Moderating Effect of Races and Ethnicity between Confidence in Healthcare Knowledge and Health Behavior

Background and Purpose: The study aims to identify the effect of confidence of knowledge in health care as a predictor of health care behaviors and the moderation effect of racial and ethnic difference. The involvement in health-related activities of individuals were highlighted more than ever during COVID-19, especially for the vulnerable populations such as older adults. Existing literature explored predictors of health behaviors such as self-efficacy or personalities. Also, there were studies about the relationship between knowledge of health or confidence in knowing how to take care of health with health attitudes or health education. We used the health belief model in order to frame the relationship between knowledge regarding health care and people’s action of caring for health. In the health belief model, perceived self-efficacy regarding health could affect health behaviors. The knowledge of health care could be considered as perceived self-efficacy in health because it explains how confident one is to find appropriate health care resources when needed.

Methods: The study used data from American Health Values Survey Wave 1 (2015-2016). Adjusting for demographic variables, we ran multiple regression analysis to examine the relationship between confidence in healthcare knowledge and health behavior, using a moderating effect of race/ethnicity.

Results: The sample consists of aged 65 and above (n=1,427). The average age of the sampled participants was 73 years (SD=6.7) and 51% were female. Race and ethnicity included White (82.2%), Black (7.8%), Hispanic (3.7%), Asian (1.4%) and other races (4.9%: Pacific Islander/American Indian/Alaskan Native, and others). Compared to non-Hispanic Whites, Blacks were less likely to implement health behavior. In addition, age, income and education were not associated with health behavior and females were more likely to carry out a health behavior. Confidence in healthcare knowledge was measured by a four-item scale (M=3.59; SD=0.42; range: 1-4); confidence about knowing time and place for medical care, and how to manage and prevent health problems. We used health behavior as the outcome variable measured by a seven-item scale (M=3.76; SD=0.66; range: 1-5); Exercising, limiting food sizes, praying, actively relieving stress, getting appropriate screenings, maintaining a healthy weight, and consulting with the doctor. Higher scores indicate a better health behavior. The all scales mentioned above consisted of each scale’s items with the total score being the average of each item.

Findings revealed self-efficacy was associated with better health behavior (b=0.4, SE=0.05, p<.05), and race/ethnicity was a significant moderator in the association between self-efficacy and health behavior for Black older adults (b=0.39, SE=0.15, p<.05) compared to non-Hispanic White older adults.

Conclusions and Implications: The result of this study argues that confidence in health care knowledge can lead to actual involvement in health care activities so education and training should align with the findings in order to raise awareness of health-related education and training among older adults. The accessibility to such services or programs should be guaranteed as well especially for black older adults who showed most increase in involvement in health activities depending on confidence in health care knowledge.