文章基本信息

标题：Unhealthy Interactions: The Role of Stereotype Threat in Health Disparities
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作者：Joshua Aronson ; Diana Burgess ; Sean M. Phelan 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2013
卷号：103
期号：1
页码：50-56
DOI：10.2105/AJPH.2012.300828
语种：English
出版社：American Public Health Association
摘要：Stereotype threat is the unpleasant psychological experience of confronting negative stereotypes about race, ethnicity, gender, sexual orientation, or social status. Hundreds of published studies show how the experience of stereotype threat can impair intellectual functioning and interfere with test and school performance. Numerous published interventions derived from this research have improved the performance and motivation of individuals targeted by low-ability stereotypes. Stereotype threat theory and research provide a useful lens for understanding and reducing the negative health consequences of interracial interactions for African Americans and members of similarly stigmatized minority groups. Here we summarize the educational outcomes of stereotype threat and examine the implications of stereotype threat for health and health-related behaviors. “Some patients, though conscious that their condition is perilous, recover their health simply through their contentment with the goodness of the physician.” — Hippocrates (460–400 BC) 1a HIPPOCRATES COULD NOT have envisioned the advances that would transform medicine from an art depending entirely on the human touch to a science built on empirically tested intervention. Yet modern physicians still emphasize the Hippocratic prescription for empathetic and humane treatment of patients, and research confirms that they are right to do so: the quality of patient–provider relations, even in the modern era, remains a significant influence on patient outcomes. 1b Indeed, research consistently finds that the way patients and their health care providers interact can matter more than even the training or expertise of the doctors and medical staff who treat them. Interaction quality affects how well patients understand information presented during visits, the amount of pertinent information they later recall, their satisfaction with their treatment, and their adherence to the recommended treatment regimen. 2,3 When interactions between care providers and their patients are stressful, unpleasant, or disrespectful, patient health often suffers. 1b–5 Most of us can report at least some instances of negative interactions with our health care providers, but members of disadvantaged groups—African Americans, Latinos, the poor, and others—appear to be particularly at risk for unpleasant interactions in the health care system, and this likely contributes to the consistent pattern of poorer health among these groups. 4,5 Thousands of studies have documented racial disparities in medical care, which an Institute of Medicine panel defines as “racial or ethnic differences in the quality of health care that are not due to access-related factors or clinical needs, preferences, and appropriateness of the intervention.” 5 ^(pp3–4) Although some of these disparities occur because racial minorities tend to receive care in underresourced health care facilities, 5,6 racial disparities also exist in high-quality health care facilities. 5,7 Research demonstrates the existence of unconscious or unintentional bias on the part of health care providers toward cultural minorities and show its contribution to racial disparities in health care outcomes. 5,8,9 For example, African American patients are less likely than Whites to receive important medications or surgical procedures, even when they present with identical conditions, and this is directly related to higher rates of mortality. 5 Yet provider bias does not fully explain why African American patients tend to be less active in their own care, are less likely than their White counterparts to adhere to treatment plans, have poorer control of their blood sugar, exercise less frequently, and so on. 10,11 Part of the answer is rooted in the negative cultural stereotypes that frequently confront African American and other minority patients when they interact with their health care providers.