Cultural Beliefs About Diabetes-Related Social Exclusion and Diabetes Distress Impact Self-Care Behaviors and HbA1c Among Patients with Type 2 Diabetes.

BACKGROUND: Type 2 diabetes mellitus (T2DM) disproportionally impacts Latin Americans (Latinos) in the U.S. compared to non-Latino Whites, as reflected by an increased risk for disease complications and higher mortality rates. Guided by an Integrative Model of Culture, Psychological Processes, and Health Behavior, the purpose of the present study was to examine the role of cultural beliefs and diabetes distress as determinants of self-care behaviors and HbA1c among Latino patients with T2DM. METHODS: Participants included 109 Latino patients with T2DM recruited from a diabetes treatment center located in a region of Southern California with high diabetes mortality rates. Structural equation modeling was employed to examine the extent to which cultural beliefs about diabetes-related social exclusion and diabetes distress impact self-care behaviors and self-reported HbA1c. RESULTS: Consistent with the study hypotheses, cultural beliefs about diabetes-related social exclusion predicted diabetes distress, which in turn predicted poor diabetes self-care. CONCLUSIONS: Findings suggest an important need for intervention efforts that address both cultural and psychological factors in order to improve diabetes self-care behaviors and associated disease outcomes among Latino patients with T2DM. Future research could benefit from investigating protective aspects of culture that could help counter the negative implications of cultural beliefs about social exclusion and diabetes distress associated with poor self-care.

Risk Factors, Clinical Presentation, Therapeutic Trends, and Outcomes in Arterial Thrombosis Complicating Unvaccinated COVID-19 Patients: A Systematic Review.

Data on characteristics and outcomes of coronavirus (COVID)-19 patients complicated with arterial thrombosis (AT) are scarce. Therefore, we carried out a systematic review (PRISMA, PROSPERO statements; PubMed, Scopus, and Web of Science) to identify risk factors, clinical presentation, treatment, and outcomes. We included publications from December 2019 to October 2020. Groups: (a) ischemic stroke, (b) thrombotic storm, (c) peripheral vascular thrombosis, (d) myocardial infarction, and (e) left cardiac thrombus or in-transit thrombus (venous system thrombus floating or attaching to the right heart). We considered 131 studies. The most frequent cardiovascular risk factors were: hypertension, diabetes, and dyslipidemia. A high proportion presented with asymptomatic, mild, or moderate COVID-19 (n = 91, 41.4%). We identified a high percentage of isolated ischemic stroke and thrombotic storm. Groups with higher mortality rate: intracardiac thrombus (1/2, 50.0%), thrombotic storm (18/49, 36.7%), and ischemic stroke (48/131, 36.6%). A small number received thromboprophylaxis. Most patients received antithrombotic treatment. The most frequent bleeding complication was intracranial hemorrhage, primarily with isolated stroke. Overall mortality was 33.6% (74/220). Despite a wide range of COVID-19 severity, a high proportion had AT as a complication of non-severe disease. AT can affect different vascular territories; mortality is associated with stroke, intensive care unit stay, and severe COVID-19.

The role of cultural beliefs and distress in adherence to recommended physical activity among patients with type 2 diabetes mellitus.

The aim of this research was to examine the role of negative cultural beliefs about exercise and their relation to diabetes distress as determinants of exercise treatment adherence among culturally and socio-economically diverse patients with type 2 diabetes mellitus (T2DM). Participants included 193 Latin American (Latino) and non-Latino White patients with T2DM from a region of Southern California, with high rates of T2DM. The research was guided by Betancourt's Integrative Model of Culture, Psychology, and Behavior which specifies the structure of relations among socio-structural, cultural, and psychological factors as determinants of health behavior. As hypothesized, structural equation modeling revealed that negative cultural beliefs about exercise predicted higher levels of diabetes distress (ß = 0.32, p < 0.05), which in turn predicted lower exercise treatment adherence (ß = - 0.34, p < 0.05). Findings suggest a critical need for interventions that target both cultural and psychological factors in order to improve diabetes outcomes.

Development and validation of a scale for measuring cultural beliefs about psychotherapy patients in southern Chile.

PURPOSE: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. METHODS: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). RESULTS: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. CONCLUSIONS: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.

Health professional cultural competence reduces the psychological and behavioral impact of negative healthcare encounters.

OBJECTIVES: Negative health care encounters have psychological and behavioral consequences for patients, particularly for minority and low socioeconomic populations. Guided by an integrative model of culture, psychological processes, and health behavior, this study examined whether provider cultural competence reduces the emotional and behavioral consequences of negative health care encounters among Latina and non-Latino White American women in the United States. METHOD: A total of 335 women participated in the study, of which 236 (Latina = 112; non-Latino White = 124) reported at least one negative health care encounter during a preventive medical screening exam. Structural equation causal modeling was used to examine whether provider cultural competence, as perceived by the patient, influenced emotions associated with negative health care encounters and subsequent medical avoidance. RESULTS: When both Latina and non-Latino White American patients perceived their provider to be higher in cultural competence, they experienced less shame and embarrassment related to the negative encounter. Lower levels of shame and embarrassment in turn, predicted less medical avoidance for Latina, but not non-Latino White American women. CONCLUSIONS: Findings revealed that provider cultural competence reduces some of the consequences of negative health care encounters that are relevant to health behavior. These findings shed light on the complexity of how providers' cultural competence impacts patient behavior, highlighting the importance of including psychological variables when investigating the role of cultural competence in health behavior and outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Development and validation of a scale for measuring cultural beliefs about psychotherapy patients in southern Chile

Abstract Purpose: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. Methods: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). Results: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. Conclusions: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.

[Health care effects of cultural beliefs about physicians and perceived discrimination]. / Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención.

BACKGROUND: Healthcare inequities may hamper physical and mental health. AIM: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. MATERIAL AND METHODS: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. RESULTS: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. CONCLUSIONS: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Creencias culturales sobre los médicos y percepción de discriminación: El impacto en la continuidad de la atención / Health care effects of cultural beliefs about physicians and perceived discrimination

Background: Healthcare inequities may hamper physical and mental health. Aim: To examine perceived discrimination in healthcare services in relation to socio-structural and cultural antecedents as well as their effect on psychological processes and health. Material and Methods: Questionnaires on beliefs about physicians, perceived discrimination, emotions and affective states and avoidance consequences in health were answered by 337 child caregivers (85% women) attending preventive health care appointments at primary health care centers. Results: Negative beliefs about healthcare professionals are directly associated with avoidance behaviors in health and perceived discrimination. The latter perception has no direct effects on avoidance behaviors, but it has an indirect effect through negative emotions associated with discrimination. Conclusions: There is an association between cultural, psychological and structural factors in health care. These results contribute to understand the phenomenon of discrimination and its negative consequences.

Healthcare Mistreatment and Cultural Beliefs Impact HbA1c in Patients with Type 2 Diabetes Mellitus / La Negligencia Médica y las Creencias Culturales impactan BhA1C en Pacientes con Diabetes Mellitus tipo 2

Abstract The aim of this research was to examine the effects of healthcare mistreatment and cultural beliefs on psychological, behavioral, and biological phenomena relevant to treatment adherence and health outcome among patients with Type 2 Diabetes Mellitus (T2DM). The study was conducted in Chile, where the prevalence of T2DM is one of the highest in Latin America and is increasing at an accelerated rate. The research was guided by Betancourt's Integrative Model and bottom-up mixed-method cultural research approach. Consistent with the hypotheses of the study, the test of a structural equation model based on the Integrative Model, including exposure to healthcare mistreatment, diabetes-related cultural beliefs, psychological distress, and medical avoidance as determinants of HbA1c, a biological measure of diabetes control, fit the data. The fact that the analysis of structural equations accounted for significant variance in HbA1c provides supporting evidence for extending the Integrative Model, to explain biological phenomena based on cultural and psychological factors.

Resumen El propósito de este trabajo fue evaluar los efectos de la negligencia médica y las creencias culturales sobre fenómenos biológicos, conductuales y psicológicos relevantes para la adherencia al tratamiento y consecuencias de salud en pacientes con diabetes mellitus tipo 2 (DMT2). El estudio se llevó a cabo en Chile, donde la prevalencia de DMT2 es una de las más altas de América Latina y sigue en aumento de manera acelerada. La investigación se basó en el Modelo Integrativo de Betancourt y en el enfoque mixto-abajo-arriba de investigación cultural. Congruente con las hipótesis del estudio, el modelo de ecuaciones estructurales basado en el modelo integrativo, que incluyó la exposición a negligencia médica, creencias culturales vinculadas a la diabetes, estrés psicológico, y evitación médica como determinantes del HbA1c, una medición biológica de control diabético, mostró buen ajuste. El hecho de que el modelo de ecuaciones estructurales explique gran parte de la varianza del HbA1c aporta suficiente evidencia para ampliar el modelo integrativo en la explicación del fenómeno biológico con base en factores culturales y psicológicos.

[Development of an instrument to assess cultural beliefs about physicians]. / Identificación y medición de creencias culturales sobre los médicos: construcción y validación de un instrumento.

BACKGROUND: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. AIM: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. MATERIAL AND METHODS: Based on a "bottom-up" methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). RESULTS: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. CONCLUSIONS: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

Identificación y medición de creencias culturales sobre los médicos: construcción y validación de un instrumento / Development of an instrument to assess cultural beliefs about physicians

Background: Beliefs about professionals' healthcare may influence healthcare behaviors. Such beliefs are in part the result of the interactions that professionals have with their patients. Recent studies highlight the importance of beliefs about physicians, their effect on health-care behaviors, and the requirement of culturally appropriate tools to measure such beliefs. Aim: To develop and validate a culturally appropriate instrument to measure beliefs about physicians. Material and Methods: Based on a "bottom-up" methodology, a culturally pertinent scale of beliefs about physicians was developed and then validated by expert judges. The resulting scale, with 26 items, was applied to 337 participants aged 31 ± 7 years (85% women). Results: Two factors, grouping 24 items, emerged from the exploratory factor analysis. The first was called negative beliefs about doctors (Cronbach's α = 0.96) and the second was called positive beliefs about doctors (Cronbach's α = 0.95). Both factors explain 70 % of the scale variance. Conclusions: The devised instrument has adequate psychometric properties and is also culturally relevant. It allows the assessment of cultural beliefs about physicians.

Desarrollo de un instrumento culturalmente pertinente para medir creencias en psicoterapia / Development of a culturally relevant instrument to measure beliefs in psychotherapy

El estudio de cómo los factores culturales se relacionan con la adherencia a psicoterapia es altamente relevante y sin embargo, en Chile no existen instrumentos que tomen en consideración tales factores. El objetivo de este estudio es ilustrar la construcción de un instrumento para medir variables culturales que se asocian a la adherencia a psicoterapia. Se utilizó una metodología mixta de tres etapas. Primero, se realizaron 32 entrevistas semiestructuradas con el objetivo de identificar creencias socialmente compartidas respecto de la psicoterapia. Luego, se desarrolló la Escala de Creencias en Psicoterapia (ECPSI) y se piloteó en una muestra de 109 personas. Finalmente, se exploró la estructura factorial y propiedades psicométricas de la nueva escala en 201 usuarias de centros de salud primaria de la Región de La Araucanía. Los resultados indican que la ECPSI es un instrumento adecuado psicométricamente y culturalmente pertinente a la sociedad Chilena.

The study of how cultural factors are related to adherence to psychotherapy is highly relevant, however in Chile there are no available measures that addresses these factors. In order to develop an instrument culturally relevant for measuring cultural factors associated with adherence to psychotherapy, a three-stage mixed methodology was used. First, 32 semi-structured interviews were conducted aiming to identifying socially shared beliefs about psychotherapy. Second, the Psychotherapy Beliefs Scale was developed and piloted with a sample of109 participants. Finally, the factorial structure, and the scale reliability were tested with a sample of 201 women recruited from several primary care health centers. The results obtained suggest that this scale is psychometrically sound and culturally relevant for measuring cultural beliefs associated with adherence to psychotherapy.

Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche / Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care

Background: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. Aim: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. Material and Methods: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Results: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Conclusions: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Fatalism, Attributions of Failure and Academic Performance in Mapuche and non-Mapuche Chilean Students / Fatalismo, atribuciones del fracaso, y rendimiento académico en estudiantes chilenos Mapuche y no-Mapuche

This study investigated the role of fatalism as a cultural value orientation and causal attributions for past failure in the academic performance of high school students in the Araucania Region of Chile. Three thousand three hundred and fourty eight Mapuche and non-Mapuche students participated in the study. Consistent with the Culture and Behavior model that guided the research, the test of causal models based on the analysis of structural equations show that academic performance is in part a function of variations in the level of fatalism, directly as well as indirectly through its influence in the attribution processes and failure-related emotions. In general, the model representing the proposed structure of relations among fatalism, attributions, and emotions as determinants of academic performance fit the data for both Mapuche and non-Mapuche students. However, results show that some of the relations in the model are different for students from these two ethnic groups. Finally, according to the results from the analysis of causal models, family SES appear to be the most important determinant of fatalism

Este estudio investiga el rol del fatalismo como orientación valórica cultural y las atribuciones causales sobre el fracaso en el rendimiento académico de estudiantes secundarios en la región de La Araucanía, Chile. Tres mil trescientos cuarenta y ocho estudiantes Mapuche y no-Mapuche participaron en el estudio. De manera consistente con el modelo sobre cultura y comportamiento que guía la investigación, los resultados del análisis de modelos causales basado en ecuaciones estructurales muestra que el rendimiento académico es en parte una función de variaciones en el nivel de fatalismo, tanto directamente como por medio de los procesos de atribución causal y las emociones relacionadas al fracaso. En términos generales, el modelo propuesto respecto a la estructura de las relaciones entre las variables fatalismo, atribuciones, y emociones relacionadas con el fracaso como determinantes del rendimiento académico explican los datos tanto para estudiantes Mapuche como no-Mapuche. Sin embargo, los resultados muestran que la naturaleza de las relaciones entre algunas de las variables del modelo es distinta para estudiantes de estos dos grupos étnicos. Finalmente, de acuerdo al análisis de modelos causales, el nivel socioeconómico de la familia aparece como el determinante más importante del fatalismo

[Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care]. / Atribución de malos tratos en servicios de salud a discriminación y sus consecuencias en pacientes diabéticos mapuche.

BACKGROUND: The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. AIM: To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. MATERIAL AND METHODS: A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. RESULTS: Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. CONCLUSIONS: Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Cultural beliefs about health professionals and perceived empathy influence continuity of cancer screening following a negative encounter.

Negative health care encounters have implications for preventive medical services and continuity of health care. This study examined cultural and interpersonal psychological factors involved in health care interactions that may ameliorate the detrimental effects of negative encounters. A mixed-methods approach was implemented to examine the relations among positive cultural beliefs about health professionals, perceived professional empathy, interpersonal emotions, and continuity of cancer screening among 237 Latin American (Latino) and non-Latino White (Anglo) American women who reported a negative health care encounter. Multi-group structural equation modeling revealed that for Latino and Anglo women, positive cultural beliefs about health professionals in general were associated with higher perceptions of empathy regarding a professional involved in a negative encounter. In addition, for Latino women, perceptions of higher professional empathy and less negative emotions were associated with better continuity of cancer screening. Interventions designed to improve professionals' empathy skills and diverse patients' perceptions of professionals could improve patient-professional relations.

Dietary Adherence, Glycemic Control, and Psychological Factors Associated with Binge Eating Among Indigenous and Non-Indigenous Chileans with Type 2 Diabetes.

BACKGROUND: Despite the strong association between obesity and binge eating, limited research has examined the implications of binge eating on dietary adherence and psychological factors in ethnically diverse type 2 diabetes patients. PURPOSE: This study investigated the prevalence of binge eating and its association with dietary adherence, glycemic control, and psychological factors among indigenous and non-indigenous type 2 diabetes patients in Chile. METHOD: Participants were 387 indigenous (Mapuche) and non-indigenous (non-Mapuche) adults with type 2 diabetes. Self-report measures of binge eating, dietary adherence, diet self-efficacy, body image dissatisfaction, and psychological well-being were administered. Participants' weight, height, and glycemic control (HbA(1c)) were also obtained. RESULTS: Approximately 8 % of the type 2 diabetes patients reported binge eating. The prevalence among Mapuche patients was 4.9 %, and among non-Mapuche patients, it was 9.9 %. Compared to non-binge eaters, binge eating diabetes patients had greater body mass index values, consumed more high-fat foods, were less likely to adhere to their eating plan, and reported poorer body image and emotional well-being. CONCLUSION: Results of this study extend previous research by examining the co-occurrence of binge eating and type 2 diabetes as well as the associated dietary behaviors, glycemic control, and psychological factors among indigenous and non-indigenous patients in Chile. These findings may increase our understanding of the health challenges faced by indigenous populations from other countries and highlight the need for additional research that may inform interventions addressing binge eating in diverse patients with type 2 diabetes.

Attributions and emotions regarding health care mistreatment impact continuity of care among Latino and Anglo American women.

Ethnic minority and lower socioeconomic status (SES) populations report less positive health care encounters and lower continuity of health care compared with higher SES and non-Latino White (Anglo) Americans. This study examined similarities and differences concerning the influence of patients' causal attributions for health care mistreatment and related emotions on continuity of health care among 335 Latin American (Latinas) and Anglo American women in Southern California. A mixed methods research approach was implemented to identify and assess perceptions of health care mistreatment, causal attributions for mistreatment, negative emotions, and continuity of cancer screening care. Multigroup structural equation modeling revealed that causal attributions for health care mistreatment and related emotions explained continuity of care above and beyond what was explained by patients' exposure to health care mistreatment alone, for both ethnic groups. Still, the improvement in variance accounted for by including attributions and emotions was considerably more for Latinas (194%) than Anglo women (109%). Compared with attributions having to do with the health care environment (e.g., time constraints), attributions to the health care professional (e.g., uncompassionate) were related to higher levels of negative emotions for both Latinas and Anglo women and lower continuity of care, particularly for Anglo women. Results also suggest that for Latinas continuity of care was more a function of the attribution-emotion process, particularly the negative emotions associated with attributions concerning mistreatment, whereas for Anglo women it was more a function of mistreatment and the attribution itself. Interventions designed to improve professionals' communication and interpersonal skills may help enhance continuity of health care and reduce health disparities. (PsycINFO Database Record

Culture, emotion, and cancer screening: an integrative framework for investigating health behavior.

BACKGROUND: Although health disparity research has investigated social structural, cultural, or psychological factors, the interrelations among these factors deserve greater attention. PURPOSE: This study aims to examine cancer screening emotions and their relations to screening fatalism as determinants of breast cancer screening among women from diverse socioeconomic and ethnic backgrounds. METHODS: An integrative conceptual framework was used to test the multivariate relations among socioeconomic status, age, screening fatalism, screening emotions, and clinical breast exam compliance among 281 Latino and Anglo women, using multi-group structural equation causal modeling. RESULTS: Screening emotions and screening fatalism had a negative, direct influence on clinical breast exam compliance for both ethnic groups. Still, ethnicity moderated the indirect effect of screening fatalism on clinical breast exam compliance through screening emotions. CONCLUSIONS: Integrative conceptual frameworks and multivariate methods may shed light on the complex relations among factors influencing health behaviors relevant to disparities. Future research and intervention must recognize this complexity when working with diverse populations.

Healthcare mistreatment and continuity of cancer screening among Latino and Anglo American women in southern california.

The aim of this research was to examine the relation of perceptions of healthcare mistreatment and related emotions to continuity of cancer screening care among women who reported healthcare mistreatment. The structure of relations among cultural beliefs about healthcare professionals, perceptions of mistreatment, mistreatment-related emotions, and continuity of screening was investigated. Participants included 313 Anglo and Latino American women of varying demographic characteristics from southern California who were recruited using multi-stage stratified sampling. Structural equation modeling confirmed the relation of perceptions of mistreatment to continuity of care for both Anglo and Latino American women, with ethnicity moderating this association. For Anglo Americans, greater perceptions of mistreatment were negatively related to continuity of screening. However, for Latinas the relation was indirect, through mistreatment-related anger. While greater perceptions of mistreatment were associated with higher levels of anger for both ethnic groups, anger was negatively related to continuity of care for Latino but not for Anglo women. Furthermore, cultural beliefs about professionals were indirectly related to continuity of screening through perceptions of mistreatment and/or mistreatment-related anger. These findings highlight the importance of the role of cultural and psychological factors in research and interventions aimed at improving patient-professional relations with culturally diverse women.