Role of ancillary staff in perceived discrimination in medical care

Objectives: Research and interventions have been directed at physicians in order to attempt to address perceived racial/ethnic discrimination in medical care and potentially provide more equitable care across the US population.  However, little is known about the contributions of other ancillary medical staff (e.g., nurses, medical assistants, and receptionists) to perceived discrimination in medical care.

Methods: We conducted focus group interviews with African-American (AA) and European-American (EA) participants stratified by race and gender who interacted with the Alabama health care system in the previous 12 months.  We utilized a focus group topic guide, based on Social Cognitive Theory, in order to probe for personal, behavioral, and environmental factors that contribute to perceived discrimination in health care.  Group interviews were audio recorded.  Two investigators independently analyzed the transcribed focus group interviews for relevant themes.

Results: 29 AA women (mean age and standard deviation, 47±10 years), 24 AA men (53±11 years), 18 EA women (54±15 years), and 19 EA men (39±13 years) participated in 12 focus groups. We identified several main themes related to perceptions of staff bias including communication and personal attitudes/behaviors.  Communication included both verbal and non-verbal forms of communication.  For example, “It’s the way they talk to you…they can talk to you like you’re below average, you know,  just the tone of the voice.” Personal attitudes/behavior themes were identified with words such as “personable”, “respectful”, and “takes their time.” Some focus group response examples included, “I mean, [they] look at you, like, up and down, like you ain’t nothing,” and “they’re kind to somebody right before you, and they’re not to you. They’re short-spoken to you.”

Conclusions: The behaviors of ancillary staff in the health care setting can potentially contribute to patients’ perceptions of discrimination.  Future efforts to reduce health care discrimination interventions should include a focus on staff’s cultural competence and customer service skills.