Although continuity of cancer-related care increases the use of early detection cancer screening exams (Doescher, Saver, Fiscella, & Franks, 2004), and thereby improves treatment outcomes (Mandelblatt et al., 2009), Latino (Latina) women in the U.S. currently report lower continuity of care than non-Latino White (Anglo) women (American Cancer Society, 2010; Doescher, Saver, Fiscella, & Franks, 2001). Such disparities may be due, in part, to interpersonal healthcare mistreatment (Smedley, Stith, & Nelson, 2003), as well as mistreatment-related attributions and emotions (Betancourt, Flynn, & Ormseth, 2011; Tucker, 2008). Therefore, according to Weiner's model of attribution and emotion (1986) as well as Betancourt's Integrative model of Culture, Psychological Processes, and Health Behavior (2009), the aim of this research was to examine the impact of mistreatment-related attributions of intentionality and controllability, as well as negative emotions, on continuity of care among Latino and Anglo women. Two hundred and fourteen Latino and Anglo women who perceived at least one instance of interpersonal healthcare mistreatment were recruited from Southern California using multi-stage stratified sampling. Structural equation modeling confirmed the expected relationships between attributions, negative emotions, and continuity of care, with ethnicity moderating these associations. For Anglos, higher attributions of intentionality were associated with higher attributions of controllability, r = .46, p < .001, and were directly related to lower continuity of care, β = -.38, p < .01. For Latinos, higher attributions of controllability were indirectly related to lower continuity of care through mistreatment-related negative emotions, βindirect = -.12, p < .05. These findings have implications for improving continuity of care in Latino American women, as well as educating healthcare professionals on how attributions and emotions related to patient-professional relationships can impact cancer-related health disparities.

LLU Discipline

Clinical Psychology




School of Behavioral Health

First Advisor

Betancourt, Hector

Second Advisor

Flynn, Patricia

Third Advisor

Owen, Jason

Degree Name

Doctor of Philosophy (PhD)

Degree Level


Year Degree Awarded

January 2012

Date (Title Page)




Library of Congress/MESH Subject Headings

Healthcare disparities; Cancer; Mammography; Health Behavior - ethnology; Hispanic Americans; Attitude to Health - Hispanic Americans; Breast neoplasms - prevention & control;

Subject - Local

Interpersonal Healthcare mistreatment; Continuity of care



Page Count

59 p.

Digital Format


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.


Loma Linda University Electronic Theses & Dissertations

Collection Website



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