive of colonoscopy use (OR = 1.10, P < .10). Neither of the religious beliefs related to health, such as the God locus of health control scale or beliefs about the sanctity of the body, are related to preventive service use in this population. Although attendance is predictive of service use in unadjusted models, the association appears to be explained by age rather than by the congregational or belief variables. These findings contribute to a more nuanced understanding of the various ways in which religion might impact health behaviors and may also help to shape and refine interventions designed to improve individual well-being.

We can handle this: parents' use of religion in the first year following their child's diagnosis with cystic fibrosis

The diagnosis of a child's life-shortening disease leads many American parents to utilize religious beliefs. Models relating religious constructs to health have been proposed. Still lacking are inductive models based on parent experience. The specific aims of this study were: 1. develop a grounded theory of parental use of religion in the year after diagnosis; 2. describe whether parents understand a relationship between their religious beliefs and their follow-through with their child's at-home treatment regimen. Fifteen parent interviews were analyzed using grounded theory method. Parents used religion to make meaning of their child's cystic fibrosis (CF) diagnosis. Parents imagined God as active, benevolent, and interventionist; found hope in their beliefs; felt supported by God; and related religion to their motivation to adhere to their child's treatment plan. Religious beliefs are clinically significant in working with many parents of children recently diagnosed with CF. Interventions that improve adherence to treatment may be enhanced by including religious aspects.

Factors associated with use of breast cancer screening services by women aged >or= 40 years in Korea: the third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III)

Background

Despite evidence that breast cancer screening reduces morbidity and mortality, until recently most women have not undergone regular mammogram examinations in Korea. We aimed to identify factors associated with use of breast cancer screening services.

Methods

The Health Promotion Knowledge, Attitude and Practice survey (HP-KAP survey) is part of the Third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III), a nationwide health survey in Korea. Of 7,802 individuals who participated in the HP-KAP survey, 4,292 were female. Of these, 2,583 were women aged at least 40 years and without a history of breast cancer; these women were included in this study. Information about breast cancer screening participation was obtained from the responses to questionnaires. The overall rate of regular breast cancer screening was measured. Factors that affect participation in a breast cancer screening program were identified using multiple logistic regression analysis.

Results

Among women aged at least 40 years, 30.4% complied with breast screening recommendations. Age of at least 65 years (adjusted odds ratio, aOR 0.61, 95% CI: 0.42-0.88), education level (no [ref], elementary school [aOR 1.51, 95% CI: 1.06-1.47], middle/high school [aOR 1.99, 95% CI: 1.36-2.92], university/higher [aOR 2.73, 95% CI: 1.71-4.35]), private health insurance (aOR 1.42, 95% CI: 1.71-4.35), attitude towards screening tests (aOR 0.18, 95% CI: 0.14-0.23), self-reported health status of 'fair' (aOR 1.26 95% CI: 1.00-1.58), and smoking (aOR 0.52, 95% CI: 0.35-0.79) were associated with the rate of regular breast cancer screening

Conclusions

To increase the nationwide breast cancer screening rate, more attention should be given to underrepresented groups, particularly the elderly, those with a low education level, smokers, and those with a negative attitude towards screening tests. These issues highlight the need for a new emphasis in health education, promotional campaigns and public health policy aimed at these underrepresented groups.

Access to health care and religion among young American men

In order to elucidate cultural correlates of utilization of primary health services by young adult men, we investigated religion in which one was raised and service utilization. Using data from a national survey we tested the hypothesis that religion raised predicts access to and utilization of a regular medical care provider, examinations, HIV and other STD testing and counseling at ages 18–44 years in men born between 1958 and 1984. We also hypothesized that religion raised would be more predictive of utilization for Hispanic Americans and non-Hispanic Black Americans than for non-Hispanic White Americans. The study included a national sample of 4276 men aged 18–44 years. Descriptive and multivariate statistics were used to assess the hypotheses using data on religion raised and responses to 14 items assessing health care access and utilization. Compared to those raised in no religion, those raised mainline Protestant were more likely (p < 0.01) to report a usual source of care (67% vs. 79%), health insurance coverage (66% vs. 80%) and physical examination (43% vs. 48%). Religion raised was not associated with testicular exams, STD counseling or HIV testing. In multivariate analyses controlling for confounders, significant associations of religion raised with insurance coverage, a physician as usual source of care and physical examination remained which varied by race/ethnicity. In conclusion, although religion is a core aspect of culture that deserves further study as a possible determinant of health care utilization, we were not able to document any consistent pattern of significant association even in a population with high rates of religious participation.

Religion, risk, and medical decision making at the end of life

OBJECTIVE

The purpose of this study is to present empirical evidence about whether religious patients are more or less willing to undergo the risks associated with potentially life-sustaining treatment.

METHODS

At least every 4 months 226 older community-dwelling persons with advanced cancer, congestive heart failure, or chronic obstructive pulmonary disease were asked questions about several dimensions of religiousness and about their willingness to accept potentially life-sustaining treatment.

RESULTS

Results were mixed but persons who said that during their illness they grew closer to God (odds ratio [OR] = 1.79; 95% confidence intervals [CI] = 1.15, 2.78) or those grew spiritually (OR = 1.61; 95% CI = 1.03, 2.52) were more willing to accept risk associated with potentially life-sustaining treatment than were persons who did not report such growth.

DISCUSSION

Not all dimensions of religiousness have the same association with willingness to undergo potentially life-sustaining treatment. Seriously ill older, religious patients are not especially predisposed to avoid risk and resist treatment.

Predictors of preventive health care use among middle-aged and older adults in Mexico: the role of religion

Research has shown that religion is associated with a wide range of health behaviors among adults of all ages. Although there is strong support for religion's influence on behaviors such as drinking and smoking, less is known about the possible relationship between religion and the use of preventive health services. This relationship may be particularly important in Mexico, a country with high levels of religiousness and low levels of preventive service utilization. The current study uses a nationally representative sample of middle-aged and older adults in Mexico (n = 9,890) to test the association between three facets of religion and three preventive services aimed at detecting chronic conditions or underlying risk factors. The findings show that religious salience is significantly related to the use of blood pressure and cholesterol screenings, even after controlling for a variety of social, demographic, and health-related factors. In addition, attending religious services and participating in religious activities are both positively associated with blood pressure and diabetes screening. This type of research adds to our knowledge of the determinants of preventive service utilization, as well as to the burgeoning literature on religion and health. Furthermore, because the vast majority of research in this field takes place in more developed and Westernized countries, such as the US and Western Europe, analyzing this relationship in a sample of older Mexicans is critical for providing the field with a more comparative orientation.