"Growing up, I saw many problems related to economic stress and poverty in my own community. I wanted to be able to help families deal with these issues," says Carolyn Tucker, a professor of psychology whose current research is aimed at identifying what low-income minority patients want from their health care providers.

Tucker's "Patient-Defined" Culturally Sensitive Health Care Project is the first of its kind in the country. Previous studies have examined how health care professionals define culturally sensitive health care, but Tucker's research is the first to directly ask patients how they feel about their health care. "The patients are the true experts on what they want from their physicians," she says. "So it makes sense to ask them what they expect out of a visit to the doctor."

The project began in 1998 when Tucker and graduate student Tyler Pederson wanted to establish a link between how comfortable patients felt with their doctors and how closely they followed the doctors' orders. Tucker explains, "We were interested in what role certain factors might play in the issue of medication adherence." They discovered that for African-Americans comfort with and trust in the physician were both strong predictors of medication adherence. For Caucasians, however, comfort was predictive of adherence but trust was not. "We also found that the belief that God helps you take your medicines was a predictor of medication adherence for African-American patients, but the same was not true for Caucasians," says Tucker. "These findings lead me to believe that maybe there really are some different factors that influence adherence and health outcomes in general for African-Americans versus Caucasians, and likely versus Hispanic-Americans."

In an extensive literature search, Tucker also found that many medical schools in the country are demanding cultural competence from their physicians. Only nine percent of medical schools in the US offer at least some cultural competence training, and it is often minimal or not required. There has also been a recent decrease in the number of ethnic minority students gaining entrance to medical schools, coupled with the fact that only four percent of physicians in the US are African-American. "All of these factors suggest that we need to train the present and future health care providers to be sensitive to the views, values and beliefs of minorities," she says.

Previous research had likewise shown that ethnicity influences the type of treatment patients receive. "One recent study, published in the New England Journal of Medicine, demonstrated that African-American patients were less likely to get more advanced treatments, such as cardiac catherization, than their Caucasian counterparts. This study confirmed my belief that we need to pay more attention to the health care being provided to ethnic minorities."

Tucker studied the responses of 20 African-American, Hispanic, and Caucasian focus groups comprised of mostly low income patients from 15 primary care health clinics in North Florida. Their responses revealed that regardless of ethnicity, patients felt they needed more time with their doctors to discuss problems and have their questions answered.

There were, however, some important ethnic group differences. Caucasians wanted to be on equal status with their doctors, whereas African-Americans felt it was important for the physician to show respect for their religious beliefs, provide them with health care education, and avoid stereotyping them. Some African-Americans were also afraid they would be given experimental drugs or used as guinea pigs and thought that doctors were uncomfortable touching them.

Hispanics who participated in the focus group expressed their desire for friendly doctors who know their names and ask questions about the families. It was also important for Hispanics that the doctor or someone on the staff could speak Spanish. They also felt they had to wait longer than Caucasians to see a doctor. Both African-Americans and Hispanics mentioned the lack of minorities among the clinic staff and the need for more culturally diverse music and magazines in the waiting area.

Tucker is using these findings to develop a Culturally Sensitive Health Care Inventory for each ethnic group. A version of each inventory will be constructed for physicians to self-evaluate their level of cultural sensitivity in health care delivery. Based on the focus group data, Tucker will develop a course and workshop for physicians and other health care providers. She will then assess the impact of the workshop to determine how the physicians relate to minority patients. She expects the project to be completed within two years.

Tucker has not undertaken this project alone. She has enlisted a group of graduate and undergraduate students to be her research associates. "We are a team, and this project could not happen without them. I have worked really hard to put together a culturally diverse group. We have nearly equal representation of African-Americans, Hispanics, and Caucasians, which is crucial since we're working on a project directly related to ethnicity and culture."

Tucker's research associates have great admiration and respect for her. Graduate student Rhonda Hackshaw, who is currently working with Tucker on the health care project, says Tucker's first goal is to cultivate the person, then the professional. "When a woman as accomplished as she is interacts with you as a peer, it raises the standard for all that you do."

Since Tucker's research is the first of its kind in the country, it has received a lot of attention from many different groups. After a press release was distributed providing a summary of the project, she was inundated with requests from doctors, health care workers, psychologists, and patients for more information.

Psychology department chair Martin Heesacker says Tucker's research has brought visibility to UF because it serves to help minority groups regain personal power. "Not only is her research devoted to empowerment, her research process is also devoted to empowerment--of colleague researchers, of student investigators, and of the systems and structures she investigates," he says. "This process of re-empowering people has triggered private, state, and federal funding and has led to real improvements in the lives of people."

Tucker has received a federal grant from the Agency for Healthcare Research and Quality and a state grant from Florida's Area Health Education Center Program. She was also recently invited to discuss her health care research at the Congressional Black Caucus' Health Braintrust Meeting in Washington, DC. In addition, she was asked to enter a summary of her research into the congressional record for the Minority Health bill.

Tucker hopes that one of the outcomes of her research will be the establishment of a Culturally Sensitive Health Care Institute at UF that will promote more patient-involved research and training.

However, Tucker says her ultimate goal is to improve the health quality of people's lives. "This project is the most important thing I've ever done professionally because we're talking about people's lives," she says. "I look at my own family and see common health problems, so it's an issue that hits home for me. If our research results help empower patients and improve the health-related quality of life for anyone, then we've accomplished what we set out to do."

--Allyson A. Beutke

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