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Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey

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  • Leslie R M Hausmann
  • Audrey L Jones
  • Shauna E McInnes
  • Susan L Zickmund

Abstract

Background: Healthcare experiences associated with perceived racial/ethnic discrimination among patients are poorly understood. Objective: Identify domains of patient dissatisfaction associated with perceived racial/ethnic discrimination among patients with pain. Design: Semi-structured telephone surveys completed in 2013–2015. Participants: White, African American, and Latino participants who reported receiving pain management from 25 Veterans Affairs (VA) Medical Centers. Main measures: Surveys included open-ended questions about healthcare satisfaction/dissatisfaction and a measure of perceived racial/ethnic-based discrimination while seeking VA healthcare. Binary indicators for ten qualitative domains of dissatisfaction were derived from open-ended questions. We used multilevel models to identify dissatisfaction domains associated with perceived discrimination, adjusting for patient characteristics and site. Within domains associated with discrimination, we identified the most frequent codes and examined whether patients primarily referenced clinical or non-clinical staff in their experiences. Key results: Overall, 622 participants (30.4% White, 37.8% African American, 31.8% Latino; 57.4% female; mean age = 53.4) reported a median discrimination score of 1.0 (IQR: 1.0–1.3) on a scale of 1 to 5; 233 (37.5%) perceived any racial/ethnic discrimination in healthcare. Individually, 7 of 10 qualitative domains were significantly associated with perceived discrimination: dissatisfaction with care quality, facilities, continuity of care, interactions with staff, staff demeanor, unresolved pain, and pharmacy services (ps

Suggested Citation

  • Leslie R M Hausmann & Audrey L Jones & Shauna E McInnes & Susan L Zickmund, 2020. "Identifying healthcare experiences associated with perceptions of racial/ethnic discrimination among veterans with pain: A cross-sectional mixed methods survey," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-19, September.
    • Handle: RePEc:plo:pone00:0237650
    DOI: 10.1371/journal.pone.0237650
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    1. Hall, W.J. & Chapman, M.V. & Lee, K.M. & Merino, Y.M. & Thomas, T.W. & Payne, B.K. & Eng, E. & Day, S.H. & Coyne-Beasley, T., 2015. "Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review," American Journal of Public Health, American Public Health Association, vol. 105(12), pages 60-76.
    2. Hausmann, L.R. & Jeong, K. & Bost, J.E. & Kressin, N.R. & Ibrahim, S.A., 2009. "Perceived racial discrimination in health care: a comparison of Veterans Affairs and other patients," American Journal of Public Health, American Public Health Association, vol. 99, pages 718-724.
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