Attitudes About Racism, Medical Mistrust, and Satisfaction With Care Among African-American and White Cardiac Patients

Johns Hopkins University, School of Hygiene and Public Health, Department of Health Policy and Management, Baltimore, MD 21205, USA.
Medical Care Research and Review (Impact Factor: 2.62). 02/2000; 57 Suppl 1(4):146-61. DOI: 10.1177/1077558700574007
Source: PubMed


The authors examine determinants of satisfaction with medical care among 1,784 (781 African American and 1,003 white) cardiac patients. Patient satisfaction was modeled as a function of predisposing factors (gender, age, medical mistrust, and perception of racism) and enabling factors (medical insurance). African Americans reported less satisfaction with care. Although both black and white patients tended not to endorse the existence of racism in the medical care system, African American patients were more likely to perceive racism. African American patients were significantly more likely to report mistrust. Multivariate analysis found that the perception of racism and mistrust of the medical care system led to less satisfaction with care. When perceived racism and medical mistrust were controlled, race was no longer a significant predictor of satisfaction.

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    • "The study attends to one dimension of religion that has been found to be associated with how an individual views and responds to racial discrimination (Lincoln & Mamiya, 1990) À religious affiliation. Discrimination in the medical encounter and, specifically, the patientphysician relationship may be a culprit for a lack of trust among blacks (LaVeist et al., 2000; Smedley, Stith, & Nelson, 2003). For instance, although only 14 percent of blacks indicate that they personally have been treated unfairly in medical encounters due to their race or ethnicity, 35 percent indicate that either a family member or someone they know has been treated unfairly (Lillie-Blanton, Brodie, Rowland, Altman, & McIntosh, 2000). "
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    ABSTRACT: Purpose: Past research indicates that blacks are less trusting of physicians than are whites; yet, researchers have not examined within group differences in physician trust by religious denomination – an effort that is complicated by the high correlated nature of race and religion. To better understand black-white differences in physician trust, this paper examines heterogeneity in trust levels among blacks associated with religious designations that distinguish Black Protestants from other ethnoreligious groups. Methodology/Approach: Using data from the 2002 and 2006 General Social Surveys, this study adopts an intersectional (i.e., race X religion) typology of religious denomination to understand the black-white gap in physician trust. Weighted multivariate linear regression is employed. Findings: Black-white differences in physician trust are identified only when religious affiliation is considered but not when religious affiliation is omitted. Blacks who are affiliated with Black Protestant churches are more trusting than other religious groups, including Evangelical Protestants, Mainline Protestants, and blacks who are affiliated with other faiths. Originality/Value of Paper: This paper indicates that there is more heterogeneity in trust levels among blacks than between blacks and whites. Moreover, the findings suggest that religion can play an important role in bridging the trust gap between blacks and the medical sciences.
    Research in the Sociology of Health Care, 33 edited by Jennie Jacobs Kronenfeld, 09/2015: chapter 12: pages 229-249; Emerald Group Publishing., ISBN: 0275-4959
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    • "Second, Blacks and Latinos are more likely than Whites to report they feel disrespected by their health care providers (Blanchard and Lurie, 2004). Third, studies indicate that Blacks and Latinos are less satisfied with the quality of the care they receive from doctors (Doescher et al., 2000; LaVeist et al., 2000; Saha et al., 1999). Fourth, studies show that minorities receive less quality communication than Whites: Physicians are more likely to dominate conversations, less likely to speak of socioemotional topics, and less likely to exchange positive affective tones with minority patients than with White patients (Johnson et al., 2004; see also Cooper-Patrick et al., 1999; Julliard et al., 2008; Morales et al., 1999). "
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    ABSTRACT: Past research yields mixed evidence regarding whether ethnoracial minorities trust physicians less than Whites. Using the 2002 and 2006 General Social Surveys, variegated ethnoracial differences in trust in physicians are identified by disaggregating a multidi-mensional physician trust scale. Compared to Whites, Blacks are less likely to trust the technical judgment and interpersonal competence of doctors. Latinos are less likely than Whites to trust the fiduciary ethic, technical judgment, and interpersonal competence of doctors. Black–Latino differences in physician trust are a function of ethnoracial differences in parental nativity. The ways ethnoracial hierarchies are inscribed into power-imbalanced clinical exchanges are discussed.
    Social Science Research 07/2015; 54:1-20. DOI:10.1016/j.ssresearch.2015.06.020 · 1.27 Impact Factor
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    • "Frank et al. Health and Justice patient-provider communication and decreased satisfaction with care (Hausmann et al. 2011; LaVeist et al. 2000). Discrimination based on one's criminal record may serve as an additional barrier to engaging in healthcare (Schnittker & John 2007; Smedley et al. 2003). "
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    ABSTRACT: Background Healthcare discrimination based on race/ethnicity is associated with decreased healthcare access and utilization among racial/ethnic minority patients. Discrimination based on criminal record may also negatively impact healthcare access and utilization among ex-prisoners. Methods We conducted a secondary analysis of data from a cross-sectional survey of 172 men recently released from state prison. We examined the association between self-reported criminal record discrimination by healthcare workers and utilization of 1) emergency department (ED) and 2) primary care services. We created staged logistic regression models, adjusting for sociodemographic characteristics and self-reported racial/ethnic discrimination. Results Among 172 male participants, 42% reported a history of criminal record discrimination by healthcare workers. Participants who reported discrimination were older (mean, 42 vs. 39 years; p = .01), more likely to be college educated (26% vs. 11%; p = .03), and had more extensive incarceration histories (median years incarcerated, 16 vs. 9; p = .002) compared to those who did not report discrimination. Self-reported criminal record discrimination by healthcare workers was significantly associated with frequent ED utilization [odds ratio (OR) = 2.7, 95% confidence interval 24 (CI) 1.2–6.2] but not infrequent primary care utilization [OR = 1.6, 95% CI 0.7–3.8]. Conclusions Recently released prisoners report criminal record discrimination by healthcare workers, and this experience may impact healthcare utilization. Future studies should seek to further characterize criminal record discrimination by healthcare workers and prospectively examine its impact on health outcomes.
    03/2014; 2(6):1-8. DOI:10.1186/2194-7899-2-6
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