Emerging evidence suggests that racial barriers in the patient-physician relationship may be an important source of disparities in the quality of health care. These barriers include cultural dissimilarity between doctors and patients; social discomfort or distrust when interacting with people from other racial or ethnic groups (""""""""interracial anxiety""""""""); and negative racial bias or stereotyping of minority patients by physicians. Training in """"""""cultural competence"""""""" has become the primary vehicle for reducing the impact of racial barriers betweens patients and physicians. To date, however, there has been limited empirical evidence to inform the content of cultural competence training. Specifically, there has been scant research on the nature and influence of specific racial barriers in the patient-physician relationship, and on the knowledge, attitudes, and skills needed to reduce them. The objective of this developmental grant application is to develop and test tools necessary to measure racial barriers and cultural competence in the patient-physician relationship, as a first step towards assessing their role in causing and mitigating, respectively, racial disparities in health care quality and outcomes.
Our specific aims are to: 1) develop a psychometrically sound instrument measuring cultural competence among physicians; 2) test the reliability and validity of scales measuring interracial anxiety among physicians; and 3) test the validity of a computerized, interactive tool measuring racial bias among physicians. We will use a multi-step approach to achieve these aims, including expert scientific review of draft survey items, cognitive interviews with practicing physicians, a national physician survey, and psychometric analysis. Developing and testing measures of cultural competence and racial barriers in the patient-physician relationship will provide essential tools necessary to advance the study of racial disparities in health care. These measures will serve at least three crucial functions. First, they will allow us to empirically assess the role of physician bias, and other racial barriers in the patient-physician relationship, in explaining disparities in the quality of health care. Second, they will allow us to determine which (if any) facets of the broad concept of cultural competence reduce racial barriers and in turn reduce health care disparities. Both of these steps will help inform the content of cultural competence training and other interventions to reduce disparities. Finally, rigorously developed measures of racial barriers and cultural competence will provide needed evaluation tools for judging the effectiveness of cultural competence programs, many of which are currently being developed under NIH sponsorship.
The aims of this project are to develop and test tools needed to explore the role of racial barriers in the patient- physician relationship as a source of disparities in the quality of health care, and the role of cultural competence among physicians as a means to mitigate those barriers. These tools are needed to inform and evaluate future interventions to reduce pervasive racial disparities in health care quality and outcomes. ? ? ? ? ? ?
