Nonwhite, Disadvantaged Patients Feel Less Respected, Survey Says

Nicola M. Parry, DVM

November 27, 2019

Nonwhite, low-income, and uninsured patients are less likely to report being treated with respect, a recent survey published online November 27 in JAMA Network Open has revealed.

These patients were also "more likely to view health care professionals' knowledge of culture as important, which highlights deficiencies in providing access to culturally appropriate care for these populations," write Lynn A. Blewett, PhD, from the University of Minnesota School of Public Health, Minneapolis, and colleagues.

Cultural competence plays a key role in addressing racial and ethnic disparities in healthcare.

However, patients' opinions of the competency of their healthcare professionals remain incompletely investigated.

To help close this gap, the Office of the Assistant Secretary for Health's Office of Minority Health and Health Equity sponsored the addition of five new cultural competency questions to the 2017 National Health Interview Survey.

The researchers used these questions to examine patients' experiences with their clinicians with respect to cultural competence.

The survey sample population comprised 22,864 adults aged 18 years or older who had seen a clinician in the past year.

Of the 22,864 respondents, 64.4% (n = 14,724) identified as white (non-Hispanic).

In response to three of the five cultural competency questions, most patients reported that clinicians "always" or "most of the time" treated them with respect (96.6%); gave them information that was easy to understand (91.8%); and asked their opinions or beliefs about care (58.5%).

In addition, almost one half of respondents indicated that it was "very," "somewhat," or "slightly" important for their clinicians to understand or share similar cultural characteristics (48.5%).

Of these 10,526 respondents, more than two thirds were able to "always" or "most of the time" see culturally similar providers (70.2%).

When the researchers adjusted the data by respondents' sociodemographic characteristics, they found that, compared with non-Hispanic white patients (n = 16,276), nonwhite patients (n = 6333) were significantly less likely to report that clinicians treated them with respect "always" or "most of the time" (P ≤ .01).

Similarly, compared with insured (n = 21,225) and higher-income (n = 15,086) respondents, significantly fewer uninsured (n = 1330) and low-income (n = 6518) patients indicated that they were "always" or "most of the time" treated with respect (P ≤ .003 for all comparisons).

Compared with respondents who identified as non-Hispanic whites (n = 16,232), were insured (n = 21,157), or had a higher income (n = 15,056), patients who were nonwhite (n = 6308), uninsured (n = 1329), and had low income (n = 6491) were also significantly more likely to view clinicians' knowledge of culture as "very" or "somewhat" important (P < .001 for all comparisons).

However, patients who were nonwhite (n = 3756), uninsured (n = 734), and had low income (n = 3395) were also significantly less likely than those who identified as non-Hispanic whites (n = 6646), were insured (n = 9638), and had a higher income (n = 6538) to be able to "always" or "most of the time" see culturally similar providers (P < .001 for all comparisons).

Although the study was limited by its cross-sectional nature and was restricted to patients who had visited a healthcare professional in the past year, the findings highlight the need to reduce health disparities and improve health equity for patients.

"Medical schools should consider improving the pipeline of diverse health care professionals and increasing efforts to eliminate structural racism that persists in the health care delivery system," Blewett and colleagues conclude.

One author reports having received a grant from the National Institutes of Child Health and Human Development during the conduct of the study. The remaining authors have reported no relevant financial relationships.

JAMA Netw Open. Published online November 27, 2019. Full text

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