Racial and ethnic differences in patient perceptions of bias and cultural competence in health care
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OBJECTIVES: To determine: 1) whether racial and ethnic differences exist in patients’ perceptions of primary care provider (PCP) and general health care system-related bias and cultural competence; and 2) whether these differences are explained by patient demographics, source of care, or patient-provider communication variables.
DESIGN: Cross-sectional telephone survey.
SETTING: The Commonwealth Fund 2001 Health Care Quality Survey.
SUBJECTS: A total of 6,299 white, African-American, Hispanic, and Asian adults.
MEASUREMENTS AND MAIN RESULTS: Interviews were conducted using random-digit dialing; oversampling respondents from communities with high racial/ethnic minority concentrations; and yielding a 54.3% response rate. Main outcomes address respondents’ perceptions of their PCPs’ and health care system-related bias and cultural competence; adjusted probabilities (Pr) are reported for each ethnic group. Most racial/ethnic differences in perceptions of PCP bias and cultural competence were explained by demographics, source of care, and patient-physician communication variables. In contrast, racial/ethnic differences in patient perceptions of health care system-wide bias and cultural competence persisted even after controlling for confounders: African Americans, Hispanics, and Asians remained more likely than whites (P<.001) to perceive that: 1) they would have received better medical care if they belonged to a different race/ethnic group (Pr 0.13, Pr 0.08, Pr 0.08, and Pr 0.01, respectively); and 2) medical staff judged them unfairly or treated them with disrespect based on race/ethnicity (Pr 0.06, Pr 0.04, Pr 0.06, and Pr 0.01, respectively) and how well they speak English (Pr 0.09, Pr 0.06, Pr 0.06, and Pr 0.03, respectively).
CONCLUSION: While demographics, source of care, and patient-physician communication explain most racial and ethnic differences in patient perceptions of PCP cultural competence, differences in perceptions of health care system-wide bias and cultural competence are not fully explained by such factors. Future research should include closer examination of the sources of cultural bias in the US medical system.
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- Racial and ethnic differences in patient perceptions of bias and cultural competence in health care
Journal of General Internal Medicine
Volume 19, Issue 2 , pp 101-110
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cultural competence
- racial and ethnic minorities
- Industry Sectors
- Author Affiliations
- 1. Received from Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Md
- 2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
- 3. Section of General Internal Medicine, Portland VA Medical Center, and Department of Medicine, Oregon Health & Science University, Portland, Ore
- 4. Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md