Patient–provider relationship and perceived provider weight bias among American Indians and Alaska Natives

Abstract

SummaryObjectiveThe objective of this study was to examine patient–provider relationships among American Indians and Alaska Native (AI/AN) patients by examining associations between patient activation, perceived provider weight bias and working alliance. Patient activation is generally defined as having the knowledge, skills and confidence to manage one's health.MethodsAmong a sample of 87 AI/AN adults presenting for general medical care at an urban clinic in the north‐west region of the USA, ordinary least squares regression analysis was completed to examine associations.ResultsBetter working alliance scores were associated with increased patient activation, while perceived provider weight bias was associated with reduced patient activation. In addition, those with class II obesity had decreased patient activation.ConclusionThese findings point to the importance of a positive patient–provider relationship in AI/ANs. Optimal patient engagement and subsequent health outcomes warrant additional consideration of patients' perceptions of provider weight bias within the context of health promotion and interventions.

Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes

“…Substance abuse (Whitbeck, Hoyt, McMorris, Chen, & Stubben, 2001), depressive symptoms (Walls, Gonzalez, Gladney, & Onello, 2015; Whitbeck, McMorris, Hoyt, Stubben, & LaFromboise, 2002), diabetes-related distress (Sittner, Greenfield, & Walls, 2018), uncontrolled blood glucose (Gonzales, Lambert, Fu, Jacob, & Harding, 2014), and physical pain and impairment (Chae & Walters, 2009) are associated with perceived discrimination. In regard to access to care, perceived discrimination and lateral oppression have been identified as barriers to health care for Indigenous people (Balestrery, 2016; Gonzales et al, 2017; Willie, 2017). Research on interpersonal and other traumas among AIs, help explain disproportionate rates of post-traumatic stress disorder (Beals et al, 2013), cardiovascular disease, chronic pain, depressive symptoms (Tehee et al, 2017), as well as differences in blood glucose levels (Goins, Noonan, Gonzales, Winchester, & Bradley, 2017) and treatment modality among AIs with T2D (Jacob et al, 2013).…”

Perceived Discrimination, Retention, and Diabetes Risk Among American Indians and Alaska Natives in a Diabetes Lifestyle Intervention

“…With regard to perceived discrimination, studies document that it adversely impacts health behaviors and health outcomes, including those related to diabetes risk and management (Dawson et al, 2015;Hunte, 2011;Johnson et al, 2012). These patterns have been documented among AI/ANs (Gonzales et al, 2013(Gonzales et al, , 2014(Gonzales et al, , 2018a(Gonzales et al, , 2018b.…”

“…Among AI/ANs, engagement and subsequent health behaviors exist in the context of the specific historical, intergenerational, and contemporary experiences of trauma, violence, and settler colonialism experienced by this population (Evans-Campbell, 2008;Gonzales, et al, 2018aGonzales, et al, , 2018bJacob et al, 2020;Paradies, 2016). Systems of care that fail to identify and address these sources of systemic inequities may unknowingly offer health programs that contribute to poor retention and engagement, with consequent failure to achieve desired health outcomes.…”

“…One form of psychosocial stress, particularly relevant in racialized groups, is perceived experiences of racial discrimination (hereinafter "perceived discrimination"), defined as the perception of unfair treatment by social institutions and individuals based on race (Paradies, 2006;Paradies et al, 2015; Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, 2003;Williams & Mohammed, 2009). Broadly, studies demonstrate that psychosocial stressors may activate unhealthy behaviors, such as smoking and the consumption of alcohol and high-fat foods (Dallman et al, 2003(Dallman et al, , 2005Gonzales, et al, 2018aGonzales, et al, , 2018b. These unhealthy behaviors are related to poor adoption of lifestyle changes, which in turn may undermine retention in a lifestyle intervention (Kong et al, 2010;omitted for review, 2018).…”

Concerning trends in allopathic medical school faculty rank for Indigenous people: 2014–2016

“…Factors that may contribute to these disparities include higher rates of unmet healthcare need and lower rates of healthcare use even when accounting for medical access [13]. Other inequities such as perceived experiences of discrimination occur not only in everyday settings [14], but also within the healthcare system itself [15–17]. These experiences contribute to disengagement in healthcare processes, lower levels of activation, and poorer health outcomes for Indigenous people [17].…”