Perceived racial/ethnic discrimination in health care settings

BACKGROUND: Perceived social discrimination (interpersonal and institutionalized) is one of many factors believed to contribute to poor health among U.S. racial/ethnic minorities. While many investigators have attempted to understand the relationships between perceived discrimination and a variety of health outcomes and inequities, limitations in existing discrimination scales pose a significant challenge to elucidating the instances and types of discrimination perceived by patients in health care settings. METHODS: Semi-structured thematic interviews were conducted as part of a larger research endeavor to develop a questionnaire that would allow for detailed measurement of perceived discrimination in primary health care settings across major U.S. racial/ethnic groups. A racially and ethnically diverse sample of adults was recruited from two community-based facilities in Los Angeles County: a federally qualified health center and a HIV/STI research and prevention service provider. Participants were asked about how they experience, perceive, and define unfair or discriminatory treatment in health care settings. Results presented here focus on patient-perceived unfair or biased interactions with providers and staff, and poor medical assessment and treatment (not specific to the facility within which participants were recruited) that were attributed to race/ethnicity. Content analysis was conducted to identify themes that emerged from participants' interviews. RESULTS: A total of 39 respondents (48.7% Latino, 33.3% African American, 12.8% Caucasian, and 5.1% Asian) participated in this qualitative study. Collectively, respondents perceived race discordance between providers and office staff as a reason for unfair treatment in medical settings. African American and Latino respondents reported differential treatment in the form of denial of medical services (e.g., “Refusing to provide care to a person because of [his or her] race.”), having to wait long periods of time (e.g., “[You have] to wait all day because of your color.”), and rude or disrespectful behavior by staff (e.g., “At [this one clinic] they frown at me because I'm the only black person.”) as discriminatory. Unique to Latino respondents were the perceptions of unfair or discriminatory treatment based on discordant language, immigration status, and being overweight. Other themes related to unfair treatment such as not having private insurance and being of lower socioeconomic status were also identified by participants across racial/ethnic groups. CONCLUSION: Perceived discrimination is linked to avoidance of health care, non-adherence to treatment, and a number of adverse health-related sequelae. Thus, constructing strategies to illuminate, quantify and eradicate discrimination in health care settings is an important public health initiative.