Unconscious Biases: Racial Microaggressions in American Indian Health Care

Abstract

Purpose This paper reports on the prevalence and correlates of microaggressive experiences in healthcare settings reported by American Indian (AI) adults with type 2 diabetes. Methods This community-based participatory research project includes two AI reservation communities. Data were collected via in-person paper-and-pencil survey interviews with 218 AI adults diagnosed with type 2 diabetes. Results Over 1/3 of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior year hospitalization. Depressive symptom ratings appeared to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. Conclusions Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for American Indians living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

Health care experiences of Indigenous people living with type 2 diabetes in Canada

“…22,23 Towle and colleagues 24 propose a model for improved relationship building with Indigenous patients by attending to issues of history, trust and time. Our findings support such strategies and deepens the elements and approaches for consideration by linking physician characteristics (e.g., empathy, humility), as well as structural and systems determinants, to clinical approaches.…”

Compounding Health Risks and Increased Vulnerability to SARS-CoV-2 for Racial and Ethnic Minorities and Low Socioeconomic Status Individuals in the United States

“…Centuries of discrimination, disenfranchisement, and perceived second-class status of indigenous populations in their own homeland due to colonial legacies 106,107,108 , have been linked to poor health outcomes 109,110,111 . Further, for American Indians, microaggressive experiences with their healthcare providers correlate with self-reported heart attack history 112 . It is worth noting that elevated stress due to discrimination for immigrants has been correlated with lower health baselines 113,114 and is likely compounded by stressors of immigration status or acculturation.…”

Pathways Between Discrimination and Quality of Life in Patients with Type 2 Diabetes

“…[7][8][9] Discrimination, specifically, has been linked to poor physical and mental health outcomes such as increased psychological distress, depression, high blood pressure, and substance abuse. [12][13][14][15][16][17][18][19][20][21][22] In patients with diabetes, perceived discrimination is associated with worse diabetes management and has been shown to undermine the patient-provider relationship. [23][24][25][26][27][28][29][30] There is evidence that the relationship between perceived discrimination and mental and physical health outcomes may occur through a mechanism involving stress response and health behaviors.…”