Previous studies have suggested that racial differences in cardiac procedure utilization may be due to differences in patient beliefs about interventions for heart disease and preferences for care. The present study contributed to the larger endeavor of assessing whether racial differences in health beliefs, attitudes, and experiences are in fact associated with racial variation in the use of invasive cardiac procedures (now well documented). In this analysis, the authors explain the development of an instrument to measure these concepts and described racial differences in health beliefs, attitudes, and experiences among Veterans Affairs (VA) patients who are potential candidates for invasive cardiac procedures.

The questionnaire was developed based on the Health Decision Model, which considers the following dimensions of health decisions: sociodemographics, social interaction, experience, knowledge, preferences, and health beliefs.

Cardiac ischemia patients were identified by screening all nuclear imaging studies conducted at five VA Medical Centers (Houston, Pittsburgh, Atlanta, Durham, and St, Louis). Only black and white patients were included. Patients were excluded if they had received cardiac catheterization, any revascularization, or heart transplant surgery in the preceding six months. Data from the first 20% of the cohort were analyzed for the present study, including 679 whites and 175 blacks.

Validity analyses of the final scale showed sufficient internal consistency for both blacks and whites (although these scores were not equal for blacks and whites). Eight scales were derived: disease severity, patient evaluation of physicians, evaluation of VA care, attitudes toward religion, satisfaction with decision-making, perceived urgency of catheterization, vulnerability to catheterization, and body impact of catheterization. Racial differences were found for only one scale – attitudes toward religion. Black patients placed stronger importance on God and religion in general, as well as in coping with their heart problems and in making decisions about treatment for their heart disease. For individual items that did not cluster within these 8 scales, there were two relevant racial differences. Black patients were more likely to indicate that (1) friends and family did not encourage them to have catheterization and (2) they, their friends, and family members had not had catheterization previously.

Additionally, the authors reported the results of using a 4-item scale related to medical skepticism (which had poor internal consistency). There were racial differences for two of the items. Black patients were less likely to agree that they can overcome illness without help from a medically trained professional, or that, when sick, their own behavior determines how soon they get well. Black patients were also more likely to indicate that they understand their health more than most doctors do.

The authors conclude that “these data provide little support for the theory that racial differences in patients’ beliefs and attitudes toward health care in general, and coronary disease in particular are strongly associated with discrepancies in procedure use.”