Ethnic differences in the perception of prayer and consideration of joint arthroplasty

CONTEXT. Ethnic differences in utilization of arthroplasty may reflect differences in health-related attitudes and beliefs. OBJECTIVE. To examine ethnic differences in the perception and use of prayer in the treatment of arthritis and its role in patients' decision making toward surgery. DESIGN. A cross-sectional survey. SETTING. VA Primary Care Clinics. PATIENTS. Patients older than 50 years with chronic moderate-to-severe knee pain, hip pain, or both. MEASURES. The "helpfulness of prayer" in the treatment of arthritis and patients' attitude toward joint arthroplasty. RESULTS. Five hundred ninety-six veterans; 44% black patients, 56% white patients. Groups were comparable with respect to age (65 ± 9.5 vs. 66 ± 9), disease severity as assessed by WOMAC (47 ± 17 vs. 45 ± 17). Black patients scored higher than white patients on the religiosity scale (77 ± 17 vs. 70 ± 21). In multivariate analysis, black patients were more likely than white patients to perceive prayer as helpful in the management of their arthritis (OR, 2.1; 95% CI, 1.19, 3.72). Black patients were also less likely than white patients to consider surgery for severe hip/knee pain (OR, 0.58; 95% CI 0.34, 0.99); this relationship between ethnicity and consideration of surgery is mediated by perceptions of "helpfulness of prayer." The odds ratio for this relationship changes to 0.70 (P = 0.215). CONCLUSION. In this sample, black patients were more likely than white patients to perceive prayer as helpful and to have actually used prayer for their arthritis. Perception of helpfulness of prayer may be an important explanatory variable in the relationship between ethnicity and patients' decision in considering arthroplasty.