'Break down health belief barriers' to eliminate disparity, says speaker

Oct. 19, 2002

ASSEMBLY EDITION • SAN DIEGO

'Break down health belief barriers' to eliminate disparity, says speaker

BY CINDY McCANSE

W hen you're looking at preventive services for minority patients, overcoming disparities in health care is the name of the game, observed Denise Rodgers, M.D., during her Thursday afternoon lecture, "Primary and Secondary Prevention in Minority Populations." Rodgers' session was offered as part of the 2003 Annual Clinical Focus on prevention, which kicked off here at the Scientific Assembly.

"Much of the important stuff that goes on to eliminate disparity is what goes on between doctor and patient," says Denise Rodgers, M.D.

Rodgers is associate dean for community health at the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick. She said reports of health disparities based on gender, race, ethnicity and other factors are abundant in the medical literature. In 1999, the most recent year for which data were available:

the life expectancy at birth for blacks was six years less than that for whites;
the infant mortality rate among blacks was 2.4 times that for whites, while Native Americans were 1.6 times more likely to die in the first year of life than were whites; and
black adults were 28 percent more likely than whites to die from heart disease and were 38 percent more likely than whites to die from cerebrovascular disease.

The numbers clearly show the problem. What they don't show is the solution. "Much of the important stuff that goes on to eliminate disparity is what goes on between doctor and patient," Rodgers said.

"As family physicians, we are extremely aware of the importance of effective communication in doing our jobs," she said. Poor communication -- poor interpretation of the information exchanged -- leads to poor quality of care and, ultimately, poor outcomes.

Respect is a key issue in getting your patients to communicate with you, Rodgers added. Patient surveys have shown that a significant proportion of patients feel they are disrespected within the health care system. That percentage is greatest among minority patient populations, she said.

And it's not just a matter of respecting the patient, Rodgers went on. It's also a matter of respecting that patient's health beliefs.

One study of African-American women in the southeastern United States who had been diagnosed with breast cancer looked at predictors of when they would come in for care. The study found that a fairly common belief among these women -- that having air hit a tumor was a bad thing -- was a predictor of poor likelihood for follow-up.

"The percent of adults who strongly believe that it's better to take care of one's own health than to go to the doctor varies significantly by race and ethnicity," she said. "And we clearly know that holding these beliefs influences the degree to which patients go in for preventive care."

Pose the following question to yourself, Rodgers suggested: "'How do I begin as a physician to understand the health beliefs that you as a patient bring to the office?' Until we break down some of these health belief barriers and begin to learn from our patients, we're going to continue to see these disparities."

"As our health care visits become shorter and our time with patients more limited, it is much more difficult for us to get at some of the health beliefs that are influencing patients' behavior," said Rodgers.

"If we do not figure out how to streamline our practices so that we can once again develop meaningful, longitudinal relationships with our patients -- so that we can understand their health beliefs and their health practices -- we will not be able to educate patients in ways that will make a difference in the elimination of disparity," Rodgers added.

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