Cultural identities and perceptions of health among health care providers and older American Indians.
BACKGROUND
Differences in provider-patient health perceptions have been associated with poor patient outcomes, but little is known about how patients' cultural identities may be related to discordant perceptions.


OBJECTIVE
To examine whether health care providers and American-Indian patients disagreed on patient health status ratings, and how differences related to these patients' strength of affiliation with American-Indian and white-American cultural identities.


METHODS
Survey of patients and providers following primary care office visits.


METHODS
One hundred and fifteen patients > or =50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American-Indian race, but varied in strength of affiliation with separate measures of American-Indian and white-American cultural identities.


METHODS
Self-reported sociodemographic and cultural characteristics, and a 5-point rating of patient's health completed by both patients and providers. Fixed-effects regression modeling examined the relationships of patients' cultural identities with differences in provider-patient health rating.


RESULTS
In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients' self-rating. Provider-patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P=.01). Differences in ratings were not associated with the separate measure of affiliation with American-Indian identity.


CONCLUSIONS
American-Indian patients, especially those who affiliate weakly with white-American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions.
Garroutte
Eva Marie
EM
Department of Sociology, Boston College, Chestnut Hill, MA, USA.
Sarkisian
Natalia
N
Arguelles
Lester
L
Goldberg
Jack
J
Buchwald
Dedra
D
D001291:Attitude of Health Personnel; D003466:Cultural Characteristics; D006282:Health Personnel / Q000523:psychology*; D006304:Health Status; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008875:Middle Aged; D009819:Office Visits; D011320:Primary Health Care; D012649:Self Concept; D011795:Surveys and Questionnaires; D044465:White People / Q000523:psychology*