African American Experiences in Healthcare: "I Always Feel Like I'm Getting Skipped Over"
African American Experiences in Healthcare: "I Always Feel Like I'm Getting Skipped Over"
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DOI：
10.1037/hea0000368
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发表时间：
2016-09-01
影响因子：
4.2
通讯作者：
Saha, Somnath
中科院分区：
文献类型：
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作者：
Cuevas, Adolfo G.;O'Brien, Kerth;Saha, Somnath
目的：尽管非洲裔美国人在医疗保健环境中受到歧视，与欧洲裔美国人相比，他们的医疗不信任程度更高，与医疗保健提供者的沟通也更差，但人们对这些障碍是如何产生和表现出来的知之甚少。本研究考察了非洲裔美国人社区成员关于这些障碍的经验，并进一步探讨了参与者在患者-提供者关系中的种族观点。方法：焦点小组进行了一项研究的一部分，探讨参与者的经验和关系在卫生保健设置。通过社区设置和活动招募了60名非裔美国成年人参加按性别划分的9个焦点小组中的1个。审查了与感知到的歧视、不信任、沟通不良和种族不和谐有关的内容。通过定性编码（使用NVivo 10）和迭代讨论，得出了参与者对这些潜在关系障碍的主观体验的主题。结果：当非裔美国患者，特别是女性患者，感觉自己的症状或问题不可信时，就会产生感知歧视。当临床医生不尊重病人时，就会产生医疗不信任，让病人怀疑他们的临床医生的治疗是否有歧视。当临床医生在互动中不承认患者的观点时，沟通不良就会出现。患者通常认为这些行为是歧视性的。结论：非裔美国人在获得医疗服务时经历了与医疗服务提供者沟通不端、医疗不信任和感知歧视，这些方式有很多，有时是相互关联的。研究人员推荐了减少这种障碍的方法，并改善非裔美国人在医疗保健方面的医患关系。
Objective: Although African Americans perceive discrimination in health care settings, experience higher levels of medical mistrust compared with European Americans, and experience poorer communication with health care providers, little is known as to how these barriers to quality patient-provider relationships arise and manifest themselves. This study examined experiences of African American community members regarding these barriers and additionally explored participants' perspectives on race in the patient-provider relationship. Methods: Focus groups were conducted as part of a study exploring participants' experiences and relationships in health care settings. Sixty African American adults were recruited through community settings and activities to participate in 1 of 9 focus groups segmented by gender. Transcripts were reviewed for content related to perceived discrimination, mistrust, poor communication, and race discordance. Themes providing insight into participants' subjective experience of these potential relationship barriers were derived through qualitative coding (using NVivo 10) and iterative discussion. Results: Perceived discrimination arose when African American patients, particularly women, felt their symptoms or problems were discredited. Medical mistrust occurred when clinicians did not convey respect to patients, leaving patients to wonder whether their clinician's treatment was discriminatory or not. Poor communication arose when clinicians did not acknowledge patients' perspectives during interactions. Patients often viewed these actions as discriminatory. Conclusions: African Americans experience poor communication with their health care providers, medical mistrust, and perceived discrimination when accessing health care in numerous and sometimes interrelated ways. The investigators recommend ways to reduce the experience of such barriers and to improve patient-provider relationships for African Americans in health care.