Perceived racial discrimination in health care and its association with patients' healthcare experiences: does the measure matter?
OBJECTIVE
Examine whether three measures of perceived racial discrimination in health care detect similar rates of discrimination and show similar associations with patients' healthcare experiences.


METHODS
Cross-sectional observational study involving telephone surveys and medical record reviews.


METHODS
Veterans Affairs Pittsburgh Healthcare System.


METHODS
50 White and 50 African American veterans with diabetes.


METHODS
Three types of measures of perceived racial discrimination in health care were compared: single-item and multi-item measures assessing personal experiences of discrimination in healthcare settings, and a measure assessing general racism in the healthcare system. Associations of each measure with patient-reported problems with their medical care and receipt of recommended preventive screenings were also explored.


RESULTS
More African American than White veterans reported perceived discrimination on all measures (personal discrimination, single-item: 42% vs 6%, P<.001; personal discrimination, multi-item: 42% vs 18%, P=.01; general racism: 74% vs 40%, P=.001). In the total sample, discrimination was more likely to be reported on the general racism measure than on the single-item (OR=36.53, 95% CI=7.95-167.89) or multi-item measures (OR=20.28, 95% CI=5.12-80.34) of personal discrimination. The multi-item measure of personal discrimination (OR=3.96, 95% CI=1.29-12.18) and general racism measure (OR=3.61, 95% CI=1.34-9.71) were significantly associated with patient-reported problems with their care. Receipt of recommended screenings was not associated with any of the discrimination measures.


CONCLUSIONS
Different measures of perceived racial discrimination in healthcare settings yield different rates of discrimination and show variable associations with patients' perceptions of care.
Hausmann
Leslie R M
LR
Health Services Research & Development Service, Veterans Affairs Pittsburgh Healthcare System, Center for Health Equity Research and Promotion, Pittsburgh, PA 15206, USA. leslie.hausmann@gmail.com
Kressin
Nancy R
NR
Hanusa
Barbara H
BH
Ibrahim
Said A
SA
D000328:Adult; D001741:Black or African American / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D007407:Interviews as Topic; D008485:Medical Audit; D008875:Middle Aged; D016017:Odds Ratio; D017060:Patient Satisfaction / Q000208:ethnology* / Q000706:statistics & numerical data; D010465:Perception; D010817:Physician-Patient Relations; D011287:Prejudice; D014481:United States; D014493:United States Department of Veterans Affairs; D044465:White People / Q000523:psychology