Previous research has shown that ethnic minority patients participate less during medical encounters than patients from majority populations. Given the positive outcomes of active patient participation, such as higher understanding of information and better treatment adherence, interventions are required to enhance ethnic minority patients' participation levels. However, little is known about what patients perceive as barriers hindering their participation. This study therefore aimed to explore differences in perceptions of barriers to patient participation among ethnic minority and ethnic majority patients in general practice. Eight focus-groups with Turkish-Dutch and indigenous Dutch participants were performed. A semi-structured topic-list concerning patients' enabling and predisposing factors to participate, and physicians' responses guided the interviews. Interviews were recorded, transcribed verbatim, and transcripts were analyzed using the constant comparison method described in Grounded Theory. Regarding Turkish-Dutch patients' enabling factors to participate, two perceptions of barriers were identified: (i) low Dutch language proficiency; (ii) a preference for an indirect communication style. Three perceptions of barriers to Turkish-Dutch patients' predisposition to participate were identified: (i) collectivistic values; (ii) power distance; (iii) uncertainty avoidance. Regarding doctors' responses, discrimination was identified among Turkish-Dutch patients as a perception of barrier to their patients' participation. None of these perceptions of barriers emerged among indigenous Dutch patients. This study contributes to our understanding of which perceptions of barriers might impede ethnic minority patients' level of patient participation. To enhance their participation, a combined intervention is needed, tackling the language barrier, raising awareness about cultural differences in values, and increasing doctors' cultural competencies to communicate adequately with ethnic minority patients.

This study addresses the determinants and outcomes of fairness perceptions in a real assessment procedure as performed by a selection agency. Fairness perceptions were investigated at three points in time: before the assessment, right after the assessment but before assessment feedback, and after assessment feedback. Using structural equation modeling, we tested how fairness perceptions develop throughout the assessment procedure. Applicants' openness to experiences affected their test beliefs before the actual test-taking. These beliefs remained powerful in the subsequent stages of the assessment procedure in that they influenced applicants' perceptions of performance, feedback and fairness. In the context of selection by an external selection agency, post-feedback fairness perceptions were not related to job attractiveness. Perceived feedback treatment and feedback content directly affected job attractiveness.

This study investigates the role of feedback in minimizing the psychological impact of a negative selection decision on job applicants. The method and findings of a laboratory experiment into subjects' reactions to rejection, combined with feedback on this decision as well as perceptions of procedural and distributive fairness, are discussed. Subjects participating in the experiment (N 5 119) were asked to complete two GMA tests and were told they had to belong to the 20% best performers to be invited for a selection interview. Upon completion, all subjects received a rejection message, supposedly based on their performance scores on the two tests. Subjects were randomly assigned to one of two feedback conditions: either a mere rejection message, or a rejection message including performance feedback. Analyses revealed that core self-evaluations and affective wellbeing of rejected subjects receiving performance feedback significantly decreased compared to that of subjects in the mere rejection message condition. Furthermore, it was found that procedural fairness perceptions interacted with feedback on subjects' core self-evaluations, while distributive fairness perceptions interacted with feedback on affective well-being. These findings raise the question whether performance feedback following a negative selection decision is as advantageous as generally assumed. Implications for giving feedback in rejection situations are discussed in the conclusion.

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