Mobilizing Class Resources and Presenting the Self: Understanding the Differential Health Care Experience of Black Middle Class Women

Background: Evidence of racial/ethnic disparities is remarkably consistent across a range of illnesses and health care services. Differences persist after controlling for socioeconomic status. This study explores how middle-class black women perceive health care providers and whether they use positive self-presentation strategies to increase the likelihood they receive “appropriate treatment” or avoid differential treatment based on race and gender. Method: The study uses in-depth interviews and vignettes to explore the experiences of black middle-class women between the ages of 35 and 55 in a large urban area. Results: Respondents reported instances in which they felt they were evaluated based on negative stereotypes of black women. They used positive self-presentation strategies, e.g., knowledge of health issues, education, personal connections, with physicians. They described using these strategies as exhausting. Younger women reported fewer negative experiences. Overall, women reported more negative experiences with OB/GYN's compared to primary providers. Conclusion: The study provides important information about the health care experiences of an understudied group. Although African-American middle-class women have resources, they are not immune to bias. They have their own strategies for mitigating bias by emphasizing their social class resources. However, the process of self-presentation may negatively affect the patient-provider relationship. Black women's experiences suggest patient strategies like self- presentation management may affect the patient-provider encounter. These strategies must be considered when developing interventions to reduce differences in treatment. Finally, because black middle-class women have many social identities, interventions based solely on increasing race-concordance are unlikely to completely reduce health disparities.