Minorities and CAM Use: A Health Services Perspective

描述(由申请人提供)： 这项拟议研究的广泛目标是进一步了解CAM的使用如何有助于消除健康方面的差异。为此，这项研究探索了CAM的使用如何与改善少数族裔人群护理质量的潜在战略相关联：卫生保健提供者的文化能力和促进健康的信念，如感知对自己健康的控制。文化能力是对健康信念和行为、治疗结果和不同患者群体的社会背景的意识的结合。研究医学多元化的细微差别，使用多种治疗实践，将进一步加深我们对文化能力需求的理解。生物医学护理与患者使用CAM的决定有何关系？获得生物医疗服务的机会和质量方面的种族/民族差异是否与CAM的使用有关？生物医学和CAM共同与健康结果有何关系？这项拟议的研究从卫生服务的角度审查了不同种族/民族人口中的医疗多元化。更具体地说，这项研究旨在： 1)研究社会因素--种族/民族、社会经济地位和性别--如何与CAM使用率和医疗多元化的差异有关； 2)探讨控制源对CAM使用的直接和中介效应； 3)评估CAM利用与生物医疗护理的各个方面之间的联系，包括获取途径、质量、患者与提供者的关系以及文化能力；以及 4)在医学多元化的框架内，评估对医生建议的遵从性和对CAM使用情况的披露。 分析将在四个种族/民族群体内和之间进行，他们是非西班牙裔白人、非西班牙裔非裔美国人、非西班牙裔亚洲人和西班牙裔美国人，使用两项全国性调查。将通过对两项全国性调查的二级分析来检验假设：2002年全国健康访谈调查和英联邦基金2001年卫生保健质量调查。这两个数据集都对少数族裔人口进行了过度抽样，并包括关于受访者在生物医学保健和各种CAM领域的丰富数据，如草药、脊椎按摩、针灸和传统民族医学疗法。

DESCRIPTION (provided by applicant): The broad goal of the proposed study is to further our understanding of how CAM utilization might contribute to eliminating disparities in health. Toward this end, this study explores how CAM use is associated with potential strategies for improving quality of care among minority populations: cultural competency of health care providers and health-promoting beliefs such as perceived control of one's health. Cultural competence is the incorporation of an awareness of health beliefs and behaviors, treatment outcomes, and the social context of different patient populations. Research on the nuances of medical pluralism, the use of multiple healing practices, would further our understanding of cultural competency needs. How does biomedical care relate to patients' decisions to use CAM? Are racial/ethnic differences in access to and quality of biomedical care associated with CAM use? How do biomedicine and CAM collectively relate to health outcomes? The proposed study examines medical pluralism in diverse racial/ethnic populations from a health services perspective. More specifically, this study aims to: 1) Examine how social factors - race/ethnicity, socioeconomic position, and gender - are associated with differences in CAM utilization and medical pluralism; 2) Explore the direct and mediating effects of locus of control on CAM use; 3) Assess the association between CAM utilization and various facets of biomedical care, including access, quality, patient-provider relationship, and cultural competence; and 4) Evaluate adherence to physician recommendations and disclosure of CAM utilization within a framework of medical pluralism. Analyses will be conducted within and between four racial/ethnic groups, non-Hispanic Whites, non-Hispanic African-Americans, non-Hispanic Asians, and Hispanics, using two national surveys. Hypotheses will be tested through secondary analysis of two national surveys: the 2002 National Health Interview Survey and the Commonwealth Fund's 2001 Health Care Quality Survey. Both datasets oversampled minority populations and include rich data on respondents' experiences with biomedical health care and a variety of CAM domains, such as herbalism, chiropractic, acupuncture, and traditional ethnomedical therapies.