Online Program

Perceived racial/ethnic discrimination in health care settings

Tuesday, November 5, 2013

Laura Hoyt D'Anna, DrPH, Center for Health Equity Research, California State University, Long Beach, Long Beach, CA
Brittney Mull, MPH, Center for Health Care Innovation, California State University, Long Beach, Long Beach, CA
Carol Canjura, Center for Health Equity Research, California State University, Long Beach, Long Beach, CA
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.

Learning Areas:

Provision of health care to the public
Public health or related research

Learning Objectives:
Describe types of discriminatory experiences and treatment in health care settings as reported by a racially/ethnically, diverse community-based sample. Compare differences in reports of discrimination by racial/ethnic group. Discuss how qualitative data can be used to construct a quantitative tool to measure discrimination that will tested in primary health care settings.

Keyword(s): Social Justice, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I received training on community-based evaluation and qualitative data collection and analysis at the UCLA School of Public Health. Research interests include racial and ethnic health disparities and how experiences of discrimination affect health and health disparities. As assistant project director for the NIH-funded RIMI Project at California State University, Long Beach, I am involved in the development of a research infrastructure across the campus that will include an academic Center for Health Equity Research.
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.