Perceptions and personal residential segregation experiences: Developing a culturally appropriate racial composition measure among medically underserved patients

Introduction:  Residential segregation is considered one of the many causes of health disparities.  Communities of color in St. Louis, MO experience higher poverty rates, lower median incomes, and less access to quality health care services.  To better understand how this environment impacts health outcomes for vulnerable populations in our region, we developed and tested a graphic measure to examine self-reported racial composition across the life course. 

Methods:  We conducted 10 cognitive interviews with blacks to ensure comprehension and refine the measure.  The revised measure was then tested in 2 focus groups with black participants.  Interview and focus group participants were recruited from a primary care clinic that serves as a medical safety net.  Participants were asked to provide feedback and reactions to six environments described on the graphic measure (junior high, high school, neighborhood growing up, current neighborhood, workplace, and place of worship).

Results:  Interview responses suggested that participants were initially confused, but were able to comprehend and answer the questions for all of the environments. The refined measure improved comprehension among focus group participants. Some placed emphasis on gender and racial diversity of pictures and provided meaningful input to further refine the measure.    Participants also used personal stories of segregation experiences to relate to the racial composition measure. 

Conclusions:  Individual racial segregation experiences are a sensitive topic, and a challenging construct to measure.  This racial composition measure may prove beneficial to researchers with an interest in how exposure to segregated environments impacts health behaviors and health outcomes.