Ethnic minority and lower SES populations report less positive healthcare encounters and worse health outcomes as compared to higher SES and mainstream populations. In Chile, the prevalence of type 2 diabetes (T2D) is one of the highest in South America and among the indigenous Mapuche population it has quadrupled over the last decade (Perez-Bravo et al., 2001). Research suggests that Mapuches have been historically discriminated in everyday life as well as in healthcare (Alarcon, et al., 2004). Based on Weiner’s attribution theory of motivation and emotion (1986, 1995, 2006) and guided by Betancourt’s integrative model of culture, psychological factors, and health behavior (Betancourt & Flynn, 2009) the aim of this study was to examine the causal attributions for healthcare mistreatment and their diabetes-related psychological and behavioral consequences. Participants included 394 Mapuche and mainstream Chilean patients with diabetes recruited from health clinics in Southern Chile. Multi-group structural equation modeling confirmed the expected relationships between perceived unfair health care treatment, attributions about the unfair treatment, and diabetes-related psychological and behavioral consequences. Findings are discussed in terms of interventions that can be designed to address unfair treatment and its impact on healthcare inequality among socially disadvantaged groups.
","abstract_html":"<p>Ethnic minority and lower SES populations report less positive healthcare encounters and worse health outcomes as compared to higher SES and mainstream populations. In Chile, the prevalence of type 2 diabetes (T2D) is one of the highest in South America and among the indigenous Mapuche population it has quadrupled over the last decade (Perez-Bravo et al., 2001). Research suggests that Mapuches have been historically discriminated in everyday life as well as in healthcare (Alarcon, et al., 2004). Based on Weiner’s attribution theory of motivation and emotion (1986, 1995, 2006) and guided by Betancourt’s integrative model of culture, psychological factors, and health behavior (Betancourt & Flynn, 2009) the aim of this study was to examine the causal attributions for healthcare mistreatment and their diabetes-related psychological and behavioral consequences. Participants included 394 Mapuche and mainstream Chilean patients with diabetes recruited from health clinics in Southern Chile. Multi-group structural equation modeling confirmed the expected relationships between perceived unfair health care treatment, attributions about the unfair treatment, and diabetes-related psychological and behavioral consequences. Findings are discussed in terms of interventions that can be designed to address unfair treatment and its impact on healthcare inequality among socially disadvantaged groups.</p>","abstract_has_math":false,"creators":["Serna, Nathalie"],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Thesis","degree_discipline":"Psychology","degree_department":null,"school":null,"contributors":["Betancourt, Hector M.","Flynn, Patricia M.","Herbozo, Sylvia M."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2018,"date_issued":"2018-03-01T08:00:00Z","date_published":"2018-03-01T08:00:00Z","updated_at":"2026-07-24T02:52:45Z","subjects":["Clinical Psychology","Medicine and Health Sciences","Psychology","Social and Behavioral Sciences","Health Policy; Health Services Accessibility; Diabetes Mellitis; Cross-Cultural Comparison; Chile","Health Disparity; South America; Mapuche Population"],"languages":["English"],"rights":["This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://scholarsrepository.llu.edu/etd/495","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Betancourt, Hector M.","Flynn, Patricia M.","Herbozo, Sylvia M."]},{"key":"dc:creator","label":"Author","values":["Serna, Nathalie"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"thesis:degree_discipline","label":"Discipline","values":["Psychology"]},{"key":"thesis:degree_level","label":"Degree Level","values":["Thesis"]},{"key":"thesis:degree_name","label":"Degree Name","values":["Doctor of Philosophy (PhD)"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["Clinical Psychology","Medicine and Health Sciences","Psychology","Social and Behavioral Sciences","Health Policy; Health Services Accessibility; Diabetes Mellitis; Cross-Cultural Comparison; Chile","Health Disparity; South America; Mapuche Population"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["English"]},{"key":"dc:rights","label":"Dc Rights","values":["This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://scholarsrepository.llu.edu/etd/495"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Ethnic minority and lower SES populations report less positive healthcare encounters and worse health outcomes as compared to higher SES and mainstream populations. In Chile, the prevalence of type 2 diabetes (T2D) is one of the highest in South America and among the indigenous Mapuche population it has quadrupled over the last decade (Perez-Bravo et al., 2001). Research suggests that Mapuches have been historically discriminated in everyday life as well as in healthcare (Alarcon, et al., 2004). Based on Weiner’s attribution theory of motivation and emotion (1986, 1995, 2006) and guided by Betancourt’s integrative model of culture, psychological factors, and health behavior (Betancourt & Flynn, 2009) the aim of this study was to examine the causal attributions for healthcare mistreatment and their diabetes-related psychological and behavioral consequences. Participants included 394 Mapuche and mainstream Chilean patients with diabetes recruited from health clinics in Southern Chile. Multi-group structural equation modeling confirmed the expected relationships between perceived unfair health care treatment, attributions about the unfair treatment, and diabetes-related psychological and behavioral consequences. Findings are discussed in terms of interventions that can be designed to address unfair treatment and its impact on healthcare inequality among socially disadvantaged groups.
"]},{"key":"dc:title","label":"Title","values":["Consequences of Attributions for Unfair Healthcare Treatment among Culturally Diverse Patients"]}]}],"canonical_facts":{"dc:contributor":["Betancourt, Hector M.","Flynn, Patricia M.","Herbozo, Sylvia M."],"dc:creator":["Serna, Nathalie"],"dc:description.abstract":["Ethnic minority and lower SES populations report less positive healthcare encounters and worse health outcomes as compared to higher SES and mainstream populations. In Chile, the prevalence of type 2 diabetes (T2D) is one of the highest in South America and among the indigenous Mapuche population it has quadrupled over the last decade (Perez-Bravo et al., 2001). Research suggests that Mapuches have been historically discriminated in everyday life as well as in healthcare (Alarcon, et al., 2004). Based on Weiner’s attribution theory of motivation and emotion (1986, 1995, 2006) and guided by Betancourt’s integrative model of culture, psychological factors, and health behavior (Betancourt & Flynn, 2009) the aim of this study was to examine the causal attributions for healthcare mistreatment and their diabetes-related psychological and behavioral consequences. Participants included 394 Mapuche and mainstream Chilean patients with diabetes recruited from health clinics in Southern Chile. Multi-group structural equation modeling confirmed the expected relationships between perceived unfair health care treatment, attributions about the unfair treatment, and diabetes-related psychological and behavioral consequences. Findings are discussed in terms of interventions that can be designed to address unfair treatment and its impact on healthcare inequality among socially disadvantaged groups.
"],"dc:identifier":["https://scholarsrepository.llu.edu/etd/495"],"dc:language":["English"],"dc:rights":["This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights."],"dc:subject":["Clinical Psychology","Medicine and Health Sciences","Psychology","Social and Behavioral Sciences","Health Policy; Health Services Accessibility; Diabetes Mellitis; Cross-Cultural Comparison; Chile","Health Disparity; South America; Mapuche Population"],"dc:title":["Consequences of Attributions for Unfair Healthcare Treatment among Culturally Diverse Patients"],"thesis:degree_discipline":["Psychology"],"thesis:degree_level":["Thesis"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T02:52:45Z"}