Perceived Racial Discrimination in Health Care, Completion of Standard Diabetes Services, and Diabetes Control Among a Sample of American Indian Women

Gonzales, Kelly; Lambert, William E.; Fu, Rongwei; Jacob, Michelle M.; Harding, Anna K.

doi:10.1177/0145721714551422

Cited by 49 publications

(38 citation statements)

References 29 publications

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“…An EDS score was calculated for each participant by summing scores across the 9 questions. Cronbach's alpha for the EDS score in this sample was 0.89, indicating high reliability (Gonzales et al, ).…”

Section: Methodsmentioning

confidence: 73%

“…Among gay, lesbian, and bisexual AIs—referred to as two‐spirited persons in Native communities—racial discrimination has been linked to greater physical pain and impairment (Chae and Walters, ). Lastly, AIs who experience discrimination in healthcare settings have been shown to receive substandard care (Burgess, Ding, Hargreaves, van Ryn, & Phelan, ), such as less frequent monitoring of blood pressure (Gonzales, Lambert, Fu, Jacob, & Harding, ). None of these studies examined the relationship between discrimination and blood pressure among AIs.…”

Section: Introductionmentioning

confidence: 99%

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Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults

Thayer

Blair

Buchwald

et al. 2017

American J Phys Anthropol

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Objectives Hypertension prevalence is high among American Indians (AIs). AIs experience a substantial burden of interpersonal racial discrimination, which in other populations has been associated with higher blood pressure. The purpose of this study is to understand whether racial discrimination experiences are associated with higher blood pressure in AIs. Materials and Methods We used the Everyday Discrimination Scale to evaluate the relationship between discrimination and measured blood pressure among 77 AIs from two reservation communities in the Northern Plains. We used multivariate linear regression to evaluate the association of racial discrimination with systolic and diastolic blood pressure, respectively. Racial discrimination, systolic blood pressure, and diastolic blood pressure were analyzed as continuous variables. All analyses adjusted for sex, waist circumference, age, posttraumatic stress disorder status, and education. Results We found that 61% of participants experienced discrimination that they attributed to their race or ancestry. Racial discrimination was associated with significantly higher diastolic blood pressure (β = 0.22, SE = 0.09, P = 0.02), and with a similar non-significant trend toward higher systolic blood pressure (β = 0.25, SE = 0.15, P = 0.09). Conclusion The results of this analysis suggest that racial discrimination may contribute to higher diastolic blood pressure within Native communities. These findings highlight one pathway through which the social environment can shape patterns of biology and health in AI and other socially and politically marginalized groups.

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Section: Methodsmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults

Thayer

Blair

Buchwald

et al. 2017

American J Phys Anthropol

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“…It is important to ensure that language is inclusive of young women who may come from a variety of family structures and who may have had positive and negative sexual experiences, honors, and which validates those women. By normalizing those realities, such as topics of sexual consent, the audience may be more receptive to the intervention, as well as experience positive impacts beyond the program by feeling accepted and seen for their true selves …”

Section: Discussionmentioning

confidence: 99%

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens

Terry¹,

Stotz

Charron‐Prochownik

et al. 2020

Pediatr Diabetes

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Background: American Indian/Alaska Native (AI/AN) adolescents are at higher risk for gestational diabetes (GDM), type 2 diabetes, and pregnancy complications than the general population.Objective: To inform cultural adaptation of a validated evidence-based intervention (VEBI) originally designed to deliver preconception counseling and diabetes education to non-AI/AN teens with diabetes.Design: Qualitative data were collected using focus group and individual interview methods with health care professionals and experts (n = 16) in AI/AN health, GDM, adolescent health, and/or mother-daughter communication. A semistructured discussion guide elicited responses about provision of care for AI/AN girls at risk for GDM, experience with successful programs for AI/AN teens, comfort of mother/daughter dyads in talking about diabetes and reproductive health and reactions to video clips and booklet selections from the VEBI. All interviews were recorded and transcribed verbatim, and data analysis included inductive coding and identification of emergent themes.Results: Providers felt teens and their moms would be comfortable talking about the VEBI topics and that teens who did not feel comfortable talking to their mom would likely rely on another adult female. Participants suggested including: AI/AN images/ motifs, education with a community focus, and avoiding directive language. Concerns included: socioeconomic issues that affect AI/AN people such as: food and housing insecurity, abuse, and historical trauma.Conclusions: Perspectives from these participants have been used to guide the development of a culturally tailored GDM risk reduction program for AI/AN girls. This program will be available to health care providers who serve the AI/AN population. K E Y W O R D S American

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“…Although we did not find a link between implicit bias and agreement with vignette treatment options, the high levels of implicit bias could be associated with the perception of discrimination in health care, documented in other studies, leading to lower access of care by American Indians. 18, 57 Addressing implicit bias in the ED setting is challenging, but may be best approached using a combination of interventions that include standardization in triage determination and treatment regimens, direct observation of ED encounters to assess subtle differential treatment, and training providers and staff about implicit bias in health care.…”

Section: Discussionmentioning

confidence: 99%

The Role of Bias by Emergency Department Providers in Care for American Indian Children

Puumala

Burgess

Kharbanda³

et al. 2016

Medical Care

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Background American Indian children have high rates of emergency department (ED) use and face potential discrimination in health care settings. Objective Our goal was to assess both implicit and explicit racial bias and examine their relationship with clinical care. Research Design We performed a cross-sectional survey of care providers at five hospitals in the Upper Midwest. Questions included American Indian stereotypes (explicit attitudes), clinical vignettes and the Implicit Association Test (IAT). Two IATs were created to assess implicit bias toward the child or the parent/caregiver. Differences were assessed using linear and logistic regression models with a random effect for study site. Results A total of 154 care providers completed the survey. Agreement with negative American Indian stereotypes was 22–32%. Overall, 84% of providers had an implicit preference for non-Hispanic white adults or children. Older providers (≥ 50 years) had lower implicit bias than those middle aged (30–49 years), (p = 0.01). American Indian children were seen as increasingly challenging (p = 0.04) and parents/caregivers less compliant (p = 0.002) as the proportion of American Indian children seen in the ED increased. Responses to the vignettes were not related to implicit or explicit bias. Conclusions The majority of ED care providers had an implicit preference for non-Hispanic white children or adults compared to those who were American Indian. Provider agreement with negative American Indian stereotypes differed by practice and respondents’ characteristics. These findings require additional study to determine how these implicit and explicit biases influence healthcare or outcomes disparities.

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Perceived Racial Discrimination in Health Care, Completion of Standard Diabetes Services, and Diabetes Control Among a Sample of American Indian Women

Cited by 49 publications

References 29 publications

Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults

Racial discrimination associated with higher diastolic blood pressure in a sample of American Indian adults

Recommendations from an expert panel of health professionals regarding a gestational diabetes risk reduction intervention for American Indian/Alaska Native Teens

The Role of Bias by Emergency Department Providers in Care for American Indian Children

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