Explicit discrimination and health: development and psychometric properties of an assessment instrument

Abstract

OBJECTIVE:To develop an instrument to assess discrimination effects on health outcomes and behaviors, capable of distinguishing harmful differential treatment effects from their interpretation as discriminatory events. METHODS:Successive versions of an instrument were developed based on a systematic review of instruments assessing racial discrimination, focus groups and review by a panel comprising seven experts. The instrument was refi ned using cognitive interviews and pilot-testing. The fi nal version of the instrument was administered to 424 undergraduate college students in the city of Rio de Janeiro, Southeastern Brazil, in 2010. Structural dimensionality, two types of reliability and construct validity were analyzed. RESULTS:Exploratory factor analysis corroborated the hypothesis of the instrument's unidimensionality, and seven experts verified its face and content validity. The internal consistency was 0.8, and test-retest reliability was higher than 0.5 for 14 out of 18 items. The overall score was higher among socially disadvantaged individuals and correlated with adverse health behaviors/conditions, particularly when differential treatments were attributed to discrimination. CONCLUSIONS:These fi ndings indicate the validity and reliability of the instrument developed. The proposed instrument enables the investigation of novel aspects of the relationship between discrimination and health. DESCRIPTORS:Prejudice. Interpersonal Relations. Socioeconomic Factors. Health Inequalities. Explicit discrimination and health Bastos JL et alThe discrimination construct is closely related to the idea of injustice and, as such, has been conceptualized as the "process by which a member, or members, of a socially defi ned group is, or are, treated differently (especially unfairly) because of his/ her/ their membership of that group." 15 It has been studied worldwide in several fi elds of knowledge, such as anthropology, epidemiology, sociology and psychology, with extensive literature documenting important discrimination effects on people's daily lives. For instance, discrimination has been associated with negative health outcomes, 25 diffi cult access to the labor market, 6 and residential segregation. 25 Disc riminatory practices may be based on characteristics such as gender, age, physical appearance, race, ethnicity, social class, and other socially ascribed or acquired characteristics. These multiple types of discrimination may also be combined and experienced all at once by their victims. 4 Yet, discriminatory practices and their behavioral and cognitive responses may vary depending on the social context and historical time period.A systematic review of instruments assessing racial discrimination 3 found no widely employed instrument RESUMO OBJETIVO: Desenvolver instrumento para avaliar os efeitos de experiências discriminatórias sobre condições e comportamentos em saúde, capaz de distinguir efeitos patológicos da exposição a tratamentos diferenciais de sua interpretação como eventos discriminatórios. MÉ...

Age, class and race discrimination: their interactions and associations with mental health among Brazilian university students

“…In this sample, internal consistency of the instrument was 0.8, and testretest reliability was higher than 0.5 for 14 out of the 18 items across a 15-day period. Construct validity was supported by the instrument score being statistically higher among socially disadvantaged groups and positively correlated with adverse health behaviors and conditions 27 .…”

“…Data were drawn from a research project that included the development and psychometric assessment of a new instrument on selfreported personally mediated experiences with discrimination 27 . We enrolled 424 participants, based on sample size recommendations for instrument development, which suggested a number between 300 and 500 28,29 .…”

“…Self-reported lifetime experiences of interpersonal discrimination, the main exposure, was assessed using a standardized instrument, which was developed considering Brazilian specificities 27,30 . The instrument includes 18 items about explicit incidents of negative differential treatments (Table 1), with the following answer options "none", "rarely", "several times" and "always".…”

“…Exposure to discrimination took into account the potential attributions, their interpretation as discriminatory, and the frequency with which the incident was reported ("none", "rarely", "several times" and "always"), so that graded relationships with the outcome could be examined. However, given that no such gradients were observed, the discrimination variable (which could theoretically vary between 0 and 54 for each of the reported attributions, as a result of multiplication of frequency categories [0, 1, 2 and 3] by the 18 items) 27 was categorized as 0 for those who were "not discriminated against", 1 for those "discriminated against due to other reasons", 2 for "skin color/ race discrimination", 3 for "class discrimination", 4 for "age discrimination", 5 for "skin color/race/ class, skin color/race/age or age/class discrimination", and 6 for "skin color/race, class and age discrimination, simultaneously", given that these combinations were the most frequently reported. The reference category in all analyses consisted of those participants who were "not discriminated against", i.e.…”

Revisão sistemática dos estudos epidemiológicos sobre discriminação interpessoal e saúde mental

“…Sintetizando, a ideia de cor (e não necessariamente de raça, significando origem ou ancestralidade), a existência de múltiplas categorias de classificação, sua relação com posição socioeconômica e, por fim, as peculiaridades da discriminação no Brasil, indicam que os instrumentos estadunidenses dificilmente abarcariam estas especificidades, não sendo adequados sem que haja adaptações pertinentes à mensuração das experiências discriminatórias em nosso contexto. Outra possibilidade à iniciativa de adaptar instrumentos concebidos em outros contextos socioculturais seria utilizar aqueles já desenvolvidos no Brasil, como tem sido recentemente observado na literatura 55 .…”