Health disparities as a function of sociodemographic characteristics are robust (Adler, 2007; Cooper, 2004; Hogue & Margraves, 1993; Williams & Collins, 2001). Although context-based causes have received a fair amount of attention (Lenton, Blaire, & Hastie, 2006; Quinn & Green, 2006), social-cognitive factors, have been under-explored (Bogart, 2001). Cooper (Cooper, 2004; Cooper, Beach, Johnson, & Inui, 2005; Saha, Arbelaez, & Cooper, 2003) has identified that aspects of the patient-physician relationship, including patient perceptions, impact disparities in patient care. We build on these ideas and consider stereotype threat, the phenomena whereby individuals experience performance deficits when they are at risk for confirming a negative stereotype (Steele & Aronson, 1995). Recently, cognitive deficits in working memory (Schmader & Johns, 2003) and attentional control (Inzlicht, McKay, & Aronson, 2006) have been found among individuals perceiving race-based stigma. Given the importance of communication between patient-physician (Stewart, 1995), and the importance of executive control to verbal processing (Dameman & Carpenter, 1980, 1982; Just & Carpenter, 1992) we argue deficits in executive control, in response to stereotype threat, may explain differences in health outcomes. We further argue that the patient-physician relationship, specifically race concordance (Cooper-patrick et al,, 1999), may attenuate these effects. The proposed research will be developed under the guidance of Dr. Lisa Cooper, and has 3 specific aims: 1) to demonstrate the impact of stereotype threat on executive attention as a function of the patient-physician interaction; 2) to examine the mpact of stereotype threat on patient verbal processing and communication, and the mediating role of executive attention; and 3) to examine the mitigating effect of patient-physician ethnicity concordance on the experience of stereotype threat in a health care context.
These aims will be advanced in a series of 3 experiments. By identifying deficits in executive attention and stereotype threat in a health care context, we in/ill substantially advance the consideration of social cognitive processes impacting inequalities in care, and provide a foundation for additional research focusing on patient factors that rely on executive control. The examination of verbal processing targets a specific and relevant applied outcome. Similarly, the examination of race concordance is an initial consideration of context factors that may reduce stereotype threat effect.
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