Date of Award
Spring 2012
Degree Type
Dissertation
Degree Name
Doctor of Nursing Science (DNS)
Department
Nursing
First Advisor
Dr. Tommie Nelms
Second Advisor
Dr. Carol Holtz
Third Advisor
Dr. Vanessa Robinson-Dooley
Abstract
Persistent disparities in African American child health may be the result of the intersection of many social determinants of health and other factors, such as health care relationships. A review of the literature revealed a gap in understanding of African Americans’ perceptions of care; and a gap in understanding of dimensions of relationship-centered care between African American patients and health care providers. The purpose of this qualitative study was to interview African American parents about their encounters with their children’s health care providers; in order to generate new understanding that could lead to interventions that can measurably improve health outcomes for African American children. The author employed an interview guide to interview 18 African American parents in a small south Georgia town about encounters with their children’s health care providers. The data were analyzed within frameworks of social phenomenology, critical ethnography, and intersectionality. Data fell within two main content areas: precursory parental relevances, and we-relationships. Precursory parental relevances included: symbolism of illness and wellness, typifications of health care providers, and various in-group/out-group memberships. Membership in the insurance out-group was particularly important in parents’ perceptions of health care encounters. Parents’ descriptions of we-relationships with children’s health care providers were categorized as routine, problematic, or transformative and were characterized by parents in terms of how patient-centric provider role expectations, relevances, group memberships, and knowledge affected the relationships. Practical recommendations include concrete relationship-centered interventions for health care providers. Recommendations for health professions education include a call for development of cultural competence curriculum with greater emphasis on understanding how health care language, mores, customs, values, codes and practices serve to alienate those persons it purports to serve; and inclusion of intersectionality as a framework for consideration of environmental macrofactors that contribute to health disparities.