142nd APHA Annual Meeting and Exposition

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Role of ancillary staff in perceived discrimination in medical care

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014

Gabriel Tajeu, MPH, Doctoral Candidate , Health Care Organization Policy, University of Alabama at Birmingham, Birmingham, AL
Andrea Cherrington, MD MPH , Division of Preventive Medicine, University of Alabama Birmingham, Birmingham, AL
Lynn Andreae, MPH , Medicine / Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL
Candice Prince
Jewell Halanych
Objectives: Research and interventions have been directed at physicians in order to attempt to address perceived racial/ethnic discrimination in medical care and potentially provide more equitable care across the US population.  However, little is known about the contributions of other ancillary medical staff (e.g., nurses, medical assistants, and receptionists) to perceived discrimination in medical care.

Methods: We conducted focus group interviews with African-American (AA) and European-American (EA) participants stratified by race and gender who interacted with the Alabama health care system in the previous 12 months.  We utilized a focus group topic guide, based on Social Cognitive Theory, in order to probe for personal, behavioral, and environmental factors that contribute to perceived discrimination in health care.  Group interviews were audio recorded.  Two investigators independently analyzed the transcribed focus group interviews for relevant themes.

Results: 29 AA women (mean age and standard deviation, 47±10 years), 24 AA men (53±11 years), 18 EA women (54±15 years), and 19 EA men (39±13 years) participated in 12 focus groups. We identified several main themes related to perceptions of staff bias including communication and personal attitudes/behaviors.  Communication included both verbal and non-verbal forms of communication.  For example, “It’s the way they talk to you…they can talk to you like you’re below average, you know,  just the tone of the voice.” Personal attitudes/behavior themes were identified with words such as “personable”, “respectful”, and “takes their time.” Some focus group response examples included, “I mean, [they] look at you, like, up and down, like you ain’t nothing,” and “they’re kind to somebody right before you, and they’re not to you. They’re short-spoken to you.”

Conclusions: The behaviors of ancillary staff in the health care setting can potentially contribute to patients’ perceptions of discrimination.  Future efforts to reduce health care discrimination interventions should include a focus on staff’s cultural competence and customer service skills.

Learning Areas:

Diversity and culture
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Define perceived health care discrimination Describe factors that contribute to perceived discrimination in the health care setting Identify health care staff as a source of perceived discrimintation

Keyword(s): Health Disparities/Inequities, Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I participated in the analysis of the data presented and am an investigator on the grant. My research during my doctoral program has focused on health disparities and quality improvement among other topics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.