title: The effect of values affirmation on race-discordant patient-provider communication.
abstract: BACKGROUND
  Communication between African American patients and white health care providers has been shown to be of poorer quality when compared with race-concordant patient-provider communication. Fear on the part of patients that providers stereotype them negatively might be one cause of this poorer communication. This stereotype threat may be lessened by a values-affirmation intervention.
  
  
  METHODS
  In a blinded experiment, we randomized 99 African American patients with hypertension to perform a values-affirmation exercise or a control exercise before a visit with their primary care provider. We compared patient-provider communication for the 2 groups using audio recordings of the visit analyzed with the Roter Interaction Analysis System. We also evaluated visit satisfaction, trust, stress, and mood after the visit by means of a questionnaire.
  
  
  RESULTS
  Patients in the intervention group requested and provided more information about their medical condition (mean [SE] number of utterances, 66.3 [6.8] in the values-affirmation group vs 48.1 [5.9] in the control group [P = .03]). Patient-provider communication in the intervention group was characterized as being more interested, friendly, responsive, interactive, and respectful (P = .02) and less depressed and distressed (P = .03). Patient questionnaires did not detect differences in visit satisfaction, trust, stress, or mood. Mean visit duration did not differ significantly between the groups (19.2 minutes in the control group vs 20.5 minutes in the intervention group [P = .29]).
  
  
  CONCLUSIONS
  A values-affirmation exercise improves aspects of patient-provider communication in race-discordant primary care visits. The clinical impact of the intervention must be defined before widespread implementation can be recommended.
authors.affiliation: Department of Medicine, Denver Health Medical Center, Denver, Colorado 80204, USA. Ed.Havranek@dhha.org
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hanratty
authors.forename: Channing
authors.initials: C
authors.lastname: Tate
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Cohen
authors.forename: Irene A
authors.initials: IA
authors.lastname: Blair
mesh_terms: D000328:Adult; D000339:Affect; D001741:Black or African American; D000368:Aged; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care; D012945:Social Values; D035502:Trust; D044465:White People