Advertisement

Journal of General Internal Medicine

, Volume 24, Issue 7, pp 789–794 | Cite as

Association Between Prior Experiences of Discrimination and Patients’ Attitudes Towards Health Care Providers Collecting Information About Race and Ethnicity

  • Namratha R. KandulaEmail author
  • Romana Hasnain-Wynia
  • Jason A. Thompson
  • E. Richard Brown
  • David W. Baker
Original Article

Abstract

BACKGROUND

Previously, we reported a high level of comfort among Californians for collecting race/ethnicity information by health care providers (HCPs). However, minorities were less comfortable providing race/ethnicity information and were more worried than non-Hispanic whites about the potential misuse of this information.

OBJECTIVE

To determine if perceived experiences of discrimination (both in general and in medical care) were associated with comfort providing race/ethnicity information, and conversely, to worry about providing the information.

DESIGN AND PARTICIPANTS

Telephone survey of 480 Californians, including 101 whites, 98 Asians, 173 Hispanics, 82 blacks, and 26 multiracial individuals.

MEASUREMENTS

Comfort level giving HCPs information about race/ethnicity (measured on a 1–10 scale, with text anchors of “very uncomfortable” at 1 and “very comfortable” at 10), worry that the information could be used to discriminate against patients, and worry that the information could be used to find undocumented immigrants. Worry was measured using a four-point Likert scale- not worried at all, a little worried, somewhat worried, and very worried. Respondents were also asked about perceived discrimination in general and perceived discrimination in medical care.

RESULTS

Compared to whites, Hispanics (Beta-coefficient (BC) = -1.16, SE = 0.51) and Mandarin/Cantonese-speaking Asians (BC = -1.40, SE = 0.65) reported significantly less comfort giving HCPs information about their race/ethnicity, while blacks (BC = 0.70, SE = 0.16), Hispanics (BC = 0.91, SE = 0.18), and multiracial individuals (BC = 0.63, SE = 0.24) were significantly more worried that race/ethnicity information could be used to discriminate against them. Adjusting for perceived experiences of discrimination in general and in medical care partially explained the higher discomfort and worry among minorities.

CONCLUSIONS

Perceived experiences of discrimination are associated with greater discomfort and worry about providing race/ethnicity data. Health care institutions should consider how they can address the public’s concerns about possible misuses of data.

KEY WORDS

race data collection discrimination 

Notes

Acknowledgement

This study was supported by a grant from The California Endowment. We would like to thank Julie Brown, Ph.D. for her assistance with the development of the sampling methodology, the questionnaire, and the conduct of the survey.

Conflict of Interest

None disclosed.

References

  1. 1.
    Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care: Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2003; Washington, D.C.Google Scholar
  2. 2.
    Friedman DJ, Cohen BB, Averbach AR, Norton JM. Race/ethnicity and OMB Directive 15: implications for state public health practice. Am J Public Health. 2000;90(11):1714–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Hasnain-Wynia R, Baker DW. Obtaining data on patient race, ethnicity, and primary language in health care organizations: current challenges and proposed solutions. Health Serv Res. 2006;41(4 Pt 1):1501–18.PubMedGoogle Scholar
  4. 4.
    Panel on DHHS Collection of Race and Ethnicity Data. Eliminating Health Disparities: Measurement and Data Needs. Washington, D.C.: National Academies Press; 2004.Google Scholar
  5. 5.
    Baker DW, Cameron KA, Feinglass J, et al. Patients’ attitudes toward health care providers collecting information about their race and ethnicity. J Gen Intern Med. 2005;20(10):895–900.PubMedCrossRefGoogle Scholar
  6. 6.
    Baker DW, Hasnain-Wynia R, Kandula NR, Thompson JA, Brown ER. Attitudes toward health care providers, collecting information about patients’ race, ethnicity, and language. Med Care. 2007;45(11):1034–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Bird ST, Bogart LM. Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethn Dis. 2001;11(3):554–63.PubMedGoogle Scholar
  8. 8.
    Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in health care. J Gen Intern Med. 2004;19(2):101–10.PubMedCrossRefGoogle Scholar
  9. 9.
    Lauderdale DS, Wen M, Jacobs EA, Kandula NR. Immigrant perceptions of discrimination in health care: the California Health Interview Survey 2003. Med Care. 2006;44(10):914–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Blanchard J, Lurie N. R-E-S-P-E-C-T: patient reports of disrespect in the health care setting and its impact on care. J Fam Pract. 2004;53(9):721–30.PubMedGoogle Scholar
  11. 11.
    Adegbembo AO, Tomar SL, Logan HL. Perception of racism explains the difference between Blacks’ and Whites’ level of healthcare trust. Ethn Dis. 2006;16(4):792–8.PubMedGoogle Scholar
  12. 12.
    U.S. Census Bureau. California – Ability to Speak English by Language Spoken at Home for the Population 5 Years and Over: 2000. Available at http://www.census.gov/population/cen2000/phc-t37/tab06a.xls. Last Accessed April 7, 2009.
  13. 13.
    American Association of Public Opinion Research. Response Rate Calculator. Available at http://www.aapor.org/uploads/Response_Rate_Calculator.xls. Last accessed April 7, 2009.
  14. 14.
    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.PubMedGoogle Scholar
  15. 15.
    Halbert CH, Armstrong K, Gandy OH Jr., Shaker L. Racial differences in trust in health care providers. Arch Intern Med. 2006;166(8):896–901.PubMedCrossRefGoogle Scholar
  16. 16.
    Mainous AG 3rd, Smith DW, Geesey ME, Tilley BC. Development of a measure to assess patient trust in medical researchers. Ann Fam Med. 2006;4(3):247–52.PubMedCrossRefGoogle Scholar
  17. 17.
    Stepanikova I, Mollborn S, Cook KS, Thom DH, Kramer RM. Patients’ race, ethnicity, language, and trust in a physician. J Health Soc Behav. 2006;47(4):390–405.PubMedCrossRefGoogle Scholar
  18. 18.
    LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust, and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57(Suppl 1):146–61.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 2009

Authors and Affiliations

  • Namratha R. Kandula
    • 1
    • 2
    Email author
  • Romana Hasnain-Wynia
    • 2
  • Jason A. Thompson
    • 1
  • E. Richard Brown
    • 3
  • David W. Baker
    • 1
    • 2
  1. 1.Division of General Internal Medicine, Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Center for Healthcare Equity, Institute for Healthcare Studies, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  3. 3.Center for Health Policy Research, Los Angeles School of Public HealthUniversity of CaliforniaLos AngelesUSA

Personalised recommendations