Background: Perceived discrimination is associated with many negative health outcomes, but the mechanisms underlying the relationship between perceived discrimination and health remain unknown. The long-term goal of this research program is to investigate mechanisms underlying the discrimination-health link, ultimately to inform the development of interventions to reduce the effects of discrimination on health and healthcare. This pilot project focuses on how perceptions of past discrimination shape patient assessments of subsequent medical encounters in a cohort of diabetic veterans. Objectives: This project will lay the groundwork for a planned HSR&D IIR proposal that will examine how patients' perceptions of past discrimination influence their assessments of doctor-patient interactions depicted in standardized video vignettes. The objectives of this pilot work are to (1) create professionally produced videos of scripted doctor-patient encounters, and (2) pilot test the protocol of the planned IIR to establish project feasibility, test and refine study procedures and survey measures, and provide preliminary data for effect size and power calculations. Methods: In Phase I of this pilot project, 4 video vignettes will be developed in which a white or African American doctor meets with a white or African American patient with diabetes. The research team will draft and revise the video script with input from VA patients and doctors. The final videos produced will reflect feedback gathered from African American and white VA patients during test screenings of preliminary versions of the videos. Phase II will consist of pilot-testing and revising procedures and measures that will be used in the planned IIR proposal. Forty African American and white veterans with diabetes, recruited via fliers and doctor referrals, will each view one randomly- assigned video and complete a brief survey that measures their assessments of the doctor-patient communication, perceived patient satisfaction, and estimated likelihood of patient adherence to treatment recommendations. Patients' perceptions of racial discrimination from their own past will be measured so their influence on patients' assessments of the video encounters can be examined.
The VA serves many patients who belong to racial and socioeconomic groups that are at increased risk of experiencing or perceiving acts of discrimination, which is a risk factor for poor health outcomes. The proposed work is the initial step of a planned series of studies aimed at understanding the mechanisms by which discrimination affects health behaviors and outcomes among veterans. Setting the stage for interventions to reduce or eliminate the negative effects of discrimination on healthcare delivery and outcomes, this work represents a novel approach to improving veterans'healthcare experiences and is an important step towards mitigating the health consequences of perceived discrimination.
