The Effect of Values Affirmation on Race-Discordant Patient-Provider Communication

Abstract

Background: Communication between African American patients and white health care providers has been shown to be of poorer quality when compared with raceconcordant patient-provider communication. Fear on the part of patients that providers stereotype them negatively might be one cause of this poorer communication. This stereotype threat may be lessened by a valuesaffirmation intervention.Methods: In a blinded experiment, we randomized 99 African American patients with hypertension to perform a values-affirmation exercise or a control exercise before a visit with their primary care provider. We compared patient-provider communication for the 2 groups using audio recordings of the visit analyzed with the Roter Interaction Analysis System. We also evaluated visit satisfaction, trust, stress, and mood after the visit by means of a questionnaire.Results: Patients in the intervention group requested and provided more information about their medical condition (mean [SE] number of utterances, 66.3 [6.8] in the values-affirmation group vs 48.1 [5.9] in the control group [P=.03]). Patient-provider communication in the intervention group was characterized as being more interested, friendly, responsive, interactive, and respectful (P=.02) and less depressed and distressed (P =.03). Patient questionnaires did not detect differences in visit satisfaction, trust, stress, or mood. Mean visit duration did not differ significantly between the groups (19.2 minutes in the control group vs 20.5 minutes in the intervention group [P=.29]). Conclusions:A values-affirmation exercise improves aspects of patient-provider communication in racediscordant primary care visits. The clinical impact of the intervention must be defined before widespread implementation can be recommended.

Social Determinants of Risk and Outcomes for Cardiovascular Disease

“…The effect of stereotype threat on clinical interactions has seen limited study. In 1 report, 58 an intervention known to blunt the effects of stereotype threat was administered to black patients about to see a primary care physician for hypertension care. Compared with those receiving a control intervention, those in the intervention group had patient-provider communication that was more interested, friendly, responsive, interactive, and respectful and was less depressed and distressed in tone.…”

Reducing Racial Health Care Disparities

“…Values affirmation can address stereotype threat in health care. In one study (Havranek et al, 2012), Black patients with hypertension completed a values affirmation exercise or a control exercise just before a regularly scheduled primary care visit. Patient–physician communication was then assessed by coding the subsequent conversation.…”

Associations of spontaneous self-affirmation with health care experiences and health information seeking in a national survey of US adults

“…Patients can also experience stereotype threat in medical settings (Aronson, Burgess, Phelan, & Juarez, 2013; Burgess et al, 2014; Burgess, Warren, Phelan, Dovidio, & Van Ryn, 2010; Havranek et al, 2012). Patients may feel threatened if they expect discrimination or that medical professionals will perceive them in accordance with stereotypes (Aronson et al, 2013; Burgess et al, 2010).…”

“…As minority populations (including Blacks and overweight individuals) have reported or experienced discrimination and perceived bias in medical settings (Penner et al, 2010; Phelan et al, 2014; Van Ryn & Burke, 2000; Van Ryn & Fu, 2003), these groups may experience stereotype threat in interactions with health care providers. Researchers have argued that concerns about stereotype threat could impair patients’ communication with their health care providers by leading to less self-disclosure and ‘colder’ interactions (Aronson et al, 2013; Burgess, 2011; Burgess et al, 2010; Havranek et al, 2012). As such, self-affirmation may be beneficial: Black patients who self-affirmed before a medical appointment gave and asked for more information and had a more positive tone, although self-affirmation did not affect trust or visit satisfaction (Havranek et al, 2012; but see Burgess et al, 2014).…”