Kindratt Tiffany B, Dallo Florence J, Allicock Marlyn, Atem Folefac, Balasubramanian Bijal A
University of Texas at Arlington, Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, 500 West Nedderman Drive, Arlington, TX 76019-0259, United States.
Oakland University, Department of Public and Environmental Wellness, School of Health Sciences, United States.
Prev Med Rep. 2020 Apr 2;18:101086. doi: 10.1016/j.pmedr.2020.101086. eCollection 2020 Jun.
Our study aimed to estimate how associations between adults' perceptions of specific domains of PPC quality and their likelihood of receiving cancer screenings differed by race and ethnicity. We analyzed 2011-2015 Medical Expenditure Panel Survey (MEPS) data. Samples included 7337 women ages 50-74 (breast), 13,276 women ages 21-65 (cervical), and 9792 adults ages ≥50 years (colorectal). To examine individual domains of PPC quality (independent variables), adults reported how often providers: listened; showed respect; spent enough time; explained things; gave specific instructions; and demonstrated health literate practices (gave clear instructions and asked them to "teach-back" how they will follow instructions). Dependent variables were breast, cervical, and colorectal cancer screenings. Multivariable logistic regression was used to evaluate the odds of receiving cancer screenings using a composite measure of PPC quality and separate domains. Hispanic and non-Hispanic black adults who reported their providers always demonstrated PPC quality had higher odds of receiving colorectal cancer screenings compared to those whose providers did not. Adults' perceptions of whether or not their provider gave them specific instructions increased their odds of receiving breast (Hispanics OR = 1.65, 95% CI = 1.09, 2.51; non-Hispanic blacks OR = 1.54, 95% CI = 1.06, 2.24) and colorectal (non-Hispanic whites OR = 1.37, 95% CI = 1.13, 1.66; Hispanics OR = 1.29, 95% CI = 1.01, 1.66; non-Hispanic blacks OR = 1.92, 95% CI = 1.39, 2.65) cancer screenings. Non-Hispanic Asian women who reported their health care providers demonstrated "teach-back" had higher odds (OR = 2.25; 95% CI = 1.10, 4.62) of receiving cervical cancer screenings. Efforts to improve cancer screenings should focus on training providers to demonstrate health literate practices to improve cancer screenings.
我们的研究旨在评估成年人对初级保健质量特定领域的认知与他们接受癌症筛查可能性之间的关联如何因种族和族裔而有所不同。我们分析了2011 - 2015年医疗支出面板调查（MEPS）的数据。样本包括7337名年龄在50 - 74岁的女性（乳腺癌筛查）、13276名年龄在21 - 65岁的女性（宫颈癌筛查）以及9792名年龄≥50岁的成年人（结直肠癌筛查）。为了考察初级保健质量的各个领域（自变量），成年人报告了医疗服务提供者倾听、表示尊重、花费足够时间、解释事情、给出具体指示以及展示具备健康素养行为（给出清晰指示并要求他们“反馈”将如何遵循指示）的频率。因变量是乳腺癌、宫颈癌和结直肠癌筛查。多变量逻辑回归用于评估使用初级保健质量综合指标和各个单独领域来接受癌症筛查的几率。报告其医疗服务提供者始终展现出初级保健质量的西班牙裔和非西班牙裔黑人成年人接受结直肠癌筛查的几率高于那些医疗服务提供者未展现出该质量的成年人。成年人对其医疗服务提供者是否给予他们具体指示的认知增加了他们接受乳腺癌（西班牙裔：比值比[OR] = 1.65，95%置信区间[CI] = 1.09，2.51；非西班牙裔黑人：OR = 1.54，95% CI = 1.06，2.24）和结直肠癌（非西班牙裔白人：OR = 1.37，95% CI = 1.13，1.66；西班牙裔：OR = 1.29，95% CI = 1.01，1.66；非西班牙裔黑人：OR = 1.92，95% CI = 1.39，2.65）筛查的几率。报告其医疗服务提供者展示了“反馈”的非西班牙裔亚洲女性接受宫颈癌筛查的几率更高（OR = 2.25；95% CI = 1.10，4.62）。改善癌症筛查的努力应侧重于培训医疗服务提供者展示具备健康素养的行为以提高癌症筛查率。
