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

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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)

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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)
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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).

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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?
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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

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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

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Description of Population

• Overall response rate was 51
• Population Demographics (N 4879)
• Average age 50 yrs
• 33 male
• 51 employed
• 55 married
• lt2 each of Native Americans, Asians, Native
  Hawaiians
• Response rates lower among
• African Americans
• Those with household incomes lt15,000
• 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

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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)
Statistically significant (plt0.05)
No significant differences in use of FBH by,
income, education, employment status, or marital
status.
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Utilization and Barriers
Adjusted for gender, income, race, employment
status, and health status
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Satisfaction and Beliefs
Adjusted for gender, income, race, employment
status, and health status
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Results Stratified Analysis by Gender and Race
Adjusted OR for Use of FBH (Adjusted for income,
employment status, health status and gender or
race)
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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

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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)

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Implications

• Prevalence rate if its 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

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Discussion