Assignment: Aversive Racism and Inequality in Health Care
Aversive racism is a subtle and indirect type of racism that can contribute to unequal treatment in a variety of settings and situations including, but not limited to, health care access for minority racial and ethnic groups. Individuals who engage in aversive racism say they support the principle of racial equality and do not believe they are prejudiced. However, they also possess subconscious negative feelings and beliefs about specific racial and/or ethnic groups. Aversive racism often results in a majority group’s failure to help a minority group, even though they do not intentionally cause harm. Aversive racism may be a contributing factor to poor quality health care for some minorities.
To prepare for this Assignment:
· Review the Section III, “Framework Essay,” and Reading 31 in the course text. Pay particular attention to aversive racism and health care access.
· Review the article, “Psychiatrists’ Attitudes Toward and Awareness About Racial Disparities in Mental Health Care,” and focus on methods for reducing aversive racism.
· Take the Race Implicit Bias test at the Project Implicit website.
· Identify two examples of racial or ethnic inequality in health care in the United States.
· Think about how aversive racism contributes to the examples that you identified.
· Consider methods for reducing aversive racism in your examples.
The Assignment (3–pages):
· Describe two examples of racial or ethnic inequality in health care in the United States.
· Explain how aversive racism contributes to the inequality illustrated in the examples (and thus in health care) you described.
· Explain methods for reducing aversive racism in your examples. Be specific and provide examples to support your explanation.
· Discuss how implicit bias might impact health care in the United States.
Support your Assignment with specific references to all resources used in its preparation.
THIS INFORMATION WAS UNDER RESOURCES FOR THE WEEK:
Published Online:1 Feb 2010https://doi-org.ezp.waldenulibrary.org/10.1176/ps.2010.61.2.173
Persons from racial-ethnic minority groups have disproportionately poor mental health status, experience more barriers to and receive lower quality mental health care, and are underrepresented in mental health research ( 1 , 2 ). The relatively lower socioeconomic status of most racial-ethnic minority groups explains some variation—that is, persons from racial-ethnic minority groups are more likely to be uninsured or underinsured, to be less educated and have lower income, and to reside in areas where medical services are less available ( 3 , 4 ). Moreover, persons from racial-ethnic minority groups may be more distrustful of health care providers, have lower health literacy, be less likely to seek care, and prefer fewer services ( 5 , 6 ). Nonetheless, disparities persist even after controlling for such factors. Some of this variation is likely due to differences based on race-ethnicity in physician-patient interactions ( 7 ,8 , 9 , 10 ).
Race-ethnicity has been shown to influence physician-patient communication during clinical encounters and physician decision making ( 10 , 11 ). Physicians tend to view patients from minority groups as less intelligent, less effective communicators, less compliant, more likely to abuse alcohol and drugs, and less likable than white patients ( 8 , 12 ). Although distressing, these facts are consistent with social categorization (or social cognition) theory ( 10 , 12 ). This theory, originating in the social psychology literature, posits that humans use categorization to make vast amounts of social information manageable. Characteristics are unconsciously assigned to social groups (for example, racial-ethnic groups), and those characteristics are then unconsciously applied to individuals through stereotyping ( 13 ). Physicians may be especially vulnerable to stereotyping because of time pressures and the need to make rapid assessments—that is, physicians have more social information to process, so rely more heavily on social categorization ( 14 ).
Social categorization and racial-ethnic stereotyping likely influence physician behavior and decision making. However, because these are unconscious processes, physicians may be unaware of them and may underestimate their own contributions to racial-ethnic disparities. Understandably, physicians may be reluctant to explore their unconscious biases; it would be difficult for most physicians, who have dedicated their careers to helping others, to confront their own contributions to racial-ethnic inequality ( 10 ). Nonetheless, attempts to eliminate disparities will not be successful as long as health care providers believe that the sources of disparities are entirely external to themselves. Physicians must become aware of their own unconscious biases in order to change the behaviors that contribute to racial-ethnic inequalities.
We hypothesized that there are several prerequisites for changing physician behavior: physicians must be aware that racial-ethnic disparities exist, physicians must believe that they may contribute to disparities, and physicians must be motivated to change their behavior. The purpose of this study was to evaluate the extent to which psychiatrists have achieved these prerequisites and to identify factors that are associated with achievement of each.
Data were collected through an online survey of American Psychiatric Association (APA) members conducted from April 2006 to August 2006. The survey was also distributed at the APA’s Institute on Psychiatric Services in October 2006. For the online portion of the study, names and addresses of 2,000 randomly selected member psychiatrists were purchased from the APA. A letter of introduction and unique access code were mailed to each; a printed survey was available. A maximum of three contact attempts were made. Of the 2,000 individuals identified, a correct address could not be obtained for 24 and seven were retired or deceased. Of the final sample of 1,969 eligible members, 186 psychiatrists (9%) completed the survey online.
Surveys were also distributed from an exhibit hall booth at the 58th Institute on Psychiatric Services, a national professional conference. Respondents were compensated with a $5 specialty coffee gift card. Of the 190 psychiatrists who completed the survey at the conference, two had previously participated, and only their responses to the online survey were used. The final sample for this study was 374 individuals.
The University of Rochester Research Subjects Review Board reviewed this study and determined that it was exempt from institutional review board review.
Content of our survey was informed by a survey developed by the Kaiser Family Foundation ( 15 ) that was subsequently modified by Lurie and colleagues ( 16 ) for use with cardiologists. The survey included questions about familiarity with racial disparities research, perceived awareness of psychiatrists about racial disparities, and changes in awareness over the past decade. To measure perceived determinants of quality of care, physicians rated the extent to which 12 patient factors (including race) affect quality of psychiatric care, both in general and in their own practice setting. A “difference” variable was calculated by subtracting the perceived influence of race in the participant’s practice from the perceived influence of race in general. Finally, respondents were asked whether they had participated in the past year in any program designed to reduce racial disparities in health care or whether they would be interested in participating in such a program; they were also asked whether they believed such programs were likely to reduce health disparities. Most items were measured on 5-point Likert scales. Key terms, such as quality of care, were defined.
Sociodemographic variables included gender, race, ethnicity, years in practice, practice setting and size, proportion of patient population that is non-Hispanic white (referred to as “white” in this article) versus other (referred to as “nonwhite” in this article), and number of professional meetings attended annually. A copy of the survey is available on request.
Univariate statistics were generated for all variables in the data set. Most data were treated as categorical, and most bivariate analyses were conducted with chi square analysis or Fisher’s exact test, as appropriate. Multivariate analyses were conducted using logistic regression. Analyses were guided by a priori hypotheses to limit type II error, and they were conducted using two-sided tests with α =.05. Analyses were performed using SAS, version 9.1.
As shown in Table 1 , most participants were male (62%) and white (63%). Most (77%) had been in practice for 15 years or more, and almost half (48%) worked in small practices (less than ten physicians). Almost one-third of participants (32%) worked in community hospitals or community mental health centers (CMHCs), and most others worked in university hospitals (21%) or private practice (24%). The racial-ethnic makeup of respondents’ patient populations varied widely, but in many respondents’ practices (48%), at least half of the patients were from racial-ethnic minority groups.
Table 1Demographic characteristics of 374 psychiatrists who completed a survey on racial disparities in mental health careEnlarge table
Awareness of disparities
Most respondents were not at all or a bit familiar with research on racial inequalities in psychiatric care (N=190 of 370, 51%), and approximately one-third of respondents were moderately familiar (N=136 of 370, 37%), and only 12% were familiar or very familiar (N=44 of 370). Compared with their respective comparison…