Defense Date


Document Type


Degree Name

Doctor of Philosophy


Counseling Psychology

First Advisor

Shawn O. Utsey

Second Advisor

Heather M. Traino

Third Advisor

Faye Z. Belgrave

Fourth Advisor

Gaurav Gupta

Fifth Advisor

Micah L. McCreary


African Americans (AA) are more susceptible to end-stage renal disease (ESRD) for several reasons. Treatment options for patients with ESRD include dialysis therapy and transplantation, with the latter typically producing better outcomes. AA are less likely to complete the medical evaluation process, which requires patients to consult with doctors and undergo a series of tests and examinations. This study sought to determine the factors that predict completion of the medical evaluation for AA ESRD patients using a mixed methods design. Participants consisted of transplant professionals (N=23) recruited from nine transplant centers in the Mid-Atlantic, Mid-Western and Southeastern parts of the United States, and kidney patients (N=30 patients) recruited from one transplant center in the Mid-Atlantic region. Semi-structured interviews and nominal focus groups were conducted to gather qualitative data; quantitative survey data were also collected. The results revealed factors classified as impacting patients at the individual-level and systemic level, and others classified as health-related and informational/educational. Participants ranked insurances issues, limited income, lack of a personal means of transportation, lack of patient motivation, the number of procedures required to complete the evaluation, scheduling difficulties and time constraints as top barriers to completing the medical evaluation process. Top motivators consisted of informational support, social support, religious beliefs, patients’ desire to get off dialysis, support from the transplant staff, center-based education, patient’s knowledge of the benefits of transplantation and patient navigators. These findings provide valuable information on factors that impact AA renal patients’ completion of the medical evaluation.


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