title: Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review.
abstract: OBJECTIVE
  Recent investigations of ethnicity related disparities in health care have focused on the contribution of providers' implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical research on the potential influence of health care professionals' attitudes and behaviors towards ethnic minority patients on health care disparities.
  
  
  METHODS
  Integrative literature review.
  
  
  METHODS
  Four internet-based literature indexes - MedLine, PsychInfo, Sociological Abstracts and Web of Science - were searched for articles published between 1982 and 2012 discussing health care professionals' attitudes or behaviors towards ethnic minority patients.
  
  
  METHODS
  Thematic analysis was used to synthesize the relevant findings.
  
  
  RESULTS
  We found 47 studies from 12 countries. Six potential barriers to health care for ethnic minorities were identified that may be related to health care professionals' attitudes or behaviors: Biases, stereotypes and prejudices; Language and communication barriers; Cultural misunderstandings; Gate-keeping; Statistical discrimination; Specific challenges of delivering care to undocumented migrants.
  
  
  CONCLUSIONS
  Data on health care professionals' attitudes or behaviors are both limited and inconsistent. We thus provide reflections on methods, conceptualization, interpretation and the importance of the geographical or socio-political settings of potential studies. More empirical data is needed, especially on health care professionals' attitudes or behaviors towards (irregular) migrant patients.
authors.affiliation: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland. Electronic address: daniel.drewniak@ethik.uzh.ch.
authors.forename: Daniel
authors.initials: D
authors.lastname: Drewniak
authors.affiliation: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland; Clinical Ethics, University Hospital Zurich, c/o Dermatologische Klinik, Gloriastrasse 31, 8091 Zurich, Switzerland. Electronic address: tanja.krones@usz.ch.
authors.forename: Tanja
authors.initials: T
authors.lastname: Krones
authors.affiliation: Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, 8006 Zurich, Switzerland; Chair of Philosophy IV, Ludwig-Maximilians-University of Munich, Geschwister-Scholl-Platz 1, 80539 Munich, Germany. Electronic address: V.Wild@lrz.uni-muenchen.de.
authors.forename: Verina
authors.initials: V
authors.lastname: Wild
mesh_terms: D001291:Attitude of Health Personnel; D005006:Ethnicity; D006282:Health Personnel / Q000523:psychology*; D054625:Healthcare Disparities; D006801:Humans; D008913:Minority Groups
keywords: Attitudes and behavior; Ethnic minorities; Health care disparities; Health care personnel; Immigrants; Integrative literature review