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 atheoretical model addressing: (1) how Black patients' and nonBlack physicians' racial attitudes influence healthcare and (2) why some Black patients are more vulnerable to health care disparities than others. The modelfocuses on one aspect of health care: medical interactions. About 75% of Black patients experience raciallydiscordant medical interactions with nonBlack physicians, and these interactions tend to be less positive thanracially concordant ones. Prior research in social psychology provides strong evidence that racial attitudes playan important role in determining the quality of racially discordant interactions. Thus, the theoretical modelproposed in this research posits that Black patients' and nonBlack physicians' racial attitudes (i.e., perceiveddiscrimination and racial bias, respectively) negatively influence their affect and communication style duringmedical interactions; these then lead to decreased patients' adherence, which results in poorer health. Themodel also concerns variations in the quality of medical interactions among Black patients. The PI and othershave shown that strong Afrocentric facial features (AFF; i.e., thick lips, wide nose) are associated with moreperceived 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) morenegative affect and communication style during medical interactions than Blacks with weaker AFF, and thusthese patients have poorer adherence and health. We propose a secondary analysis of existing data thatinclude 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 linguisticanalysis of the interactions) of patients' and physicians' affect and communication style;
and Aim #2) Toempirically test a theoretical model that explains: (1) how patients' and physicians' racial attitudes influence thequality of racially discordant medical interactions, which in turn influence patients' subsequent health-relatedbehaviors and health; and (2) how AFF influences racial attitudes, the quality of racially discordant medicalinteractions, and patients' subsequent adherence and health. Our study is significant, because it will informthe development of effective and efficient interventions addressing health disparities by focusing on relativelyeasily 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 Blackpatients' and nonBlack physicians' racial attitudes, addresses within-group variations in health care/healthdisparities, 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.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Small Research Grants (R03)
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Special Emphasis Panel (ZRG1-RPHB-P (02))
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Cotton, Paul
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Wayne State University
Internal Medicine/Medicine
Schools of Medicine
United States
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Hagiwara, Nao; Slatcher, Richard B; Eggly, Susan et al. (2017) Physician Racial Bias and Word Use during Racially Discordant Medical Interactions. Health Commun 32:401-408
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