Racial and ethnic differences in patient perceptions of bias and cultural competence in health care

Will public health's response to terrorism be fair? Racial/ethnic variations in perceived fairness during a bioterrorist event

OBJECTIVES

Public health departments' effectiveness during catastrophic bioterrorism will require trust on the part of diverse communities. This study describes variations in perceptions that the public health system will respond fairly to one's needs in a bioterrorist event, regardless of race/ethnicity, income, or other characteristics.

METHODS

Using the Los Angeles County Health Survey, a random-digit, population-based, telephone survey, we conducted multivariate logistic regression of race/ethnicity on perceived fairness, adjusting for demographic factors and perceived neighborhood safety. We performed similar analyses stratified by race/ethnicity subgroup.

RESULTS

Overall, 72.7% of respondents perceived that the public health system will respond fairly in a bioterrorist event. African Americans (AA) and Asian/Pacific Islanders (API) reported the lowest perceived fairness (AA 63.0%, API 68.2%, Latino 73.1%, White 76.6%, p = 0.005 for group differences). Adjusting for demographic factors and neighborhood safety, African Americans had lower perceived fairness compared to whites (adjusted odds ratio, aOR 0.45; 95% confidence intervals, CI 0.26-0.79; p < 0.005). Other factors associated with lower perceived fairness included Asian-language compared to English-language interview (aOR 0.29; 95% CI 0.11-0.76; p < 0.05) and lower compared to higher neighborhood safety (aOR 0.48; 95% CI 0.31-0.74; p < 0.005). Among African Americans, participants aged 18-29 years were less likely to report perceived fairness (aOR 0.06; 95% CI 0.01-0.59) compared to participants older than 60 years of age. Among Asian/Pacific Islanders, Asian-language interview (aOR 0.07; 95% CI 0.01-0.48) and lower perceived neighborhood safety (aOR 0.01; 95% CI <0.01-0.13) were associated with perceived fairness.

CONCLUSIONS

To strengthen bioterrorism preparedness, public health officials must continue to improve perceived fairness among African American and Asian/Pacific Islander communities.

Patient race/ethnicity and quality of patient-physician communication during medical visits

OBJECTIVES

We examined the association between patient race/ethnicity and patient-physician communication during medical visits.

METHODS

We used audiotape and questionnaire data collected in 1998 and 2002 to determine whether the quality of medical-visit communication differs among African American versus White patients. We analyzed data from 458 African American and White patients who visited 61 physicians in the Baltimore, Md-Washington, DC-Northern Virginia metropolitan area. Outcome measures that assessed the communication process, patient-centeredness, and emotional tone (affect) of the medical visit were derived from audiotapes coded by independent raters.

RESULTS

Physicians were 23% more verbally dominant and engaged in 33% less patient-centered communication with African American patients than with White patients. Furthermore, both African American patients and their physicians exhibited lower levels of positive affect than White patients and their physicians did.

CONCLUSIONS

Patient-physician communication during medical visits differs among African American versus White patients. Interventions that increase physicians' patient-centeredness and awareness of affective cues with African Americans patients and that activate African American patients to participate in their health care are important strategies for addressing racial/ethnic disparities in health care.