The Role of Racial Attitudes in Medical Interactions and Health Disparities

2003年医学研究所的报告《不平等待遇》提出，种族态度导致黑人-- 白人医疗保健差距，这反过来又导致健康差距。这项研究的目标是测试一个 理论模型：(1)黑人患者和非黑人医生的种族态度如何影响健康 以及(2)为什么一些黑人患者比其他人更容易受到医疗保健差距的影响。模型 重点关注医疗保健的一个方面：医疗互动。约75%的黑人患者经历了种族问题 与非黑人医生的不和谐的医疗互动，这些互动往往不如 种族和谐的人。社会心理学先前的研究提供了强有力的证据，证明种族态度在其中起作用 在决定种族不和谐互动的质量方面发挥着重要作用。因此，理论模型 在这项研究中提出的假设是黑人患者和非黑人医生的种族态度(即，感知 歧视和种族偏见)分别对他们的情感和沟通方式产生负面影响 医疗互动；这会导致患者的依从性降低，从而导致更差的健康。这个 模型还涉及黑人患者之间医疗互动质量的差异。少年派和其他人 已经表明，强烈的非偏心面部特征(AFF；即厚嘴唇、宽鼻子)与更多 在黑人中感觉到歧视，在非黑人中有更多的偏见和刻板印象的激活。因此， 该模型假设，AFF较强的黑人患者(非黑人医生)表现和诱发的更多 与AFF较弱的黑人相比，在医疗互动中的负面情绪和沟通方式，因此 这些患者的依从性和健康状况较差。我们建议对现有数据进行二次分析， 包括黑人患者和非黑人医生之间的视频初级保健互动，患者的 以及医生对互动的反应，以及关于患者依从性和健康的纵向数据。我们的目标 目标1)应用和测试措施的有效性(即观察者对“薄片”和语言的判断 分析患者和医生的情感和沟通方式的交互作用；以及目标2) 经验性地检验一个理论模型，该模型解释：(1)患者和医生的种族态度如何影响 种族不和谐的医疗互动的质量，这反过来又影响患者随后的健康相关 行为和健康；以及(2)AFF如何影响种族态度、种族不和谐的医疗质量 互动，以及患者随后的依从性和健康。我们的研究意义重大，因为它将为 制定有效和高效的干预措施来解决健康差距问题，重点是相对 容易修改的因素(情感、沟通方式)和特定的高危患者(AFF较强的患者)。 这一研究具有创新性，因为该模型同时考虑了Black的独立效应 患者和非黑人医生的种族态度，解决医疗保健/健康方面的群体内差异 并通过评估情感和沟通风格的多项措施进行测试。

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 a theoretical model addressing: (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. The model focuses on one aspect of health care: medical interactions. About 75% of Black patients experience racially discordant medical interactions with nonBlack physicians, and these interactions tend to be less positive than racially concordant ones. Prior research in social psychology provides strong evidence that racial attitudes play an important role in determining the quality of racially discordant interactions. Thus, the theoretical model proposed in this research posits that Black patients' and nonBlack physicians' racial attitudes (i.e., perceived discrimination and racial bias, respectively) negatively influence their affect and communication style during medical interactions; these then lead to decreased patients' adherence, which results in poorer health. The model also concerns variations in the quality of medical interactions among Black patients. The PI and others have shown that strong Afrocentric facial features (AFF; i.e., thick lips, wide nose) are associated with more perceived 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) more negative affect and communication style during medical interactions than Blacks with weaker AFF, and thus these patients have poorer adherence and health. We propose a secondary analysis of existing data that include 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 linguistic analysis of the interactions) of patients' and physicians' affect and communication style; and Aim #2) To empirically test a theoretical model that explains: (1) how patients' and physicians' racial attitudes influence the quality of racially discordant medical interactions, which in turn influence patients' subsequent health-related behaviors and health; and (2) how AFF influences racial attitudes, the quality of racially discordant medical interactions, and patients' subsequent adherence and health. Our study is significant, because it will inform the development of effective and efficient interventions addressing health disparities by focusing on relatively easily 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 Black patients' and nonBlack physicians' racial attitudes, addresses within-group variations in health care/health disparities, and is tested through multiple measures to assess affect and communication style.