Unconscious biases: racial microaggressions in American Indian health care.
OBJECTIVE
This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM).


METHODS
This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM.


RESULTS
Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models.


CONCLUSIONS
Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.
From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO). mlwalls@d.umn.edu.
Melissa L
ML
Walls
From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO).
John
J
Gonzalez
From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO).
Tanya
T
Gladney
From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO).
Emily
E
Onello
D002908:Chronic Disease; D055812:Community-Based Participatory Research; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000379:methods*; D015995:Prevalence; D014481:United States / Q000453:epidemiology
Cross-Cultural Care; Patient-Centered Care; Populations; Underserved