title: Patient perspectives on disparities in healthcare from African-American, Asian, Hispanic, and Native American samples including a secondary analysis of the Institute of Medicine focus group data.
abstract: The existence of racial and ethnic disparities in healthcare in the United States is well recognized. However, often overlooked in the planning and design of initiatives to address those disparities are the patient perspectives regarding the issues of racial and ethnic disparities that directly affect them. The objective of this study was to identify the patient priorities and to provide recommendations for action to improve minority health-care quality. A secondary objective was the qualitative analysis of the Institute of Medicine (IOM) focus group data. Six focus groups were conducted with nine participants in each. These included an African-American focus group in Washington, D.C., an African-American focus group in Los Angeles, an Asian focus group in Los Angeles, an Hispanic focus group in Washington, D.C., an Hispanic focus group in Los Angeles, and a Native American focus group in Albuquerque, NM. The barriers and priorities for action included difficulty in making informed choices when identifying and selecting providers, poor service delivery from medical office staff, the inefficiency of medical visits, provider communication and cultural competence barriers, and stressful treatment settings. Patient recommendations targeted provision of tools to empower patients throughout the process of care, provider and staff training in communication and cultural competence, alternate models of service delivery, and accessible mechanisms for evaluation and oversight. This study concluded that patient-identified priorities and recommendations warranted modification of current explanatory models for minority health-care quality and the provision of greater clarity regarding directions for policy and behavioral initiatives and criteria for performance evaluation be advanced.
authors.affiliation: Acute and Chronic Care Department, Johns Hopkins University, School of Nursing, Baltimore, MD 21205, USA. fannie@son.jhmi.edu
authors.forename: Fannie
authors.initials: F
authors.lastname: Gaston-Johansson
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.forename: Lola
authors.initials: L
authors.lastname: Oguntomilade
authors.forename: Vanessa
authors.initials: V
authors.lastname: Bradley
authors.forename: Phyllis
authors.initials: P
authors.lastname: Mason
mesh_terms: D001741:Black or African American / Q000208:ethnology*; D001213:Asian / Q000208:ethnology*; D001291:Attitude of Health Personnel; D001294:Attitude to Health / Q000208:ethnology*; D003144:Communication Barriers; D003431:Cross-Cultural Comparison; D054521:Cultural Competency; D017144:Focus Groups; D006287:Health Planning Guidelines; D006292:Health Priorities; D006297:Health Services Accessibility / Q000458:organization & administration; D054625:Healthcare Disparities / Q000458:organization & administration; D006630:Hispanic or Latino / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American / Q000208:ethnology*; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D020380:Needs Assessment; D009516:New Mexico; D015404:Nursing Methodology Research; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D017749:Total Quality Management; D014481:United States