Eliciting patient past experiences of healthcare discrimination as a potential pathway to reduce health disparities: A qualitative study of primary care staff.
Dharma E Cort��s, Ana M Progovac, Frederick Lu, Esther Lee, Nathaniel M Tran, Margo A Moyer, Varshini Odayar, Caryn R R Rodgers, Leslie Adams, Valeria Chambers, Jonathan Delman, Deborah Delman, Selma de Castro, Mar��a Jos�� S��nchez Rom��n, Natasha A Kaushal, Timothy B Creedon, Rajan A Sonik, Catherine Rodriguez Quinerly, Ora Nakash, Afsaneh Moradi, Heba Abolaban, Tali Flomenhoft, Ruth Nabisere, Ziva Mann, Sherry Shu-Yeu Hou, Farah N Shaikh, Michael W Flores, Dierdre Jordan, Nicholas Carson, Adam C Carle, Benjamin L�� Cook, Danny McCormick
Author Information
Dharma E Cort��s: Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA. ORCID
Ana M Progovac: Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA. ORCID
Frederick Lu: Warren Alpert Medical School of Brown University, Brown University Health, Providence, Rhode Island, USA. ORCID
Esther Lee: University of Michigan, School of Public Health, Ann Arbor, Michigan, USA.
Nathaniel M Tran: University of Illinois Chicago, Chicago, Illinois, USA. ORCID
Margo A Moyer: John Snow Institute, Boston, Massachusetts, USA.
Varshini Odayar: Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Caryn R R Rodgers: Department of Pediatrics and Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, USA.
Leslie Adams: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Valeria Chambers: Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Jonathan Delman: UMass Chan Medical School, Worcester, Massachusetts, USA.
Deborah Delman: Operation ABLE, Boston, Massachusetts, USA.
Selma de Castro: Just A Start, Cambridge, Massachusetts, USA.
Mar��a Jos�� S��nchez Rom��n: College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Natasha A Kaushal: ECOG-ACRIN Cancer Research Group, Philadelphia, Pennsylvania, USA.
Timothy B Creedon: U.S. Department of Health and Human Services, Washington, DC, USA. ORCID
Rajan A Sonik: Brandeis University, Waltham, Massachusetts, USA.
Catherine Rodriguez Quinerly: Massachusetts Department of Mental Health, Boston, Massachusetts, USA.
Ora Nakash: Smith College School for Social Work, Northampton, Massachusetts, USA.
Afsaneh Moradi: Blair Athol Medical Clinic, Adelaide, South Australia, Australia.
Heba Abolaban: Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Tali Flomenhoft: Equip, Carlsbad, California, USA.
Ruth Nabisere: Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Ziva Mann: Ascent Leadership Networks, New York, New York, USA.
Sherry Shu-Yeu Hou: Public Policy and Population Health Observatory, McGill University, Montreal, Quebec, Canada.
Farah N Shaikh: Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Michael W Flores: Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA. ORCID
Dierdre Jordan: Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Nicholas Carson: Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Adam C Carle: James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA.
Benjamin L�� Cook: Harvard Medical School, Boston, Massachusetts and Health Equity Research Lab, Cambridge Health Alliance, Cambridge, Massachusetts, USA.
Danny McCormick: Cambridge Health Alliance, Cambridge, Massachusetts, USA.
OBJECTIVE: To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care. DATA SOURCES/STUDY SETTING: Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care. STUDY DESIGN: Qualitative study. DATA COLLECTION/EXTRACTION METHODS: Data were collected via semi-structured qualitative interviews between December 2018 and January 2019, with health care staff in primary care roles at a hospital-based clinic within an urban safety-net health system that serves a patient population with significant racial, ethnic, and linguistic diversity. PRINCIPAL FINDINGS: Providers did not routinely, or in a structured way, elicit information about past experiences of healthcare discrimination. Some providers believed that information about healthcare discrimination experiences could allow them to be more aware of and responsive to their patients' needs and to establish more trusting relationships. Others did not deem it appropriate or useful to elicit such information and were concerned about challenges in collecting and effectively using such data. CONCLUSIONS: While providers see value in eliciting past experiences of discrimination, directly and systematically discussing such experiences with patients during a primary care encounter is challenging for them. Collecting this information in primary care settings will likely require implementation of multilevel systematic data collection strategies. Findings presented here can help identify clinic-level opportunities to do so.
