Cultural identities and perceptions of health among health care providers and older American Indians


BACKGROUND: Differences in provider-patient health perceptions have been associated with poor patient outcomes, but little is known about how patients’ cultural identities may be related to discordant perceptions.

OBJECTIVE: To examine whether health care providers and American-Indian patients disagreed on patient health status ratings, and how differences related to these patients’ strength of affiliation with American-Indian and white-American cultural identities.

DESIGN: Survey of patients and providers following primary care office visits.

PARTICIPANTS: One hundred and fifteen patients ≥ 50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American-Indian race, but varied in strength of affiliation with separate measures of American-Indian and white-American cultural identities.

MEASUREMENTS: Self-reported sociodemographic and cultural characteristics, and a 5-point rating of patient’s health completed by both patients and providers. Fixed-effects regression modeling examined the relationships of patients’ cultural identities with differences in provider-patient health rating.

RESULTS: In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients’ self-rating. Provider-patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P=.01). Differences in ratings were not associated with the separate measure of affiliation with American-Indian identity.

CONCLUSIONS: American-Indian patients, especially those who affiliate weakly with white-American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions.

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Author information



Corresponding author

Correspondence to Dr. Eva Marie Garroutte PhD.

Additional information

Data collection was funded by a grant under the Resource Centers for Minority Aging Research program, by the National Institute of Nursing Research, and the Office of Research on Minority Health, National Institutes of Health. Research was also supported in part by grants P30AG/15297 from the National Institute of Aging and the National Institute of Nursing Research, P01 HS10854 from the Agency for Healthcare Research and Quality, and P60 MD000507 from the National Center for Minority Health and Health Disparities to Dr. S. Manson, and by a research expense grant from Boston College. The author gratefully acknowledges the guidance of the Cherokee Nation Institutional Review Board, as well as assistance in data collection and Cherokee translation by staff and volunteers at the research site, and the technical advice of Dr. Spero DManson.

Disclaimer: The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the Cherokee Nation.

The authors have no conflict of interest to declare for this paper.

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Garroutte, E.M., Sarkisian, N., Arguelles, L. et al. Cultural identities and perceptions of health among health care providers and older American Indians. J Gen Intern Med 21, 111–116 (2006).

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Key words

  • health status
  • minority health
  • cultural differences
  • doctor-patient relationships
  • aging