"Demonstrate You Are Also a Person": Healthcare Disparities Among Black Middle Class Women

Background: Evidence of racial/ethnic disparities is remarkably consistent across a range of health conditions. 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 avoid differential treatment based on race and gender. Method: The study uses in-depth interviews, focus groups and vignettes to explore the experiences of 30 black middle-class women between 35 and 67. Results: Respondents overwhelmingly endorsed the importance of positive self-presentation to mitigate differential treatment. Of seven potential strategies, they strongly endorsed the importance of physical presentation (dress), making a personal connection with the provider, and emphasizing conducting research on their health condition. These strategies were important regardless of the race or gender of the provider although they were less important if they had an established relationship. Respondents noted that although the strategies were often burdensome, they considered them necessary manifestations of self-advocacy. Women also used these strategies to counteract prevailing stereotypes of black women and to be recognized as individuals.

Conclusion: The study provides important information about an understudied group. Although black middle-class women have resources, they are not immune to stereotyping. They have their own strategies for mitigating bias by emphasizing certain resources, i.e., specific knowledge of health care issues, demonstrating intelligence, etc. The study suggests potential avenues for provider education that specifically address stereotyping and bias toward members of minority groups who are not poor. This represents a new avenue for addressing racial disparities in healthcare.