Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study

Abstract

Introduction Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care. Methods Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use. Results Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine. Conclusions The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups.

Age-Based Reproductive Healthcare Stereotype Threat (HCST) as a Stressor Affecting Prenatal Mental Health in Pregnant Women of Advanced Maternal Age: Measurement, Process, Outcomes, and Interactions with Ethnicity/Race, SES, and Other Social Identities

“…HCST is one of the first applications of stereotype threat theory that examines the longer-term, rather than only immediate, mental and physical health consequences of the threat of being judged by negative group stereotypes in stereotype-relevant domains [16]. HCST is also the first application of stereotype threat specifically in relation to healthcare and health experiences and disparities, as well as to the specific stereotypes that are salient in healthcare settings [15,16].…”

“…HCST is also the first application of stereotype threat specifically in relation to healthcare and health experiences and disparities, as well as to the specific stereotypes that are salient in healthcare settings [15,16]. Further, HCST is a critical application of stereotype threat theory that examines domains that are directly critical to livelihood [15, 16]. To date, it is unclear how the process of stereotype threat-induced disidentification unfolds in domains that are critical to livelihood, including the domain of healthcare.…”

“…To date, it is unclear how the process of stereotype threat-induced disidentification unfolds in domains that are critical to livelihood, including the domain of healthcare. HCST has been linked to underutilization of preventive care, physician distrust, and heightened anxiety in healthcare settings [15, 16]. HCST has also been hypothesized to lead to avoidance of healthcare and delayed care in the face of ambiguous or chronic health problems [15, 16].…”

“…For instance, females indicate less interest in math [20–22], leadership roles [23], and other traditionally masculine domains [24–27] when female stereotypes are made salient. HCST—a healthcare-specific form of stereotype threat—is defined as the threat of being judged by, and/or of personally confirming through one’s own actions, behaviors, or outcomes, negative group-based stereotypes that are salient in healthcare settings [15, 16]. Notably, the types of healthcare-relevant stereotypes that are called to mind differ with the particular dimension(s) of social identity under threat.…”

Let’s not blame the patient: Understanding the benefits and shortcomings of population health in orthopaedic surgery

“…Patients may resist following up on planned treatments, rate physicians poorly on evaluations, as well as disregard recommendations for preventative health measures, which is a significant goal of population health initiatives. [41,42] Dr. Hilary Hatch outlines three reasons why patients may not adhere to treatment guidelines based off of population information that may become too formulaic and standardized without taking into account individual patient circumstances. [43] People are keenly aware of being told to do things that are not for their personal benefit.…”