Anti-Black discrimination in primary health care: a qualitative study exploring internalized racism in a Canadian context

OBJECTIVES

A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care.

DESIGN

This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically.

RESULTS

Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination.

CONCLUSION

Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.

The influence of internalized racism on the relationship between discrimination and anxiety

OBJECTIVES

This study used 2 waves of data to longitudinally examine whether internalized racism moderated the association between racial discrimination and anxiety symptom distress.

METHOD

Participants were 157 Black college students attending a predominantly White institution who completed measures of racial discrimination, internalized racism, and psychological distress.

RESULTS

Using hierarchical linear regression, results indicated a positive association between racial discrimination and subsequent anxiety symptom distress for individuals with moderate and high levels of internalization of negative stereotypes and hair change.

CONCLUSIONS

Findings suggest that experiences of anxiety symptom distress, in the context of racial discrimination, may differ as a function of one's acceptance and internalization of dominant White culture's actions and beliefs toward Black people. (PsycInfo Database Record (c) 2020 APA, all rights reserved).