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Theses Doctoral

The Influence of Discriminatory Beliefs on Practice

Armbrister, Adria

Black women in the United States suffer disproportionately from a number of chronic and acute diseases. Not only do black women suffer from these diseases, they also have poorer outcomes and higher levels of morbidity and mortality than others. Years of biomedical and social science research have identified various permutations of patient-level factors, including cultural mistrust and genetic predisposition, to explain the existence of this race and gender-specific reality. However, few studies have looked at physician-level influences on poor health results for black women.
Through the use of face-to-face and internet-based instruments combining patient vignettes and closed and open-ended treatment questions, the Implicit Association Test (IAT) and a series of measures of explicit discriminatory beliefs, this study used the case of Systemic Lupus Erythematosus (SLE) to illustrate how and whether decisions about medical treatment and follow-up for black women patients differ from decisions made for white women patients in varying degrees according to: the patient´s race; the severity of symptoms; the physician's perception of the patient's personal characteristics (e.g., personality, mood); the physician's demographic characteristics; and the physician´s score on the discriminatory belief measures named above. The study has collected data from 94 rheumatologists.
The study enabled the assessment of differences in treatment recommendations for women SLE patients presenting with symptoms of lupus nephritis (LN), a fairly common organ involvement for people with SLE. The only difference between the patients seen by the doctors through the study was their race, black or white, so the study asked whether treatment recommendations were significantly different for black patients as compared to white patients. The study also asked whether these treatment decisions could be predicted by scores on a series of measures of implicit (unconscious) and explicit racial bias. Overall, this study did not find evidence that physicians recommended less optimal treatment to black patients. Several possible reasons for the non-significant findings are discussed.
The thesis recommends further study and intervention into the identification and treatment of early symptoms of disease among black women to reduce the incidence of avoidable morbidity and mortality in this population. These studies should as well take into account the possibility that over-compensatory behaviors may be exhibited by physician study participants who suspect that their racism or discriminatory beliefs may be revealed through their responses. New methods to obscure explicit and implicit discriminatory measures and to reduce the threat of racism for respondents should be explored.

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More About This Work

Academic Units
Sociomedical Sciences
Thesis Advisors
Phelan, Jo C.
Degree
Ph.D., Columbia University
Published Here
August 6, 2014
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