Electronic Theses and Dissertations

Date

2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Psychology

Committee Chair

Idia B Thurston

Committee Member

Frank Andrasik

Committee Member

Fedoria Rugless

Committee Member

Kevin Gibson

Committee Member

James Murphy

Abstract

Despite the growing number of U.S. patients impacted by chronic pain (Nahin, 2015), many, particularly African Americans go without adequate treatment due inequitable care (Anderson, Green, & Payne, 2009; Resnik, Rehm, & Minard, 2001). Even when the gold-standard treatment is accessible, many African Americans do not remain in care, electing to prematurely terminate treatment (Bonham, 2001; Green, Baker, Sato, Washington, & Smith, 2003). The Behavioral Model for Healthcare Utilization (BMHU) is widely used to understand how individuals engage in health care treatment and was recently expanded to be more inclusive for racial minorities (Bradley et al., 2002). However, little research has applied this model to premature termination, particularly in patients with chronic pain. The current study investigated the three-part BMHU model (i.e. predisposing, enabling, and severity factors) to explore associations with the decision-making process for African Americans patients with chronic pain who prematurely terminated treatment. A concurrent parallel mixed methods study design was used. Participants, recruited from Church Health Center a midsouth integrated primary care center, were seen by a physical therapist between 2015-2018. Retrospective medical chart review was conducted for the 164 African American patients with chronic pain who had demographic data, depression (PHQ-9) total scores, anxiety (GAD-7) total scores, and pain severity (MPQ item for qualitative pain rating) scores. Results of a point-biserial correlation assessing the relationship between the variables of interest and premature termination did not suggest any significant relationships. Additionally, logistic regression analyses were not statistically significantly. A subset of the quantitative sample was interviewed for the qualitative arm. Specifically, an open-ended interview of 15 African American patients with chronic pain who ended treatment prematurely was completed. Qualitative interviews identified three domains of patient concerns: perceived treatment inefficacy, patient-provider disconnection, and treatment de-prioritization. These findings highlight how critical patients perception of the first treatment session is for continued care and the value of mixed methods research in gaining a complete picture of participants experiences. Future researchers should examine retention interventions that can be implemented in the first treatment session for African American patients with chronic pain.

Comments

Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest

Notes

Open Access

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