Kemmick Pintor Jessie B, McAlpine Donna, Beebe Timothy J, Johnson Pamela J
*Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis †Department of Health Sciences Research, Mayo Clinic, Rochester ‡Division of Epidemiology & Community Health, Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN.
Med Care. 2015 May;53(5):471-6. doi: 10.1097/MLR.0000000000000351.
To examine the effect of survey mode (mail vs. telephone) on the likelihood of reporting health care-related discrimination based on race, ethnicity, or nationality.
We use data from a mixed-mode, mail and telephone survey of public health care program enrollees (N=2807), including Somali, Hmong, African American, American Indian, and Latino populations. Self-reported discrimination was measured as the experience of unfair treatment by health care providers due to race, ethnicity, or nationality. We use propensity score matching to create exchangeable groups of phone and mail respondents based on the probability of completing the survey by phone.
Overall, 33.1% of respondents reported having experienced discrimination in health care, but only 23.6% of telephone respondents reported discrimination compared with 36.8% of mail respondents. After matching phone and mail respondents based on probability of responding by telephone, all observable significant differences between respondents that were brought about by differential self-selection into mode were erased, allowing us to estimate the effect of survey mode on report of discrimination. Even after matching, the mode effect remains, where report of health care discrimination for telephone respondents would have been 12.6 percentage points higher had they responded by mail (22.6% vs. 35.2%).
Survey mode has a significant effect on report of discrimination. Respondents may be more willing to disclose experiences of discrimination in a mail survey than to a telephone interviewer. Findings have substantial policy and clinical significance as variation in report of discrimination based on mode may lead to underestimation of the extent of the problem.
研究调查方式（邮寄问卷与电话调查）对基于种族、族裔或国籍报告医疗保健相关歧视可能性的影响。
我们使用了对公共医疗保健项目参与者（N = 2807）进行的混合模式（邮寄问卷和电话调查）的数据，这些参与者包括索马里人、苗族、非裔美国人、美洲印第安人和拉丁裔人群。自我报告的歧视被定义为医疗保健提供者因种族、族裔或国籍而给予的不公平待遇经历。我们使用倾向得分匹配法，根据通过电话完成调查的概率，创建电话调查和邮寄问卷调查对象的可交换组。
总体而言，33.1%的受访者报告在医疗保健方面经历过歧视，但电话调查的受访者中只有23.6%报告了歧视，而邮寄问卷调查的受访者中这一比例为36.8%。在根据电话回应概率对电话调查和邮寄问卷调查对象进行匹配后，因选择调查方式不同而导致的受访者之间所有可观察到的显著差异都被消除了，这使我们能够估计调查方式对歧视报告的影响。即使在匹配之后，调查方式的影响仍然存在，如果电话调查的受访者通过邮寄问卷方式回应，他们报告医疗保健歧视的比例会高出12.6个百分点（22.6%对35.2%）。
调查方式对歧视报告有显著影响。受访者在邮寄问卷调查中可能比在电话访谈中更愿意披露歧视经历。由于基于调查方式的歧视报告差异可能导致对问题严重程度的低估，这些发现具有重大的政策和临床意义。
