Abstract

Introduction: Although both socioeconomic and race- related factors both influence quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits. Current study investigated psychosocial determinants of physician visit satisfaction of Black adults based on racial concordance of the medical encounter.


Materials and Methods: Data came from the Detroit Area Study (DAS), a community survey of adults in Michigan, United States. The current analysis included 336 Black individuals who had visited a White (n = 191) or a Black (n=145) physician in the last year. Outcome was satisfaction with the quality of communication with the doctor. Demographics (age and gender), socioeconomic staus (education and income), psychosocial factors (control beliefs and social support), race related factors (having a close White friend, negative attitudes about Blacks, discrimination), and health status (chronic disease count, self-rated health, and distress) of the patient as well as race of the doctor were measured. We used multi-group structural equation modeling (SEM) for data analysis, where the two groups were racially concordant (those who met a Black physician) and racially discordant (those who met a White physician) visits.  


Results: Satisfaction with physician visit was lower in racially discordant than racially concordant encounters. In racially concordant visits, high education was associated with higher satisfaction, however, racial discrimination was associated with lower satisfaction. In racially discordant visits (i.e. with a White doctor), having a White friend as well as high sense of control were associated with a higher satisfaction, while negative attitudes about Blacks was associated with lower level of satisfaction.


Conclusions: Racially concordant and discordant visits have different satisfaction levels. Racially concordant and discordant visits also have different predictors of communication satisfaction among Black patients. Socioeconomic status as well as racial attitudes and experiences impact quality of communication of the Black patients with their doctors, however, these effects depend on the race of the doctor.


References

  1. Smedley, B. D., Stith, A. Y., & Nelson, A. R. Unequal treatment: Confronting racial and ethnic disparities in healthcare. Washington, DC: National Academy Press. 2003.
  2. LaVeist TA, Arthur M, Morgan A, Rubinstein M, Kinder J, Kinney LM, Plantholt S. The cardiac access longitudinal study. A study of access to invasive cardiology among African American and white patients. J Am Coll Cardiol. 2003 Apr 2;41(7):1159-66.
  3. LaVeist TA, Arthur M, Morgan A, Plantholt S, Rubinstein M. Explaining racial differences in receipt of coronary angiography: the role of physician referral and physician specialty. Med Care Res Rev. 2003 Dec;60(4):453-67; discussion 496-508.
  4. Shavers, V. L., Brown, M., Klabunde, C. N., Potosky, A. L., Davis, W., Moul, J. W., & Fahey, A. Race/Ethnicity and the intensity of medical monitoring under 'watchful waiting' for prostate cancer. Medical Care, 2004. 42, 239-250.
  5. Shavers, V. L., Brown, M. L., Potosky, A. L., Klabunde, C. N., Davis, W. W., Moul, J. W., & Fahey, A. Race/ethnicity and the receipt of watchful waiting for the initial management of prostrate cancer. Journal of General Internal Medicine, 2004. 19, 146-155.
  6. Penner LA, Hagiwara N, Eggly S, Gaertner SL, Albrecht TL, Dovidio JF. Racial Healthcare Disparities: A Social Psychological Analysis. Eur Rev Soc Psychol. 2013;24(1):70-122.
  7. Penner LA, Dovidio JF, Hagiwara N, Foster T, Albrecht TL, Chapman RA, Eggly S. An Analysis of Race-related Attitudes and Beliefs in Black Cancer Patients: Implications for Health Care Disparities. J Health Care Poor Underserved. 2016;27(3):1503-20. doi: 10.1353/hpu.2016.0115.
  8. Penner LA, Albrecht TL, Coleman DK, Norton WE. Interpersonal perspectives on Black-White health disparities: Social policy implications. Social Issues and Policy Review. 2007;1:63–98.
  9. Nunez-Smith M, Ciarleglio M, Sandoval-Minero T, Elumn J, Castillo-Page L, Peduzzi P, Bradley E. Medical school faculty promotion in the United States: Is there institutional variation by race/ethnicity? American Journal of Public Health. 2012;102:852–858.
  10. Cooper LA, Roter DL, Johnson RL, Ford DE, Steinwachs DM, Powe NR. Patient-centered communication, ratings of care, and concordance of patient and physician race. Annals of Internal Medicine. 2003;139:907–915.
  11. Johnson RL, Saha S, Arbelaez JJ, Beach MC, Cooper LA. Racial and ethnic differences in patient perceptions of bias and cultural competence in healthcare. Journal of General Internal Medicine. 2004;19:101–110.
  12. Street RL, Gordon HS, Haidet P. Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor? Social Science & Medicine. 2007;65:586–598.
  13. Siminoff LA, Graham GC, Gordon NH. Cancer communication patterns and the influence of patient characteristics: Disparities in information-giving and affective behaviors. Patient Education and Counseling. 2006;62:355–360.
  14. Oliver MN, Goodwin MA, Gotler RS, Gregory PM, Stange KC. Time use in clinical encounters: are African-American patients treated differently? Journal of the National Medicical Association. 2001;93:380–385.
  15. Penner LA, Eggly S, Harper FWK, Albrecht TL, Ruckdeschel JC. Patient attributes and information provided about clinical trials. Proceedings of the American Association for Cancer Research Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved. 2007 Nov;95
  16. Eggly S, Barton E, Winckles A, Penner L, Albrecht T. A disparity of words: A comparison of offers to participate in cancer clinical trials by patient race. Health Expectations in press.
  17. Eggly S, Harper FWK, Penner LA, Gleason MJ, Foster T, Albrecht TL. Variation in question asking during cancer clinical interactions: A potential source in access to information. Patient Education and Counseling. 2011;82:63–68.
  18. Gordon HS, Street RL, Sharf BF, Kelly PA, Souchek J. Racial differences in trust and lung cancer patients’ perceptions of physician communication. Journal of Clinical Oncology. 2006;24:904–909.
  19. Willems S, De Maesschalck S, Deveugele M, Derese A, De Maeseneer J. Socio-economic status of the patient and doctor-patient communication: does it make a difference? Patient Educ Couns. 2005 Feb;56(2):139-46.
  20. Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci. 1999;896:173-88.
  21. Taira DA, Safran DG, Seto TB, Rogers WH, Tarlov AR. The relationship between patient income and physician discussion of health risk behaviors. JAMA 1997;278:1412–7.
  22. Pendleton DA, Bochner S. The communication of medical information in general practice consultations as a function of patients’ social class. Soc Sci Med 1980;14A:669–73.
  23. Street R, Buller D. Patients characteristics affecting physician–patient nonverbal communication. Hum Commun Res 1988;15:60–90.
  24. Street R. Information giving in medical consultations: the influence of patients communicative styles and personal characteristics. Soc Sci Med 1991;32:541–8.
  25. Penner LA, Dovidio JF, West TV, Gaertner SL, Albrecht TL, Dailey RK, Markova T. Aversive Racism and Medical Interactions with Black Patients: A Field Study. J Exp Soc Psychol. 2010 Mar 1;46(2):436-440.
  26. Burgess DJ, Warren J, Phelan S, Dovidio JF, van Ryn M. Stereotype threat and health disparities: What medical educators and future physicians need to know. Journal of General Internal Medicine. 2010;25(Suppl 2):S169–177.
  27. Dovidio JF, Penner LA, Albrecht TL, Norton WE, Gaertner SL, Shelton JN. Disparities and distrust: The implications of psychological processes for understanding racial disparities in health and healthcare. Social Science & Medicine. 2008;67:478–486.
  28. Greer TM. Perceived racial discrimination in clinical encounters among African American hypertension patients. Journal of Healthcare for the Poor and Underserved. 2010;21:251–263.
  29. Benkert R, Peters RM, Clark R, Keves-Foster K. Effects of perceived racism, cultural mistrust and trust in providers on satisfaction with care. Journal of National Medical Association. 2006;98:1532–1540.
  30. LaVeist, T. A., & Nuru-Jeter, A. Is doctor-patient race concordance associated with greater satisfaction with care? Journal of Health and Social Behavior, 2002, 43, 296-306.
  31. LaVeist, T. A., Nuru-Jeter, A., & Jones, K. E. The association of doctor-patient race concordance with health services utilization. Journal of Public Health Policy, 2003, 24, 312-323.
  32. Jackson J, Williams D. Detroit Area Study, 1995: Social Influence on Health: Stress, Racism, and Health Protective Resources. ICPSR03272-v1. Ann Arbor, MI: Inter- university Consortium for Political and SocialResearch [distributor], 2002-08-16. http://doi.org/10.3886/ICPSR03272.v1
  33. Taylor, T. R., Kamarck, T. W., & Shiffman, S. Validation of the Detroit area study discrimination scale in a community sample of older African American adults: The Pittsburgh healthy heart project. International Journal of Behavioral Medicine, 2004. 11, 88–94. doi:10.1207/s15327558ijbm1102_410.1207/s15327558ijbm1102_4
  34. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. Racial differences in physical and mental health: socio-economic status, stress and discrimination. Journal of Health Psychology, 1997, 2, 335–351. doi:10.1177/13591053970020030510.1177/135910539700200305.
  35. Taylor, T. R., Kamarck, T. W., & Shiffman, S. Validation of the Detroit area study discrimination scale in a community sample of older African American adults: The Pittsburgh healthy heart project. International Journal of Behavioral Medicine, 2004,11, 88–94. doi:10.1207/s15327558ijbm1102_410.1207/s15327558ijbm1102_4
  36. Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. Racial differences in physical and mental health: socio-economic status, stress and discrimination. Journal of Health Psychology, 1997, 2, 335–351. doi:10.1177/13591053970020030510.1177/135910539700200305
  37. Desalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. Mortality prediction with a single general self-rated health question. Journal of General Internal Medicine, 2005, 21, 267–275. doi:10.1111/j.1525-1497.2005.0291.x
  38. Jylhä, M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science and Medicine, 2009, 69, 307–316. doi:10.1016/j.socscimed.2009.05.01310.1016/j.socscimed.2009.05.013
  39. Kessler, R. C., Andrews, G., Colpe, L. J., Hiripi, E., Mroczek, D. K. and Normand, S.-L. T. 2002. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med, 32(6): 959–76.
  40. Witt, W. P., Kahn, R., Fortuna, L., Winickoff, J., Kuhlthau, K., Pirraglia, P. A. and Ferris., T. 2009. Psychological distress as a barrier to preventive healthcare among U.S. women. J Primary Prevent, 30(5): 531–547. doi:10.1007/s10935-009-0190-z.
  41. Procidano ME, Heller K. Measures of perceived social support from friends and from family: three validation studies. Am J Community Psychol. 1983 Feb;11(1):1-24
  42. James SA, Hamett SA, Kalsbeek WD. John Henryism and blood pressure differences among black men. J Behav Med 1983,6:259-78.
  43. LaVeist TA, Carroll T. Race of physician and satisfaction with care among African-American patients. J Natl Med Assoc. 2002 Nov;94(11):937-43.
  44. LaVeist TA, Nickerson KJ, Bowie JV. Attitudes about racism, medical mistrust,
  45. and satisfaction with care among African American and white cardiac patients. Med Care Res Rev. 2000;57 Suppl 1:146-61.
  46. Alessi, P. Professional iOS Database Applications, and Programming, 2nd ed.; Taylor and Francis Group: New York, NY, USA, 2002.
  47. Arbuckle, J.L. Amos™ 18 User’s Guide; Amos Development Corporation: Crawfordville, FL, USA, 2009.
  48. Kline, R.B. Principles and Practice of Structural Equation Modeling; Guilford Press: New York, NY, USA, 2011.
  49. Hu, L.; Bentler, P.M. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct. Equ. Model. 1999, 6, 1–55.
  50. Lei, M.; Lomax, R.G. The effect of varying degrees of nonnormality in structural equation modeling. Struct. Equ. Model. 2005, 12, 1–27.
  51. Tabachnick, B.G.; Fidell, L.S. Using Multivariate Statistics, 3rd ed.; Harper Collins: New York, NY, USA, 1996.
  52. Johnson RL, Roter DL, Powe NR, Cooper LA. Patient race and the quality of patient-physician communication during medical visits. American Journal of Public Health. 2004;94:2084–2090.
  53. Elfenbein HA, Ambady N. On the universality and cultural specificity of emotion recognition: A meta-analysis. Psychological Bulletin. 2002;128:203–235.
  54. Young SG, Hugenberg K. Mere social categorization modulates identification of facial expressions of emotion. Journal of Personality and Social Psychology. 2010;99:964–977.
  55. Dunham Y. An angry = outgroup effect. Journal of Experimental Social Psychology. 2011;47:668–671.
  56. Hugenberg K, Bodenhausen GV. Ambiguity in social categorization: The role of prejudice and facial affect in racial categorization. Psychological Science. 2004;15:342–345.
  57. Brown R, Hewstone M. An integrative theory of intergroup contact. In: Zanna M, editor. Advances in experimental social psychology. San Diego, CA: Academic Press; 2005. pp. 255–343.
  58. Boldry JG, Gaertner L, Quinn J. Measuring the measures: A meta-analytic investigation of the measures of outgroup homogeneity. Group Processes and Intergroup Relations. 2007;10:147–178.
  59. Foddy M, Platow MJ, Yamagishi T. Group-based trust in strangers: the role of stereotypes and expectations. Psychol Sci. 2009 Apr;20(4):419-22.
  60. Brown R, Hewstone M. An integrative theory of intergroup contact. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 37,pp. 255–343). San Diego, CA: Elsevier Academic Press. 2005.
  61. Wright SC. Cross-group contact effects. In S. Otten, T. Kessler & K. Sassenberg (Eds.), Intergroup relations: The role of emotion and motivation (pp. 262–283). New York, NY: Psychology Press. 2009.
  62. Judd CM, Park B, Yzerbyt V, Gordijn EH, Muller D. Attributions of intergroup bias and outgroup homogeneity to ingroup and outgroup others. European Journal of Social Psychology. 2005;35:677–704.
  63. Street RL. Communicative styles and adaptations in physician–parent consultations. Soc Sci Med 1992;34:1155–63.
  64. Allport GW. The nature of prejudice. Cambridge, MA: Perseus Books. 1954.
  65. Whitley BE. Kite ME. The Psychology of Prejudice and Discrimination. Belmont, CA: Wadsworth. 2010.
  66. Brown KT; Brown TN; Jackson JS; Sellers RM; Manuel WJ. Teammates on and off the field? Contact with Black teammates and the racial attitudes of White student athletes. Journal of Applied Social Psychology. 2003; 33: 1379–1403. doi:10.1111/j.1559-1816.2003.tb01954.x.
  67. Pettigrew TF; Tropp LR. A meta-analytic test of intergroup contact theory. Journal of Personality and Social Psychology. 2006, 90 (5): 751–783. doi:10.1037/0022-3514.90.5.751.
  68. Otten S, Moskowitz GB. Evidence for implicit evaluative ingroup bias: Affect-biased spontaneous trait inference in a minimal group paradigm. Journal of Experimental Social Psychology. 2000;36:77–89.
  69. Tajfel H, Turner J. An integrative theory of intergroup conflict. In: Austin WG, Worchel S, editors. The social psychology of intergroup relations. Monterey, CA: Brooks/Cole; 1979. pp. 33–48.
  70. Street RL, Jr, O’Malley KJ, Cooper LA, Haidet P. Understanding concordance in patient-physician relationships: Personal and ethnic dimensions of shared identity. Annals of Family Medicine. 2008;6:198–205.
  71. Hagiwara N, Penner LA, Gonzalez R, Eggly S, Dovidio JF, Gaertner SL, West T, Albrecht TL. Racial attitudes, social control, and adherence in racially discordant medical interactions. Social Science and Medicine. 2013;87:123–131.
  72. Penner LA, Dovidio JF, Edmondson D, Dailey RK, Markova T, Albrecht TL, Gaertner SL. The experience of discrimination and Black-White health disparities in medical care. Journal of Black Psychology. 2009;35:180–203.
  73. Casagrande SS, Gary TL, LaVeist TA, Gaskin DJ, Cooper LA. Perceived discrimination and adherence to medical care in a racially integrated community. Journal of General Internal Medicine. 2007;22 :389–395.
  74. LaVeist TA, Nuru-Jeter A, Jones KE. The association of doctor-patient race concordance with health services utilization. Journal of Public Health Policy. 2003;24:312–323.
  75. Burgess DJ, van Ryn M, Crowley-Matoka M, Malat J. Understanding the provider contribution to race/ethnicity disparities in pain treatment: Insights from dual process models of stereotyping. Pain Medicine. 2006;7:119–134.
  76. Burgess D, van Ryn M, Dovidio JF, Saha S. Reducing racial bias among healthcare providers: Lessons from social-cognitive psychology. Journal of General Internal Medicine. 2007;8:882–887.
  77. Chen FM, Fryer GE, Phillips RL, Wilson E, Pathman DE. Patients’ beliefs about racism, preferences for physician race, and satisfaction with care. Annals of Family Medicine. 2005;3:139–143.
  78. Garcia JA, Paterniti DA, Romano PS, Kravitz RL. Patient preferences for physician characteristics in university-based primary care clinics. Ethnicity and Disease. 2003;13:259–267.
  79. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007 Jul;97(7):1283-9.
  80. Lurie N, Zhan C, Sangl J, Bierman AS, Sekscenski ES. Variation in racial and ethnic differences in consumer assessments of health care. Am J Manag Care. 2003 Jul;9(7):502-9.
  81. Murray-García JL, Selby JV, Schmittdiel J, Grumbach K, Quesenberry CP Jr. Racial and ethnic differences in a patient survey: patients' values, ratings, and reports regarding physician primary care performance in a large health maintenance organization. Med Care. 2000 Mar;38(3):300-10.
  82. Wong MD, Asch SM, Andersen RM, Hays RD, Shapiro MF. Racial and ethnic differences in patients' preferences for initial care by specialists. Am J Med. 2004 May 1;116(9):613-20.
  83. Assari S, Lee DB, Nicklett EJ, Moghani Lankarani M, Piette JD, Aikens JE. Racial Discrimination in Health Care Is Associated with Worse Glycemic Control among Black Men but Not Black Women with Type 2 Diabetes. Front Public Health. 2017 Sep 12;5:235. doi: 10.3389/fpubh.2017.00235.
  84. Poma PA. Race/Ethnicity Concordance Between Patients and Physicians. J Natl Med Assoc. 2017 Spring;109(1):6-8. doi: 10.1016/j.jnma.2016.12.002.
  85. Smith GH, Hampton C, Brandon WP. Physicians, Physician Extenders and Health Outcomes: Race, Gender and Patient-Health Provider Concordance in North Carolina Medicaid. J Health Care Poor Underserved. 2018;29(1):530-555. doi:10.1353/hpu.2018.0035.
  86. Scheid TL, Smith GH. Is physician-patient concordance associated with greater trust for women of low socioeconomic status? Women Health. 2017 Jul;57(6):631-649. doi: 10.1080/03630242.2016.1202881.
  87. Harvey VM, Ozoemena U, Paul J, Beydoun HA, Clemetson NN, Okoye GA. Patient-provider communication, concordance, and ratings of care in dermatology: Results of a cross-sectional study. Dermatol Online J. 2016 Nov 15;22(11). pii:13030/qt06j6p7gh.
  88. Byrne BM, Structural Equation Modeling With AMOS: Basic Concepts, Applications, and Programming, Second Edition (Multivariate Applications Series) . Routledge, Taylor & Francis group, New York. 2010.

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