Understanding negative feedback from South Asian patients: an experimental vignette study.
In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care.



Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16.



Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling.



564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach.



Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression.



Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor.



Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Jenni
0000-0002-0037-274X
J
Burt
University of Exeter Medical School, Exeter, UK.
Gary
G
Abel
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Natasha
N
Elmore
Faculty of Health and Social Care, The Open University, Milton Keynes, UK.
Cathy
C
Lloyd
Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
John
J
Benson
Ipsos MORI, London, UK.
Lara
L
Sarson
Ipsos MORI, London, UK.
Anna
A
Carluccio
University of Exeter Medical School, Exeter, UK.
John
J
Campbell
RAND Corporation, Santa Monica, California, USA.
Marc N
MN
Elliott
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK.
Martin
M
Roland
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data*; D003144:Communication Barriers; D004739:England; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010154:Pakistan / Q000208:ethnology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
PRIMARY CARE; communication; healthcare disparities; minority groups; physician-patient relations