The 2003 Institute of Medicine report, "Unequal Treatment," proposed that racial attitudes contribute to Black- White health care disparities, which in turn result in health disparities. The goal of this research is to test a theoretical model addressing: (1) how Black patients'and nonBlack physicians'racial attitudes influence health care and (2) why some Black patients are more vulnerable to health care disparities than others. The model focuses on one aspect of health care: medical interactions. About 75% of Black patients experience racially discordant medical interactions with nonBlack physicians, and these interactions tend to be less positive than racially concordant ones. Prior research in social psychology provides strong evidence that racial attitudes play an important role in determining the quality of racially discordant interactions. Thus, the theoretical model proposed in this research posits that Black patients'and nonBlack physicians'racial attitudes (i.e., perceived discrimination and racial bias, respectively) negatively influence their affect and communication style during medical interactions;these then lead to decreased patients'adherence, which results in poorer health. The model also concerns variations in the quality of medical interactions among Black patients. The PI and others have shown that strong Afrocentric facial features (AFF;i.e., thick lips, wide nose) are associated with more perceived discrimination among Blacks and with more bias and stereotype activation among nonBlacks. Thus, the model posits that Black patients with stronger AFF display and elicit (in nonBlack physicians) more negative affect and communication style during medical interactions than Blacks with weaker AFF, and thus these patients have poorer adherence and health. We propose a secondary analysis of existing data that include video-recorded primary care interactions between Black patients and nonBlack physicians, patients' and physicians'reactions to the interactions, and longitudinal data on patients'adherence and health.
Our aims are:
Aim #1) To apply and test the validity of measures (i.e., observer judgments of "thin slices" and linguistic analysis of the interactions) of patients'and physicians'affect and communication style;
and Aim #2) To empirically test a theoretical model that explains: (1) how patients'and physicians'racial attitudes influence the quality of racially discordant medical interactions, which in turn influence patients'subsequent health-related behaviors and health;and (2) how AFF influences racial attitudes, the quality of racially discordant medical interactions, and patients'subsequent adherence and health. Our study is significant, because it will inform the development of effective and efficient interventions addressing health disparities by focusing on relatively easily modifiable factors (affect, communication style) and specific at-risk patients (those with stronger AFF). This research is innovative because the model simultaneously considers the independent effects of Black patients'and nonBlack physicians'racial attitudes, addresses within-group variations in health care/health disparities, and is tested through multiple measures to assess affect and communication style.

Public Health Relevance

The goal of this research is to address health disparities by testing a theoretical model of (1) how Black patients'and nonBlack physicians'racial attitudes influence health care and (2) why some Black patients are more vulnerable to health care disparities than others. We will test this model by using two innovative methods of analyzing previously collected video-recorded patient-physician interactions and using them along with patients'and physicians'reports of their reactions to the interactions and patients'long-term adherence and health. Findings will inform the development of future interventions to improve the quality of medical interactions and the health of vulnerable populations.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Small Research Grants (R03)
Project #
5R03NR013249-02
Application #
8422973
Study Section
Special Emphasis Panel (ZRG1-RPHB-P (02))
Program Officer
Roary, Mary
Project Start
2012-02-08
Project End
2014-07-31
Budget Start
2013-02-01
Budget End
2014-07-31
Support Year
2
Fiscal Year
2013
Total Cost
$72,048
Indirect Cost
$24,648
Name
Wayne State University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
001962224
City
Detroit
State
MI
Country
United States
Zip Code
48202
Hagiwara, Nao; Kashy, Deborah A; Penner, Louis A (2014) A novel analytical strategy for patient-physician communication research: the one-with-many design. Patient Educ Couns 95:325-31
Hagiwara, Nao; Penner, Louis A; Gonzalez, Richard et al. (2013) Racial attitudes, physician-patient talk time ratio, and adherence in racially discordant medical interactions. Soc Sci Med 87:123-31
Hagiwara, Nao; Penner, Louis A; Gonzalez, Richard et al. (2013) Within-group health disparities among Blacks: the effects of Afrocentric features and unfair treatment. Cultur Divers Ethnic Minor Psychol 19:477-80