Blavatnik Family Women's Health Research Institute, New York, NY.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
Ethn Dis. 2020 Sep 24;30(4):533-542. doi: 10.18865/ed.30.4.533. eCollection 2020 Fall.
Black and Latina women in New York City are twice as likely to experience a potentially life-threatening morbidity during childbirth than White women. Health care quality is thought to play a role in this stark disparity, and patient-provider communication is one aspect of health care quality targeted for improvement. Perceived health care discrimination may influence patient-provider communication but has not been adequately explored during the birth hospitalization.
Our objective was to investigate the impact of perceived racial-ethnic discrimination on patient-provider communication among Black and Latina women giving birth in a hospital setting.
We conducted four focus groups of Black and Latina women (n=27) who gave birth in the past year at a large hospital in New York City. Moderators of concordant race/ethnicity asked a series of questions on the women's experiences and interactions with health care providers during their birth hospitalizations. One group was conducted in Spanish. We used an integrative analytic approach. We used the behavioral model for vulnerable populations adapted for critical race theory as a starting conceptual model. Two analysts deductively coded transcripts for emergent themes, using constant comparison method to reconcile and refine code structure. Codes were categorized into themes and assigned to conceptual model categories.
Predisposing patient factors in our conceptual model were intersectional identities (eg, immigrant/Latina or Black/Medicaid recipient), race consciousness ("…as a woman of color, if I am not assertive, if I am not willing to ask, then they will not make an effort to answer"), and socially assigned race (eg, "what you look like, how you talk"). We classified themes of differential treatment as impeding factors, which included factors overlooked in previous research, such as perceived differential treatment due to the relationship with the infant's father and room assignment. Themes for differential treatment co-occurred with negative provider communication attributes (eg, impersonal, judgmental) or experience (eg, not listened to, given low priority, preferences not respected).
Perceived racial-ethnic discrimination during childbirth influences patient-provider communication and is an important and potentially modifiable aspect of the patient experience. Interventions to reduce obstetric health care disparities should address perceived discrimination, both from the provider and patient perspectives.
在纽约市，黑人和拉丁裔女性在分娩期间经历潜在危及生命的发病率是白人女性的两倍。人们认为医疗质量在这种明显的差异中发挥了作用，而医患沟通是医疗质量的一个方面，需要加以改进。感知到的医疗保健歧视可能会影响医患沟通，但在分娩住院期间并未得到充分探讨。
我们的目的是调查在医院环境中分娩的黑人和拉丁裔女性中，感知到的种族歧视对医患沟通的影响。
我们对在纽约市一家大医院过去一年分娩的 27 名黑人和拉丁裔女性进行了 4 次焦点小组讨论。具有一致性种族/民族的主持人询问了一系列关于女性在分娩住院期间与医疗保健提供者的经历和互动的问题。其中一组是用西班牙语进行的。我们采用了综合分析方法。我们使用适应于批判种族理论的脆弱人群行为模型作为起始概念模型。两名分析师使用恒定性比较方法对转录本进行演绎编码，以协调和完善代码结构。代码被归类为主题，并分配给概念模型类别。
我们概念模型中的前置患者因素是交叉身份（例如，移民/拉丁裔或黑人/医疗补助接受者）、种族意识（“……作为一个有色人种女性，如果我不自信，如果我不愿意提问，那么他们就不会努力回答”）和社会分配的种族（例如，“你的样子，你的说话方式”）。我们将差异化待遇的主题归类为阻碍因素，其中包括以前研究中忽略的因素，例如由于与婴儿父亲的关系和房间分配而导致的感知到的差异化待遇。差异化待遇的主题与负面的提供者沟通属性（例如，冷漠、评判性）或体验（例如，不被倾听、被置于低优先级、不尊重偏好）同时出现。
分娩期间感知到的种族歧视会影响医患沟通，是患者体验的一个重要且潜在可改变的方面。减少产科医疗保健差异的干预措施应从提供者和患者的角度解决感知到的歧视。
