QUALITY OF PAST EXPERIENCES WITH HEALTHCARE PROVIDERS, LEVEL OF SELF-EFFICACY, AND DEGREE OF TRUST IN PROVIDERS AS DETERMINANTS OF PROVIDER AVOIDANCE: TESTING THE MODERATING EFFECTS OF RACE AND GENDER
Epstein, Norman B
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A critical component in the prevention and treatment of illness and disease is individuals' timely and consistent consultation with healthcare providers. The purpose of the current study was to examine factors influencing individuals' avoidance of healthcare providers in a national sample of insured U.S. adults who potentially have access to healthcare but may not use it. Inadequate access to healthcare as a function of disparities (e.g., lack of health insurance) has increasingly received attention. However, there has been a lack of attention to factors that interfere with use of healthcare among individuals who potentially have access based on insurance coverage. Those individuals are at risk of negative health outcomes when they avoid medical consultation for serious health symptoms. Consequently, the present study examined factors influencing healthcare avoidance among individuals who have health insurance. A secondary analysis was conducted with a publically available data set, the 2007 Health Information National Trends Survey (NCI, 2009). The study examined the extent to which health self-efficacy, quality of past interactions that an individual has had with healthcare providers (HCPs), and trust in HCPs to take care of one's health needs predicted current avoidance of HCPs. The study also examined individuals' levels of trust in HCPs as a potential mediator of the relationship between the quality of interactions with HCPs and the degree to which individuals avoid HCPs, as well as patient race/ethnicity and gender as potential moderators of the relationship between quality of interactions with HCPs and trust in HCPs. Control variables included age, education, and income. Results provided support for the expected relationships between health self-efficacy, quality of interactions with HCPs, and trust in HCPs, and HCP avoidance. Furthermore, results revealed that trust in HCPs is a significant mediator between quality of interactions with HCPs and HCP avoidance. However, results did not provide support for race/ethnicity and gender as clinically significant moderators between quality of interactions with HCPs and trust in HCPs. Findings provide useful information about factors that influence individuals' avoidance of HCPs, thereby identifying targets for reducing this problematic public health phenomenon. Implications for theory, research, practice, and policy are presented.