Nazione S, Nazione A. Reducing Health Disparities: Understanding the Unintended Effects of Health Care Professional and Patient Characteristics on Treatment. J Am Osteopath Assoc 2018;118(6):376–383. doi: 10.7556/jaoa.2018.081.
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The responsibility-affect-helping model proposes that helping behavior is a function of perceived responsibility and affect.
To examine the effect of medical students’ degree (DO or MD) and gender on attitudes toward patients and how these factors could act as moderators in the responsibility-affect-helping model.
This 2×3 experimental study included third- and fourth-year osteopathic (ie, DO) and allopathic (ie, MD) medical students. Students were given a survey that included the medical record and photograph of a fictitious male patient with diabetes and a message from the patient regarding his diet nonadherence. The patients differed in race (black or white) and the cause of diet nonadherence (healthy foods don't taste good, no reason given, or inability to access healthy foods). Survey items measured students’ perception of the patient's responsibility for his nonadherence, level of anger, intention to help, level of sympathy, and ethnocentrism. Data were analyzed using a multivariate analysis of covariance with ethnocentrism as a covariate.
Of 1520 potential students, 231 were included in the study. Mean (SD) responsibility scale scores showed that DO students viewed the patient who gave dislike of healthy food or no reason for their diet nonadherence as more responsible for his nonadherence than did MD students (4.69 [0.99] vs 3.93 [1.00] and 4.35 [0.88] vs 3.65 [1.01], respectively). Conversely, mean (SD) responsibility scores showed that DO students viewed patients who indicated lack of access to healthy food as his reason for diet nonadherence as less responsible for his nonadherence than did MD students (2.45 [0.94] vs 2.59 [1.08]) (F2,228=3.21, P<.05, η2=.03). Furthermore, female students perceived patients to be less responsible for their diet nonadherence than did male students (3.28 [1.22] vs 3.88 [1.22]) (F2,228=8.87, P<.01, η2=.04). Ethnocentrism was consistently a significant covariate for students’ perception of patient characteristics, predicted patient behaviors, perception of the patient's responsibility for his nonadherence, students’ level of anger, students’ intention to help, and students’ level of sympathy.
Survey results showed that DO students perceived patients who reported dislike of healthy food or no reason for diet nonadherence as more responsible for their health issue and patients who indicated lack of access to healthy food as less responsible for their nonadherence than did MD students. Additionally, female students perceived patients to be less responsible for their health issue than did male students. Results of the current study indicate that physician demographic factors could be taken into account as proxy variables when using the responsibility-affect-helping model in the health care field.
a Variables were assessed on 7-point scales in which 1 indicates the lowest level of the construct and 7 indicates the highest level of the construct.
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