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The Patient Experience: Stereotype Threat in Medical Care

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Promoting Health Equity Among Racially and Ethnically Diverse Adolescents

Abstract

Stereotype threat has significant potential to contribute to disparities in health and health care experience. Health care provider behavior can sometimes be perceived as endorsing group stereotypes. When a patient senses that they are being seen in terms of a group stereotype, stereotype threat may occur. Stereotype threat triggers a stress response that requires emotional regulation. The experience of stereotype threat causes increased vigilance for further evidence of discrimination or stereotyping. Both the physiologic and psychological effects of the stress response and vigilance can reduce a patient’s cognitive capacity, making it difficult to communicate effectively or to store new information. A patient may also withdraw from the encounter and further clinical guidance. Combined, this response is thought to contribute to poor post-encounter adherence, less trust, and delay of follow-up care. Health care providers can help patients protect themselves from stereotype threat by encouraging them to affirm values or recall accomplishments. Providers can also take steps to reduce the likelihood that implicit attitudes or stereotypes affect their behavior and prioritize creating a clinical environment that feels inclusive to all patients.

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References

  1. Academies IoMoTN. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2002.

    Google Scholar 

  2. Stevens GD, Shi L. Racial and ethnic disparities in the primary care experiences of children: a review of the literature. Med Care Res Rev. 2003;60(1):3–30.

    Article  Google Scholar 

  3. Flores G, Olson L, Tomany-Korman SC. Racial and ethnic disparities in early childhood health and health care. Pediatrics. 2005;115(2):e183–93.

    Article  Google Scholar 

  4. Saydah S, Lochner K. Socioeconomic status and risk of diabetes-related mortality in the U.S. Public Health Rep. 2010;125(3):377–88.

    Article  Google Scholar 

  5. Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Med Care. 2008;46(9):905–14.

    Article  Google Scholar 

  6. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Ann Intern Med. 2003;139(11):907–15.

    Article  Google Scholar 

  7. Stevens GD, Shi L, Cooper LA. Patient-provider racial and ethnic concordance and parent reports of the primary care experiences of children. Ann Fam Med. 2003;1(2):105–12.

    Article  Google Scholar 

  8. Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94(12):2084–90.

    Article  Google Scholar 

  9. Ngui EM, Flores G. Satisfaction with care and ease of using health care services among parents of children with special health care needs: the roles of race/ethnicity, insurance, language, and adequacy of family-centered care. Pediatrics. 2006;117(4):1184–96.

    Article  Google Scholar 

  10. Nagarajan N, Rahman S, Boss EF. Are there racial disparities in family-reported experiences of care in inpatient pediatrics? Clin Pediatr (Phila). 2017;56(7):619–26.

    Article  Google Scholar 

  11. Calvo R, Hawkins SS. Disparities in quality of healthcare of children from immigrant families in the US. Matern Child Health J. 2015;19(10):2223–32.

    Article  Google Scholar 

  12. Cooper LA, Roter DL. Patient-provider communication: the effect of race and ethnicity on process and outcomes of healthcare. In: Smedley BD, Stith AY, Nelson AR, editors. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academies Press; 2003. p. 552–93.

    Google Scholar 

  13. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–34.

    Article  Google Scholar 

  14. Griffin SJ, Kinmonth AL, Veltman MW, Gillard S, Grant J, Stewart M. Effect on health-related outcomes of interventions to alter the interaction between patients and practitioners: a systematic review of trials. Ann Fam Med. 2004;2(6):595–608.

    Article  Google Scholar 

  15. Stewart M, Brown JB, Donner A, et al. The impact of patient-centered care on outcomes. J Fam Pract. 2000;49(9):796–804.

    CAS  PubMed  Google Scholar 

  16. Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–39.

    Article  Google Scholar 

  17. Steele CM, Aronson J. Stereotype threat and the intellectual test performance of African Americans. J Pers Soc Psychol. 1995;69(5):797–811.

    Article  CAS  Google Scholar 

  18. Danaher K, Crandall CS. Stereotype threat in applied settings re-examined. J Appl Soc Psychol. 2008;38(6):1639–55.

    Article  Google Scholar 

  19. Kray LJ, Galinksy AD, Thompson L. Reversing the gender gap in negotiations: an exploration of stereotype regeneration. Organ Behav Hum Decis Process. 2002;87:386–409.

    Article  Google Scholar 

  20. Kray LJ, Thompson L, Galinsky A. Battle of the sexes: gender stereotype confirmation and reactance in negotiations. J Pers Soc Psychol. 2001;80(6):942–58.

    Article  CAS  Google Scholar 

  21. Hogg MA, Terry DJ. Social identity and self-categorization processes in organizational contexts. Acad Manag Rev. 2000;25(1):121–40.

    Article  Google Scholar 

  22. Tajfel H, Turner J. An integrative theory of intergroup conflict. In: Hogg MA, Abrams D, editors. Intergroup relations: essential readings. Philadelphia, PA, USA: Psychology Press; 2001.

    Google Scholar 

  23. Stets JE, Burke PJ. Identity theory and social identity theory. Soc Psychol Q. 2000;63(3):224–37.

    Article  Google Scholar 

  24. Murphy MC, Steele CM, Gross JJ. Signaling threat: how situational cues affect women in math, science, and engineering settings. Psychol Sci. 2007;18(10):879–85.

    Article  Google Scholar 

  25. Ben-Zeev T, Fein S, Inzlicht M. Arousal and stereotypre threat. J Exp Soc Psychol. 2005;41(2):174–81.

    Article  Google Scholar 

  26. Schmader T, Johns M. Converging evidence that stereotype threat reduces working memory capacity. J Pers Soc Psychol. 2003;85(3):440–52.

    Article  Google Scholar 

  27. Schmader T, Johns M, Forbes C. An integrated process model of stereotype threat effects on performance. Psychol Rev. 2008;115(2):336–56.

    Article  Google Scholar 

  28. Steele CM. A threat in the air. How stereotypes shape intellectual identity and performance. Am Psychol. 1997;52(6):613–29.

    Article  CAS  Google Scholar 

  29. Aronson J, Lustina MJ, Good C, Keough K, Steele CM, Brown J. When white men can’t do math: necessary and sufficient factors in stereotype threat. J Exp Soc Psychol. 1999;35(1):29–46.

    Article  Google Scholar 

  30. Burgess DJ, Warren J, Phelan S, Dovidio J, van Ryn M. Stereotype threat and health disparities: what medical educators and future physicians need to know. J Gen Intern Med. 2010;25(Suppl 2):S169–77.

    Article  Google Scholar 

  31. Aronson J, Burgess D, Phelan SM, Juarez L. Unhealthy interactions: the role of stereotype threat in health disparities. Am J Public Health. 2013;103(1):50–6.

    Article  Google Scholar 

  32. Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. J Gen Intern Med. 2007;22(3):389–95.

    Article  Google Scholar 

  33. Frable DE, Blackstone T, Scherbaum C. Marginal and mindful: deviants in social interactions. J Pers Soc Psychol. 1990;59(1):140–9.

    Article  CAS  Google Scholar 

  34. von Hippel W, von Hippel C, Conway L, Preacher KJ, Schooler JW, Radvansky GA. Coping with stereotype threat: denial as an impression management strategy. J Pers Soc Psychol. 2005;89(1):22.

    Article  Google Scholar 

  35. Schmader T, Major B, Gramzow RH. Coping with ethnic stereotypes in the academic domain: perceived injustice and psychological disengagement. J Soc Issues. 2001;57(1):93–111.

    Article  Google Scholar 

  36. Major B, Schmader T. Coping with stigma through psychological disengagement. Prejudice: the target’s perspective. San Diego: Academic Press; 1998. p. 219–41.

    Google Scholar 

  37. Boulware LE, Cooper LA, Ratner LE, LaVeist TA, Powe NR. Race and trust in the health care system. Public Health Rep. 2003;118(4):358–65.

    Article  Google Scholar 

  38. Burgess DJ, Ding Y, Hargreaves M, van Ryn M, Phelan S. The association between perceived discrimination and underutilization of needed medical and mental health care in a multi-ethnic community sample. J Health Care Poor Underserved. 2008;19(3):894–911.

    Article  Google Scholar 

  39. Good C, Aronson J, Inzlicht M. Improving adolescents’ standardized test performance: an intervention to reduce the effects of stereotype threat. J Appl Dev Psychol. 2003;24(6):645.

    Article  Google Scholar 

  40. Shelvin KH, Rivadeneyra R, Zimmerman C. Stereotype threat in African American children: the role of black identity and stereotype awareness. RevInt Psychol Soc. 2014;27(3–4):175–204.

    Google Scholar 

  41. Shenouda CK, Danovitch JH. Effects of gender stereotypes and stereotype threat on children’s performance on a spatial task. RevInt Psychol Soc. 2014;27(3–4):53–77.

    Google Scholar 

  42. Regner I, Steele JR, Huguet P. Stereotype threat in children: past and present. RevInt Psychol Soc. 2014;27(3–4):5–12.

    Google Scholar 

  43. Wasserberg MJ. Stereotype threat effects on African American children in an urban elementary school. J Exp Educ. 2014;82(4):502–17.

    Article  Google Scholar 

  44. Aquino AT, AAI UMION, OpenUrl, et al. The impact of stereotype threat on the cognitive testing performance of children diagnosed with learning disabilities. Dissertation Abstracts International: Section B: The Sciences and Engineering; 2012.

    Google Scholar 

  45. Wasserberg MJ, AAI UMION, OpenUrl, et al. Stereotype threat and the standardized testing experiences of African American children at an urban elementary school. Dissertation Abstracts International Section A: Humanities and Social Sciences; 2010.

    Google Scholar 

  46. Desert M, Preaux M, Jund R. So young and already victims of stereotype threat: socio-economic status and performance of 6 to 9 years old children on Raven’s progressive matrices. Eur J Psychol Educ. 2009;24(2):207.

    Article  Google Scholar 

  47. Muzzatti B, Agnoli F. Gender and mathematics: attitudes and stereotype threat susceptibility in Italian children. Dev Psychol. 2007;43(3):747.

    Article  Google Scholar 

  48. Howard KE, AAI UMION. Stereotype threat and anxiety: examining their connection to working memory capacity in middle school children. Dissertation Abstracts International Section A: Humanities and Social Sciences; 2006.

    Google Scholar 

  49. Miyake A, Kost-Smith LE, Finkelstein ND, Pollock SJ, Cohen GL, Ito TA. Reducing the gender achievement gap in college science: a classroom study of values affirmation. Science. 2010;330(6008):1234–7.

    Article  CAS  Google Scholar 

  50. Cohen GL, Garcia J, Apfel N, Master A. Reducing the racial achievement gap: a social-psychological intervention. Science. 2006;313(5791):1307–10.

    Article  CAS  Google Scholar 

  51. Martens A, Johns M, Greenberg J, Schimel J. Combating stereotype threat: the effect of self-affirmation on women's intellectual performance. J Exp Soc Psychol. 2006;42(2):236–43.

    Article  Google Scholar 

  52. Cohen GL, Steele CM. A barrier of mistrust: how negative stereotypes affect cross-race mentoring. In: Improving academic achievement: impact of psychological factors on education. San Diego: Academic Press; 2002. p. 303–27.

    Chapter  Google Scholar 

  53. Yeager D, Walton G, Cohen GL. Addressing achievement gaps with psychological interventions. Phi Delta Kappan. 2013;94(5):62–5.

    Article  Google Scholar 

  54. Yeager DS, Walton GM, Brady ST, et al. Teaching a lay theory before college narrows achievement gaps at scale. Proc Natl Acad Sci U S A. 2016;113(24):E3341–8.

    Article  CAS  Google Scholar 

  55. Wanzer MB, Booth-Butterfield M, Gruber K. Perceptions of health care providers' communication: relationships between patient-centered communication and satisfaction. Health Commun. 2004;16(3):363–83.

    Article  Google Scholar 

  56. Bodenhausen GV, Lichtenstein M. Social stereotypes and information-processing strategies: the impact of task complexity. J Pers Soc Psychol. 1987;52(5):871.

    Article  CAS  Google Scholar 

  57. Gordon RA, Anderson KS. Perceptions of race-stereotypic and race-nonstereotypic crimes: the impact of response-time instructions on attributions and judgments. Basic Appl Soc Psychol. 1995;16(4):455–70.

    Article  Google Scholar 

  58. Brown KW, Ryan RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822–48.

    Article  Google Scholar 

  59. Kemeny ME, Foltz C, Cavanagh JF, et al. Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses. Emotion. 2012;12(2):338–50.

    Article  Google Scholar 

  60. Walton GM, Cohen GL. A question of belonging: race, social fit, and achievement. J Pers Soc Psychol. 2007;92(1):82.

    Article  Google Scholar 

  61. Purdie-Vaughns V, Steele CM, Davies PG, Ditlmann R, Crosby JR. Social identity contingencies: how diversity cues signal threat or safety for African Americans in mainstream institutions. J Pers Soc Psychol. 2008;94(4):615–30.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA

    Sean M. Phelan

  2. Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA

    Sarah Atunah-Jay

  3. School of Nursing, Oregon Health and Science University, Portland, OR, USA

    Michelle van Ryn

Authors
  1. Sean M. Phelan
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  2. Sarah Atunah-Jay
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  3. Michelle van Ryn
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Corresponding author

Correspondence to Sean M. Phelan .

Editor information

Editors and Affiliations

  1. Program Director, Family Medicine Residency, Vice-Chair, Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

    Lisa Barkley

  2. Medical Director, Faculty, Department of Family and Community Medicine, Hennepin Healthcare, Minneapolis, MN, USA

    Maria Veronica Svetaz

  3. Chief, Section of Adolescent Medicine, Department of General Pediatrics and Adolescent Medicine, Phoenix Children’s Hospital, Phoenix, AZ, USA

    Veenod L. Chulani

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Phelan, S.M., Atunah-Jay, S., van Ryn, M. (2019). The Patient Experience: Stereotype Threat in Medical Care. In: Barkley, L., Svetaz, M., Chulani, V. (eds) Promoting Health Equity Among Racially and Ethnically Diverse Adolescents. Springer, Cham. https://doi.org/10.1007/978-3-319-97205-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-97205-3_11

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-97205-3

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