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

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					 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

• 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

What is the relationship between access to
medical care and the use of faith-based
healers?


                Hypothesis:
 Those who have difficulty accessing medical
  care are more likely to use 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

• 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

• 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
• 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
                                        Demographic Characteristics of FBH Users
 (Odds Ratios adjusted for gender, income, employment status, health status and race)

                                                                      Use of FBH
N=4680                                                                  n (%)             Adjusted OR for Use
                                                                       n = 180                  of FBH
Age
65 years and older                                                      28 (3.4)
Under 65 years                                                          165 (4.3)                0.55
Self-Reported Health Status
Fair or poor                                                            76 (6.4)*
Good or excellent                                                       121 (3.5)                1.68
Gender
Female                                                                 121 (4.8)*
Male                                                                    72 (3.4)                 1.29
Race
Black                                                                   73 (4.5)
White                                                                   120 (4.0)                1.11
 * Statistically significant (p<0.05)

                             No significant differences in use of FBH by, income, education,
                                          employment status, or marital status.
             Utilization and Barriers
                                                                              Adjusted OR*
                                                                             for Use of FBH

Utilization of      Foregone medical care within past twelve
    Medical Care       months                                                       1.98
                    Delayed medical care within past twelve
                       months                                                       1.81
                    4 or more physician visits within past year                     1.16


Barriers to         Break in insurance coverage within past
   Medical Care        twelve months                                                1.68
                    Lives in Whole- or Part-County HPSA
                       (2002)                                                       1.48
                    Usual source of care is ER                                      1.64
                    Difficulty traveling to place of care                           1.39

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

                                                                    Adjusted OR*
                                                                   for Use of FBH
                  No statistically significant differences in
                     FBH use for any of the satisfaction                *****
Satisfaction         variables (e.g., overall, quality, concern)


Beliefs about     Believes one should use doctors as a last
                                                                        1.54
   Medical Care      resort
                  Believes that, if a person waits long
                     enough, one can get over almost any                1.24
                     illness without medical care
                  Believes one should delay or avoid using
                                                                        1.92
                     physicians
*Adjusted for gender, income, race, employment status, and health status
  Results – Stratified Analysis by
        Gender and Race
                        Adjusted OR for Use of FBH
   (Adjusted for income, employment status, health status and gender or race)


 Access            Blacks         Whites            Males          Females
Parameter
Foregone
medical care          2.28           1.78             1.80             2.09

Delayed
medical care          1.93           1.73             1.84             1.79

Break in health
care insurance        1.43           1.84             1.43             1.85
coverage
                    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

• 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
• 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