217908 Validating measures of perceived discrimination in medical care for American Indian women

Tuesday, November 9, 2010 : 1:15 PM - 1:30 PM

Kelly Gonzales, PhD , Department of Public Health, Oregon State University, Corvallis, OR
Anna Harding, PhD , School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR
William E. Lambert, PhD , Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR
Background: The majority of research on medical discrimination may not be generalizable to diverse racial and ethnic groups, such as American Indian and Alaska Natives (AI/AN). There are currently no validated instruments to accurately measure medical discrimination in AI/AN populations. Objectives: Our objectives were to validate measures of medical discrimination and report prevalence of medical discrimination in American Indians (AI). Methods: Data were collected using a survey specifically designed for this study among 270 eligible AI women whose primary medical care is from Northwest reservation-based Indian health care facilities. Results: Three medical discrimination scales tested in our study had high internal reliability (alpha=0.85, 0.90, and 0.94). Approximately 37.8-62.8% of perceived (self-report) medical discrimination (PMD) were missed when assessed by single-item questions when compared to a multi-item scale. Prior studies using single-item measures of PMD may under-report PMD in AIs by as much at 63%. Our reported prevalence of general and race-based PMD was 4 to 6.5 times greater than that reported in previously published studies. Conclusions: Our study found that a large proportion of AI women report PMD, and that our measured prevalence greatly exceeds that of earlier published studies. The use of multi-item measures of PMD was found to be reliable and valid. Our findings suggest that single-item measures of PMD may grossly underestimate PMD. Additionally, inclusion of a broad-qualitative question provided important new ideas for future measures of PMD. More research is needed to investigate associations of PMD on AI health care decisions.

Learning Areas:
Chronic disease management and prevention
Diversity and culture
Public health or related research

Learning Objectives:
1. Discuss the contribution of perceived discrimination on racial/ethnic disparities in health status and medical utilization, and implications for persistent health disparities for Indigenous peoples of North America and the Hawaiian Islands. 2. Demonstrate psychometric properties of perceived medical discrimination measures for American Indians and the need for more valid measures for this population.

Keywords: American Indians, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee health research projects conducted among American Indian populations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.