HEALTH CARE STEREOTYPE THREAT AMONG PATIENTS WITH MULTIPLE MARGINALIZED IDENTITIES: A QUALITATIVE STUDY

Author

Lauren Vanhusen, Southern Illinois University CarbondaleFollow

Date of Award

12-1-2018

Degree Name

Doctor of Philosophy

Department

Psychology

First Advisor

Chwalisz, Kathleen

Abstract

It is well documented that some populations experience higher rates of certain diseases. While researchers have explored factors contributing to health disparities, attention has turned to the influence of social factors. For instance, stereotype threat has recently been applied to the health care setting in order to explain growing health disparities (e.g., Aronson et al., 2013). Health care stereotype threat (HCST) may arise when patients become aware that a negative health stereotype exists about a group or groups with which they identify, thus negatively impacting their utilization of health care services. Furthermore, patients with multiple marginalized identities have unique experiences of stereotyping and discrimination within the health care system. The purpose of the current study is to address Abdou et al.’s (2016) recommendation that researchers examine health care stereotype threat among individuals with multiple marginalized identities. The present study identified patients with a chronic illness and multiple marginalized identities including: (a) identifying as Black, (b) being considered overweight by medical community, and/or (c) identifying as Lesbian, Gay, Bisexual, and Transgender (LGBT). These identities were chosen based on research indicating that physicians hold implicit bias attitudes towards and stereotypes about these groups (e.g., Blair et al., 2013; Chapman et al., 2001; Sabin et al., 2009). I utilized qualitative research methodology to contextualize patients’ experiences of stereotyping in a health setting. In person, semi-structured interviews were conducted with eight patients. During the interview process, four major categories and 22 sub-level categories emerged. Grounded theory methodology (Corbin & Strauss, 2008) was used to analyze the data. The results of the study revealed a complex relationship between negative experiences with a provider (i.e., dismissive communication and perceived stereotyping) and health care utilization. Patients’ negative experiences with providers made it more difficult for patients to continue engaging in care. Systemic barriers as well as level of coping and social support influenced patients’ perception of stereotyping and discrimination. Level of support from other providers and use of coping skills also determined the extent to which patients continued to utilize available health care in the face of discrimination. Implications for future research and clinical practice are delineated.