The degree to which patients perceive discrimination throughout their life is associated with long term health consequences. However, little is published about the health and health consequences to a patient who perceives discrimination during encounters with the health care system. This is particularly true in the case of hypertension (HTN) whose prolonged asymptomatic nature belies devastating consequences if left untreated. One potential reason for the paucity of knowledge regarding perceived discrimination (PD) in primary care is that the existing measures of discrimination do not focus on primary care or even more generally, health care. In order to comprehensively assess perceived discrimination (PD) in primary care settings, we first need to better understand from patients'perspectives the individual and cultural meanings associated with PD and determine what environmental, behavioral, and personal factors contribute to PD in primary care. Therefore, the overall goal of the application is to develop a theory-based, psychometrically sound measure of PD in primary care among a group of patients who heavily utilize primary care, patients with HTN. The rationale for the proposed research is that this theory-driven assessment can be used as a tool to determine factors that are associated with PD in primary care settings, which, in turn, will assist in the development of targeted interventions to reduce PD in these settings.
The Specific Aims are: (1) Through focus groups with African American (AA) and European American (EA) patients with HTN who report having a primary care provider, we will explore how PD is conceptualized or socially constructed and what environmental, behavioral, and personal factors contribute to PD in primary care;(2) Based on the themes captured in specific aim 1, we will develop a theory-driven instrument to assess PD in primary care;(3) In a sample of 460 AA and EA individuals we will evaluate the psychometric properties of the instrument by examining its reliability (internal consistency and test-retest) and validity (convergent, divergent, and criterion-related). The overall conceptual framework that serves as our philosophical guide is Social Constructionism, which states that a person's cognitive processing, social experiences, and subjective and linguistic meanings influence an individual's understanding of their own reality. The theoretical model that will guide the measure development is the Social Cognitive Theory, which views human functioning as the dynamic interaction between environment, behavior, and personal factors. This multidisciplinary team is well suited to undertake the proposed research because the team has the scope and breadth of expertise in the areas of public health, health psychology, measurement, and qualitative research. Once we complete the work proposed in the R21 application, we expect to be well-positioned to develop an R01 application to test the efficacy of an intervention focusing on reduction/elimination of PD in primary care settings.
The perception that patients are being discriminated against while receiving health care may be an important contributor to health care disparities. This project will develop an instrument to measure what personal, behavioral, and environmental factors contribute to perceived discrimination in primary care. This instrument will allow the investigators to test the efficacy of interventions focusing on reduction/elimination of perceived discrimination in primary care settings.
