Statement of Research Activities

I am interested in studying what barriers inhibit help-seeking and service utilization by African Americans for cancer. I am interested in studying these barriers because I propose that they contribute to the health disparities observed between Whites and Blacks. Potential barriers I plan to explore include trust in individual physicians and the health system itself, as well as stigma and health literacy.

I work in the Communication and Behavioral Oncology (CBO) Department at the Barbara Ann Karmanos Cancer Institute (KCI) and Wayne State University (WSU) School of Medicine under the direction of Dr. Terrance Albrecht, who is my mentor.  My primarily assignment is research.

I received a competitive Research Supplement to Promote Diversity in Health-Related Research from the National Cancer Institute (NCI). This supplement stems from the Detroit Community Network Program (CNP) [U01 CA114583-02S2A1; PI: T. L. Albrecht].  The Detroit CNP is a five-year effort that seeks to reduce cancer health disparities in breast, prostate, colorectal and lung cancers which adversely affect older African Americans in metropolitan Detroit.

Current Research Projects

Healthier Black Elders Survey to Assess Health Status in Detroit

Currently I am working on a Detroit CNP project to survey older African Americans in Detroit regarding their health status. I am the Principal Investigator (PI) on this project. The research team is multidisciplinary and includes those in the field of nursing, psychology, communications and nursing. The research sample will be drawn from Detroit’s Healthier Black Elder (HBE), a research pool run by the Institute of Gerontology at Wayne State University in conjunction with Michigan Center for Urban African American Aging Research (MCUAAAR) program. This research pool consists of older African American men and women who are willing to participate in non-invasive research associated with the health of minorities.  We will be using a modified version of the Health and Retirement Survey (HRS) used by the University of Michigan for their longitudinal study of the health status of older Americans. Their results provide an emerging portrait of an aging America's physical and mental health, insurance coverage, financial status, family support systems, labor market status, and retirement planning. We are interested in examining how well older African Americans are doing in Detroit compared to national sample data. Data for our study will be collected via phone interviews. Currently, I am working with my team to adapt the survey for our population. The survey will be pilot-tested and actual data collection will take place in 2008. It is anticipated that this research will lead to presentations at national conferences as well as peer-reviewed journal publications.

Detroit CNP Network Analysis

I am also working on a planned network analysis of the Detroit CNP. Funding for this project is pending. This planned analysis will determine the feasibility of using social network analysis (Luke & Harris, 2007) as a tool for tracking and monitoring the development of the CNP. The structure of our community network will be examined related to perceived benefits vs. costs, commitments, social trust, satisfaction, and sense of ownership. Further, this analysis will determine the extent to which partners engage in resource exchange in ways that may likely lead to a reduction in cancer health disparities. I am a Co-Investigator on this grant and I helped with the re-submission of this project. As part of the project, I will attend the social network analysis short course at the University of Michigan Institute for Social Research. I will also have the opportunity to collaborate and be mentored by other key personnel particularly the project leader, Dr. Phyllis Meadows, Director and Public Health Officer, City of Detroit Department of Health and Wellness Promotion. I will oversee the daily activities and logistics associated with the project. Further, I will supervise the Research Assistant working on this project. I will also present research findings of the CNP network analysis pilot project at national conferences. It is anticipated that peer-reviewed journal publications will stem from this project. Further, findings from this project will be used for two additional grants. The first will be a conference grant on community network analysis to be hosted by the Detroit CNP on behalf of other interested CNPs funded throughout the United States. The second will be an R01 grant application to use network analysis to evaluate a multi-year community based intervention for developing and sustaining coalitions to reduce cancer health disparities in large urban areas (with subcontracts to study these patterns longitudinally in several U.S. cities).

Planned Research Projects

What influences the assessment of trust in patient-oncologist interactions?

In addition to working on already established grants, I have submitted a R03 that aims to examine trust in patient-oncologist interactions in response to #PAR-06-458, Small Grants for Behavioral Research in Cancer Control. Trust between a patient and physician is an essential component in a provider/patient relationship (Tarn, et al. 2005).  Trust determines a patient’s willingness to seek care, follow through on treatments, and the likelihood of the patient returning for follow-up care (Boulware, et al., 2003; Tarn, et. al, 2005).  Most often the patient/oncologist relationship has to develop quickly, most often during the initial visit, as the patient copes with the diagnosis and ensuing treatment plan.  The brevity of the oncologist/patient relationship hampers trust.  Previous studies have shown that the longer a patient has known the physician the more trust a patient is likely to have (Mainous, et al., 2006).  Another potential obstacle is that the ability to choose one’s physician is also linked to trust but often a person seeing an oncologist does not have the opportunity to choose their oncologist (Tarn, et. al, 2005). 

My proposed research is a secondary analysis of data collected as part of a larger, NCI-funded study [RO1CA075003-03, PI:  T. L. Albrecht].  The larger study investigated the communication process during oncologist-patient/companion video-taped interactions with a specific focus on discussion of clinical trials and other treatment options. The larger study also evaluated trust qualitatively using a global assessment of observed trust. I plan to delve into what specific behavioral markers/indicators coders are using to assess trust. Coders will view the videotapes of the patient-oncologist interactions and rate levels and indicators of trust using Observer Video-Pro Software. In addition to traditional coders (e.g. research assistants, graduate students), community members that are participants in the Detroit CNP will be used to aid in the development of an observational measure of trust. It will be important to ascertain that extent to which our target population’s assessment of trust matches our ratings of trust. Community members’ ratings will be compared to traditional coders to see if there are any systematic differences in conceptualizations of trust. Generalizability theory will be employed so that percentages of variance can be teased out to discover whether it is characteristics of our coders, the actual interaction between patient and oncologist, the actual trust measure, or any combination of the already mentioned factors driving results.

Publications and Future Research

Over the course of the next two years, I will work to increase my publication record in the area of cancer health disparities particularly in peer-reviewed publications. Thus far, I have co-authored a review article on Black-White health disparities (Penner, et al., in press). This article discusses several potential direct causes of Black–White disparities in health status, which include biological or genetic factors, prejudice and related processes, and socioeconomic factors. I also contributed to a book chapter on health disparities (Penner, et al., in press). This chapter examined the relationships between prejudice, stereotypes, and discrimination and the problem of health disparities. I anticipate additional publications stemming from projects that I am currently working on.

I currently have an article stemming from my dissertation under review for publication. This article examines family help-seeking and service utilization preferences for adolescent mental health and adolescent alcohol use (Coleman & Stanton, under review).  I developed a model demonstrating that problem recognition precedes any help-seeking and/or service use (Sayal, Taylor & Beecham, 2003). Once problem recognition occurs, complex issues related to barriers, such as stigma, may inhibit help-seeking and service use (Keller & McDade, 2000). Further, perceptions of problem seriousness and treatment efficacy increase the likelihood that help-seeking and/or service use will occur (Morrissey-Kane & Prinz, 1999). Research findings supported this model. I would like to extend this model to examine barriers (e.g. stigma, health literacy) to help-seeking and service utilization by African Americans which contribute to cancer health disparities. In January 2008, I plan to put together an inter-disciplinary team consisting of those from psychology, sociology, nursing, medicine, and communication to develop a pilot project to begin exploring these barriers and implementing solutions.

References:

Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A., & Powe, N. R. (2003). Race and trust in the health care system. Public Health Rep, 118(4), 358-365.

Coleman, D. K. (2006). Parental problem recognition, help-seeking and service utilization for adolescent mental health: Do age, gender and the presence of school problems affect parental decisions? Dissertation Abstracts International, 67(5), 2857. (UMI No. AAT 3218276).

Coleman, D. K., & Stanton, B. (under review). Parental preferences for help-seeking and service utilization for adolescent mental health: What factors influence their decisions? Journal of Adolescence

Hall, M. A., Camacho, F., Dugan, E., & Balkrishnan, R. (2002). Trust in the medical profession: conceptual and measurement issues. Health Serv Res, 37(5), 1419-1439.

Keating, N. L., Gandhi, T. K., Orav, E. J., Bates, D. W., & Ayanian, J. Z. (2004). Patient characteristics and experiences associated with trust in specialist physicians. Arch Intern Med, 164(9), 1015-1020.

Keller, J., & McDade, K. (2000).  Attitudes of low-income parents toward seeking help with parenting:  Implications for practice.  Child Welfare, 79, 285-312.

Luke, D. A., & Harris, J. K. (2007). Network analysis in public health:  History, methods, and applications. Annual Review of Public Health, 28, 69-93.

Mainous, A. G., 3rd, Smith, D. W., Geesey, M. E., & Tilley, B. C. (2006). Development of a measure to assess patient trust in medical researchers. Annual Family Medicine, 4(3), 247-252.

Morrissey-Kane, E., & Prinz, R. J. (1999).  Engagement in child and adolescent treatment:  The role of parental cognitions and attributions.  Clinical Child and Family Psychology Review, 2, 183-198.

Penner, L., Albrecht, T., Coleman, D. K. & Norton, W. E. (in press). Interpersonal perspectives on Black-White health disparities: Social policy implications. Social Issues and Policy Review.

Penner, L. A., Albrecht, T. L., Orom, H. A., Coleman, D. K., & Underwood, W. U. (in press). An examination of the role of prejudice, stereotyping, and discrimination in Black-White health disparities in the United States. In J. Dovidio, M. Hewstone, & P. Glick, (Eds.), Handbook of prejudice, stereotyping, and discrimination.  London:  Sage.

Sayal, K., Taylor, E., Beecham, J. (2003).  Parental perceptions of problems and mental health service use for hyperactivity.  Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1410-1414.

Schwartz, A., et al. (2003, September). Cancer statistics in metropolitan Detroit, 2003.  Detroit, MI:  Metropolitan Detroit Cancer Surveillance System, Surveillance, Epidemiology and End Results Program, Epidemiology Section.

Schwartz, K., Crossley-May, H., Vigneau, F., Brown, K., & Banerjee, M. (2003). Race, SES, and stage at diagnosis for five common malignancies. Cancer Causes & Control, 14, 761-766.

Tarn, D. M., Meredith, L. S., Kagawa-Singer, M., Matsumura, S., Bito, S., Oye, R. K., et al. (2005). Trust in one's physician: the role of ethnic match, autonomy, acculturation, and religiosity among Japanese and Japanese Americans. Annual Family Medicine, 3(4), 339-347.