Abstract

Access to healthcare requires individuals to have a place to go, a healthcare provider to see them, resources to obtain proper care, and the appropriate health services given in an appropriate timeframe. Non-Hispanic Black American men have the highest incidence rate of prostate cancer in the world, 180.6 per 100,000 (NCI, 2004). It is not clear as to why high rates persist, but higher death rates are associated with late detection. This mixed-methods ecological study was to investigate physician and Black male perceptions and practices regarding prostate cancer early detection with prostate specific antigen (PSA) blood test, and the digital rectal examination (DRE) to identify what social ecological factors were predictive of PSA and DRE. Qualitative and quantitative secondary data from a 2001 CDC funded study in San Bernardino, California, the “Prostate Cancer Prevention Behaviors among African American Men” study (Montgomery et al., 2001) were analyzed for this project. Analyses included cross sectional data from the healthcare provider sample of 93 primary care providers, and ecological longitudinal data from a cohort of 276 Black males.

A social ecological model with five main levels was created to explore social factors predictive of PSA test and DRE. To reduce data and identify data patterns, factor analyses (tested for reliability by calculating Cronbach alpha scores) were performed. Model variables were standardized with Z-scores for multivariate logistic regression analyses with SPSS Version 12.

A significant predictor of PSA and DRE was the physician's direct prostate cancer communication message (P<0.010). Significant correlations exist with PSA and DRE outcomes, and physician's engaging communication style (P<0.012), encouragement to screen (P<0.000), and sharing prostate cancer information (P<0.000); as was men understanding the serious rick of prostate cancer (P<0.001); culture (P<0.004); positive interaction with healthcare staff, significant other(s), and providers (P<0.000); and a supportive environment (P<0.006). These findings could lead to the development of effective health promotion strategies that engage Black men into prostate cancer early detection activities, and provide a meaningful guide to improving Black male health.

School

School of Public Health

First Advisor

Susanne B. Montgomery

Second Advisor

Robert Gardner

Third Advisor

R. Patti Herring

Fourth Advisor

Daniel Stokols

Degree Name

Doctor of Public Health (DrPH)

Degree Level

Ph.D.

Year Degree Awarded

2005

Date (Title Page)

6-2005

Language

English

Library of Congress/MESH Subject Headings

Prostatic Neoplasms -- prevention and control; African Americans -- education; Health promotion; Early Diagnosis; Health services

Type

Dissertation

Page Count

xiii; 223

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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