Louis Kengthsagn, Crum Alia J, Markus Hazel R
Department of Psychology, Stanford University, United States.
Department of Psychology, Stanford University, United States.
Soc Sci Med. 2023 Jan;316:115141. doi: 10.1016/j.socscimed.2022.115141. Epub 2022 Jun 14.
Most patients assume that it is adaptive to present oneself in a positive light when interacting with medical professionals. Here in two studies focused on Black patients we ask: might this desire to present oneself well inhibit the disclosure of health-relevant information when patients are concerned about negative and stereotypic evaluations by their health care providers?
Specifically, we explore three important questions: First, whether self-presentational efforts (e.g., working hard to sound knowledgeable or "smart") are negatively associated with disclosure of health information (e.g., not taking certain medications); Second, whether patient-provider racial congruence (e.g. Black patients interacting with a Black vs. a White doctor) moderates that relationship; and third, more broadly, what factors promote or inhibit disclosure of health information for Black patients in medical interactions.
These questions were investigated using mixed methodology (survey, experimental, qualitative) studies on CloudResearch and Prolific.
We found a potential catch-22: participants who spend more effort self-presenting tend to be less comfortable disclosing health information to their healthcare providers. Moreover, Study 1 (N = 321) indicated that the negative relationship between self-presentation and disclosure was significant in Black-incongruent (i.e., Black patient and White provider) and White-congruent (i.e., White patient and White provider) medical interactions. Study 2 (N = 361) did not find a significant moderation by race of the provider but instead suggested that the relationship between self-presentation and disclosure was moderated by expectations of unfair treatment. Exploratory qualitative analyses suggested that some Black participants face a dilemma when deciding whether to disclose information to their healthcare providers. They weigh the kind of information they will share, and how sharing some information might lead to embarrassment and judgment.
Mitigating the potentially counteractive effects of self-presentation on disclosure and working to foster contexts that encourage honest disclosure of health information may help to reduce health care inequalities.
大多数患者认为，在与医疗专业人员互动时以积极的形象展现自己是一种适应性行为。在这两项针对黑人患者的研究中，我们提出疑问：当患者担心医护人员的负面和刻板评价时，这种想要展现良好形象的愿望是否会抑制与健康相关信息的披露？
具体而言，我们探讨三个重要问题：第一，自我展示的努力（例如，努力让自己听起来知识渊博或“聪明”）是否与健康信息的披露（例如，不服用某些药物）呈负相关；第二，患者与医护人员的种族一致性（例如，黑人患者与黑人医生还是白人医生互动）是否会调节这种关系；第三，更广泛地说，在医疗互动中，哪些因素促进或抑制黑人患者披露健康信息。
我们使用混合方法（调查、实验、定性）在CloudResearch和Prolific平台上进行研究，以调查这些问题。
我们发现了一个潜在的困境：那些在自我展示上投入更多精力的参与者，往往不太愿意向医护人员披露健康信息。此外，研究1（N = 321）表明，在黑人与医护人员种族不一致（即黑人患者和白人医护人员）以及白人与医护人员种族一致（即白人患者和白人医护人员）的医疗互动中，自我展示与信息披露之间的负相关关系显著。研究2（N = 361）没有发现医护人员种族对这种关系有显著调节作用，而是表明自我展示与信息披露之间的关系受到不公平待遇预期的调节。探索性定性分析表明，一些黑人参与者在决定是否向医护人员披露信息时面临两难境地。他们会权衡要分享的信息类型，以及分享某些信息可能如何导致尴尬和评判。
减轻自我展示对信息披露的潜在反作用，并努力营造鼓励诚实披露健康信息的环境，可能有助于减少医疗保健不平等现象。
