Zo Ramamonjiarivelo

Trust, Medication Adherence, and Hypertension Control in Southern African American Men

We examined the relationship between trust in the medical system, medication adherence, and hypertension control in Southern African American men. The sample included 235 African American men aged 18 years and older with hypertension. African American men with higher general trust in the medical system were more likely to report better medication adherence (odds ratio [OR] = 1.06), and those with higher self-efficacy were more likely to report better medication adherence and hypertension control (OR = 1.08 and OR = 1.06, respectively).

Adoption of electronic medical records: the role of network effects

Purpose – This paper aims to examine the role of network effects (defined as increased utility for users of a technology that occurs when adoption increases among other users) in the adoption of electronic medical records (EMR) systems. EMR systems, which have experienced slow adoption rates, promise to improve the efficiency of the healthcare system by facilitating information exchange among physicians caring for the same patients.Design/methodology/approach – Survey responses from physicians are used to test several hypotheses. The authors are interested in how market level EMR adoption was related to physician adoption intentions. The authors also test the “strong ties” notion of network effects by examining whether EMR adoption among generalists, and specialist physicians, had differing influences on adoption intentions in a given market.Findings – Support for network effects is found; each one unit increase in market‐level EMR adoption is associated with a significant increase in overall physician ad...

MEDTOUR: a scale for measuring medical tourism intentions.

Purpose – The purpose of this paper is to use a theoretical model to create a scale to predict medical tourism (MT) intentions.Design/methodology/approach – The theory of planned behavior (TPB) model was applied to MT by creating a 49‐item questionnaire and collecting data from a convenience sample of 453 undergraduate students enrolled in a university located in the USA. Factor analysis was used to evaluate the results, and yielded a MEDTOUR scale containing 29 items.Findings – A regression of the three variables on an intentions scale of participation in MT had an R‐value of 0.587. The model was able to explain around 35 percent of the variance in intentions. Given the general nature of the model and the first attempt at predicting MT, the results are positive.Research limitations/implications – This research is limited due to the use of a convenience sample of undergraduate students. Further research utilizing additional samples is needed to verify the MEDTOUR scale. In addition, future research can fo...

Public hospitals in financial distress: Is privatization a strategic choice?

Background: As safety net providers, public hospitals operate in more challenging environments than private hospitals. Such environments put public hospitals at greater risk of financial distress, which may result in privatization and deterioration of the safety net. Purpose: The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. Methodology/Approach: We used panel data merged from the American Hospital Association Annual Survey, Medicare Cost Reports, Area Resource File, and Local Area Unemployment Statistics. Our study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009, resulting in 6,426 hospital-year observations. The dependent variable “privatization” was defined as conversion from public status to either private not-for-profit or private for-profit status. The main independent variable, “financial distress,” was based on the Altman Z-score methodology. Control variables included market and organizational factors. Two random-effects logistic regression models with state and year fixed-effects were constructed. The independent and control variables were lagged by 1 year and 2 years for Models 1 and 2, respectively. Findings: Public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress: (OR = 4.53, p < .001) for Model 1 and (OR = 3.05, p = .001) for Model 2. Practice Implications: Privatization eases access to resources and may provide financial relief to government entities from the burden of continuously funding a hospital operating at a loss, which in turn may help keep the hospital open and preserve access to care for the community. Privatizing a financially distressed public hospital may be a better strategic alternative than closure. The Altman Z-score could be used as a managerial tool to monitor hospitals’ financial condition and take corrective actions.

Acupuncture Use in the United States: Who, Where, Why, and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.

The Determinants of Medical Tourism Intentions: Applying the Theory of Planned Behavior

This study introduces the theory of planned behavior to health care marketers by extending and replicating a prior study that predicted students intention to engage in medical tourism. Based on a sample of 164 usable survey responses, our findings suggested that the MEDTOUR scale (developed and introduced a prior study) is robust and works reasonably well with a national sample. Based on these findings, MEDTOUR appears to be worthy of further consideration by health marketing scholars.

Why Choose a Credit Union? Determinants of Credit Union Deposits

This study examines the impact of credit union risk characteristics and macroeconomic events on deposits. Looking at a sample of credit unions from 2004-2008 we find that credit union depositors do not consistently punish credit union by deposit withdrawal for risky behavior. Furthermore, we find that credit union deposits increase in times of economic uncertainty. This indicates that there is a group of people that consider credit unions a safe haven during an economic crisis, which sheds a whole new light on the importance of these financial institutions.

Abstract B33: Motivating African American women with hereditary breast cancer risk to participate in genetic counseling

Background: The emerging precision health paradigm for breast cancer control will base screening and prevention on individual level of risk. An important element of this approach is cancer genetic risk assessment and genetic counseling for women with familial breast cancer risk. Despite a referral from their primary care physician (PCP), prior work from our group demonstrated poor uptake of genetic counseling among African American (AA) women with a family history of breast/ovarian cancer who meet national guidelines for genetic counseling. This is consistent with other reports of poor utilization of BRCA testing among AA women. We found a strong desire among both PCPs and AA women for culturally sensitive educational material tailored to AA women at risk for hereditary breast cancer to help them understand the purpose of genetic counseling. In response to that finding, we are developing an educational animation delivered on a mobile device platform that is designed to motivate AA women to attend genetic counseling. Content for the animation will be informed by constructs from a theoretical model of health behavior and by themes identified in semistructured interviews with women who were recommended for genetic counseling by their PCP in our formative work. Methods: We conducted key informant interviews with healthy AA women without a personal history of cancer who all met criteria established by the National Comprehensive Cancer Network for genetic counseling based on a family history of breast/ovarian cancer. Potential participants were identified from a cohort of women who participated in an earlier study of cancer genetic risk assessment performed as part of routine care in a Federally Qualified Health Center in Chicago, IL. All potential participants were referred for genetic counseling by their PCP and provided consent for re-contact for future research. Recruitment letters were mailed to all eligible women, followed 2 weeks later by phone contact. The study group includes both women who did and who did not attend the counseling session. The semistructured interview guide was based on constructs from the Integrative Model of Behavioral Prediction (IMBP). Standard qualitative data analysis techniques were used, including an iterative process to develop a codebook and use of 2 coders to analyze each interview transcript. An inductive methodology using a modified version of constant comparative analysis was the key methodologic strategy for analyzing the qualitative interviews data. Results: A total of 60 AA women who were age 25-69 at the time of the prior study were eligible to participate in the interviews. Eleven of these women (18%) attended a genetic counseling session. The mean age of eligible participants was 45 years; 25% reported either a high school diploma or a GED as their highest level of attained education, and 73% completed some education beyond high school; 55% reported receiving their health insurance from Medicaid; and the majority (70%) reported annual household income of less than

Individuals With Disabilities Who Have Diabetes: Do We Have Targeted Interventions?

30,000. Of 60 eligible women, 16 (27%) were not available for a recruitment phone call (13 had an invalid address or phone number, 2 declined a recruitment phone call, and 1 moved out of the area). Twenty interviews will be completed by the end of June, 2017, and themes from IMBP constructs that emerge as key motivators of attendance at a genetic counseling session will be reported. Conclusion: The findings from this study will provide data to inform interventions that will be necessary to ensure that underserved AA women with familial breast cancer risk receive genetic counseling. In the absence of effective interventions to increase utilization of cancer genetic services, the emergence of precision health care is likely to exacerbate cancer disparities in underserved AA communities. Citation Format: DeLawnia Comer-HaGans, Zo Ramamonjiarivelo, Shirley Spencer, Beverly Chukwudozie, Vida Henderson, Karriem Watson, Catherine Balthazar, Rupert Evans, Robert Winn, Angela Odoms-Young, Kent Hoskins. Motivating African American women with hereditary breast cancer risk to participate in genetic counseling [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B33.

The Impact of Privatization on Efficiency and Productivity: The Case of American Public Hospitals

According to 2010 data from the Centers for Disease Control and Prevention (CDC), diabetes is the seventh leading cause of death in the United States. It is assumed that various diabetes interventions are available to help individuals manage this chronic disease, but that is not the case. The literature is scant regarding interventions focused on people with disabilities who have diabetes. The purpose of this article is to review interventions specifically focused on people with disabilities who have diabetes and to discuss the effect of these interventions on this population.