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The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health

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Abstract

Healthcare discrimination experience is expected to be a consequential variable that explains racial/ethnic inequities in patient activation and health; however, existing scales assessing healthcare discrimination experience are limited by insufficient psychometric development and overly narrow construct definitions. A new Healthcare Discrimination Experience Scale was developed, validated, compared to an existing scale, and used to estimate effects in explaining racial/ethnic health inequities. Across two studies, 975 patients with hypertension or diabetes (43% Black, 10% other Persons of Color, 47% White, 53% having household incomes < 40 thousand dollars) were recruited through marketing research panels to complete online questionnaires. Compared to an existing measure, the new scale better detected differences between People of Color and White people. It produced good results in confirmatory factor analysis and item response theory analysis, and it mediated the effects of racial/ethnic identity on eight variables regarding patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress. The new scale is valid for assessing a broadly defined healthcare discrimination experience construct in diverse patients with chronic medical conditions, and it is more sensitive to group differences than the best existing alternative scale. Compared to research using unvalidated scales, the results of this study demonstrate that healthcare discrimination experience plays a larger role in explaining racial/ethnic inequities in patient activation and health.

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Data Availability

Data and materials available via request by email to the corresponding author.

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Funding

This research was supported by a grant from the Baylor University Research Committee.

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Authors and Affiliations

  1. Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA

    Keith Sanford & Alexandra E. Pizzuto

Authors
  1. Keith Sanford
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  2. Alexandra E. Pizzuto
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Contributions

KS was responsible for the study conception and design, data collection, data analysis, and writing the manuscript. AP contributed to conducting literature reviews and writing the manuscript.

Corresponding author

Correspondence to Keith Sanford.

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Ethics Approval

This study was declared exempt by the Baylor University Institutional Review Board due to the online survey methodology.

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All participants provided informed consent.

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All participants consented for their deidentified responses to be included in research publications.

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The authors declare no competing interests.

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Sanford, K., Pizzuto, A.E. The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities in Patient Activation and Health. J. Racial and Ethnic Health Disparities 10, 1642–1652 (2023). https://doi.org/10.1007/s40615-022-01350-2

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  • DOI: https://doi.org/10.1007/s40615-022-01350-2

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