Department of Family Medicine, McGill University, Montréal, Canada.
Department of Community Health & Epidemiology, Dalhousie University, Halifax, Canada.
Ethn Health. 2024 Apr;29(3):343-352. doi: 10.1080/13557858.2024.2311429. Epub 2024 Feb 9.
A growing body of evidence points to persistent health inequities within racialized minority communities, and the effects of racial discrimination on health outcomes and health care experiences. While much work has considered how anti-Black racism operates at the interpersonal and institutional levels, limited attention has focused on internalized racism and its consequences for health care. This study explores patients' attitudes towards anti-Black racism in a Canadian health care system, with a particular focus on internalized racism in primary health care.
This qualitative study employed purposive maximal variation and snowball sampling to recruit and interview self-identified Black persons aged 18 years and older who: (1) lived in Montréal during the COVID-19 pandemic, (2) could speak English or French, and (3) were registered with the Québec health insurance program. Adopting a phenomenological approach, in-depth interviews took place from October 2021 to July 2022. Following transcription, data were analyzed thematically.
Thirty-two participants were interviewed spanning an age range from 22 years to 79 years (mean: 42 years). Fifty-nine percent of the sample identified as women, 38% identified as men, and 3% identified as non-binary. Diversity was also reflected in terms of immigration experience, financial situation, and educational attainment. We identified three major themes that describe mechanisms through which internalized racism may manifest in health care to impact experiences: (1) the internalization of anti-Black racism by Black providers and patients, (2) the expression of anti-Black prejudice and discrimination by non-Black racialized minority providers, and (3) an insensitivity towards racial discrimination.
Our study suggests that multiple levels of racism, including internalized racism, must be addressed in efforts to promote health and health care equity among racialized minority groups, and particularly within Black communities.
越来越多的证据表明，在种族化少数群体社区中存在持续的健康不平等现象，以及种族歧视对健康结果和医疗保健体验的影响。虽然许多工作都考虑了反黑人种族主义在人际和制度层面上的运作方式，但对内化的种族主义及其对医疗保健的影响关注有限。本研究探讨了患者在加拿大医疗保健系统中对反黑人种族主义的态度，特别关注初级保健中的内化种族主义。
这项定性研究采用目的性最大变异和滚雪球抽样方法招募和访谈了自认为是黑人的 18 岁及以上的人，他们：（1）在 COVID-19 大流行期间居住在蒙特利尔，（2）能够讲英语或法语，（3）在魁北克医疗保险计划中注册。采用现象学方法，从 2021 年 10 月至 2022 年 7 月进行了深入访谈。转录后，采用主题分析法进行数据分析。
共访谈了 32 名参与者，年龄从 22 岁到 79 岁不等（平均年龄 42 岁）。样本中 59%为女性，38%为男性，3%为非二元性别。移民经历、财务状况和教育程度也反映出多样性。我们确定了三个主要主题，描述了内化的种族主义可能在医疗保健中表现出来影响体验的机制：（1）黑人提供者和患者内化的反黑人种族主义，（2）非黑人种族化少数群体提供者表达的反黑人偏见和歧视，（3）对种族歧视的不敏感。
我们的研究表明，在努力促进种族化少数群体，特别是黑人社区的健康和医疗保健公平方面，必须解决包括内化种族主义在内的多个层面的种族主义。
