Reducing health care disparities through improving trust: An identity safety cues intervention for stigmatized groups.

Abstract

A vast literature examines the role of contextual cues in signaling identity safety for stigmatized group members in potentially threatening contexts. Yet, to date, a striking lack of research has utilized this literature to improve stigmatized populations' experiences in health care settings. This review discusses how identity cues embedded in medical contexts may signal safety or potential threat to varied stigmatized group members, including those with visible or concealable stigmas. We propose that identity safety cues have the potential to improve patientϪprovider communication and comfort and, moreover, rates of health care utilization and adherence to medical suggestions. We discuss factors that may promote or hinder the efficacy of such cues and the relative power of different identity safety cues in past research. Finally, we review limitations of the cue implementation approach and describe suggestions for implementation within medical contexts. What is the significance of this article for the general public?Varied stigmatized group members, for example, people who are overweight, those with chronic illnesses, and racial and sexual minorities, utilize health care services at lower rates and often have poorer physical and mental health than do their majority counterparts. Extending the psychological literature on identity safety cues to the medical context may improve stigmatized group members' health care utilization, visit satisfaction, adherence, and subsequent health.

Religiosity, spirituality, gender identity, and sexual orientation of sexual minorities.

“…Given the association between religiosity and spirituality with LGB negative identity, psychologists must be aware of interventions aimed at managing these identities. A psychologist's work may involve acceptance toward a client's autonomy (American Counseling Association, 2014), the acknowledgment that identity is both fluid and complex (American Psychological Association, 2017), and the public display of identity safety cues (Cipollina & Sanchez, 2019). Some clients from conservative traditions may be unable to examine their beliefs about this intersection as the outcome may include "cultural suicide," in which the client may be ostracized for even examining the belief system (Brookfield, 2012).…”

A Taxonomy of Identity Safety Cues Based on Gender and Race: From a Promising Past to an Intersectional and Translational Future

“…Situational cues are features of a setting or situation that signal the likelihood of how one will be treated (i.e., by conveying the possibility of stigma; Murphy et al, 2007;Murphy & Taylor, 2012). A particular type of situational cue, called an identity safety cue, communicates support for stigmatized identities and generates important implications for enhancing outcomes among stigmatized groups, such as heightened belonging, performance, trust, and engagement (see Cipollina & Sanchez, 2019). Specifically, identity safety cues refer to aspects of an environment or setting that signal to stigmatized groups that the threat of discrimination is limited and their social identities are welcomed and valued (e.g., Cipollina & Sanchez, 2020;Davies et al, 2005;Emerson & Murphy, 2014;Johnson et al, 2019;Murphy et al, 2007;Pietri et al, 2018;Wout et al, 2014).…”

“…Identity safety cues can be intentionally constructed or naturally occurring, subtle or explicit, and hold particular promise for improving stigmatized groups' outcomes in threatening domains (e.g., Cheryan et al, 2009;Cheryan, Meltzoff, et al, 2011;Cipollina & Sanchez, 2020;Davies et al, 2005;Johnson et al, 2019;Pietri, Drawbaugh, et al, 2019). For example, Cipollina and Sanchez (2019) provide a compelling case for using identity safety cues in medical contexts to improve relations between providers and patients and to reduce the negative effects of threat for stigmatized groups in healthcare settings.…”

“…found that the presence of a Black man, compared to a White or Asian man, caused less concern about gender stereotypes among White women and greater working memory performance on a task. Given that White women and Black men share underlying stereotype content of lacking intelligence (i.e., both stereotyped as incompetent; Wout et al, 2009), the potential effect that minority representation can have on another minoritized group may depend on whether social groups share similar stereotype content (Cipollina & Sanchez, 2019).…”

“…Such practices are problematic because they deprioritize the benefits of safety cues for stigmatized groups and instead shift the focus to what cue implementers can gain. As a result, the use of a cue like racial minority representation, such as in universities' advertising materials (Roediger, 2005 as cited in Cipollina & Sanchez, 2019), can be met with criticism and suspicion, as can the superficial and appropriated use of rainbow pride diversity-related symbols-a phenomenon often occurring during Pride month called "rainbow washing" (Bitterman, 2021, p. 125;Hess, 2021). We recommend that individuals and organizations listen to stakeholders (i.e., stigmatized groups) to understand and meet evolving needs with identity safety cues, create infrastructure that reinforces their values conveyed through cues, and contemplate potential pitfalls of implementing identity safety cues.…”