Linguistic cues via the telephone and Black parents' access to well child visits

Background: Black children continue to attend well child visits less often than White children. Despite efforts to promote equitable access to care, scant attention has been paid to the likely first interaction between parents and provider offices: the initial telephone inquiry. This study assesses the influence of name and accent based racial cues when parents call pediatric offices to schedule initial well child visits. 

Methods:  We conducted a national audit study based on a stratified sampling method (by region and level of segregation at the metropolitan areas). Three hundred twenty pediatric offices were subjected to the audit (i.e. experiment). Each office received two phone calls: one from a parent speaking standard English with a White name, and one from a parent EITHER speaking Black accented English OR with a Black name.  The auditors read similar scripts and posed the question “Are you accepting new patients?”

Results: Dichotomous measures of acceptance versus non-acceptance indicate an overall difference of 14% (p=.04).  Office staff were also more likely to pose their own questions before answering “Black” auditors’ question (a 33% difference (p<.001)).  Finally, in the West (difference=13%, p=.02) and Northeast (difference=8%, p=.04) staff members were more likely to warn “Black” auditors about prerequisites to scheduling an appointment. 

Conclusions: Black parents may receive more restrictive information about well child visits during their initial telephone contact with pediatric offices.  This constitutes actionable information about dynamics contributing to racial inequity in access to well-child visits, which is associated with health disparities across the life-course.