ABSTRACT
Lesbian, gay, bisexual, transgender, queer, or other sexual and gender minorities (LGBTQ+) populations in the United States continue to experience disparities in health and health care. Discrimination in both health care and society at large negatively affects LGBTQ+ health. Although progress has been made in addressing health disparities and reducing social inequality for these populations, new challenges have emerged. There is a pressing need for physicians and other health professionals to take a stance against discriminatory policies as renewed federal and state public policy efforts increasingly impose medically unnecessary restrictions on the provision of gender-affirming care. In this position paper, the American College of Physicians (ACP) reaffirms and updates much of its long-standing policy on LGBTQ+ health to strongly support access to evidence-based, clinically indicated gender-affirming care and oppose political efforts to interfere in the patient-physician relationship. Furthermore, ACP opposes institutional and legal restrictions on undergraduate, graduate, and continuing medical education and training on gender-affirming care and LGBTQ+ health issues. This paper also offers policy recommendations to protect the right of all people to participate in public life free from discrimination on the basis of their gender identity or sexual orientation and encourages the deployment of inclusive, nondiscriminatory, and evidence-based blood donation policies for members of LGBTQ+ communities. Underlying these beliefs is a reaffirmed commitment to promoting equitable access to quality care for all people regardless of their sexual orientation and gender identity.
Subject(s)
Healthcare Disparities , Sexual and Gender Minorities , Humans , Sexual and Gender Minorities/legislation & jurisprudence , United States , Male , Female , Physician-Patient Relations , Health Services Accessibility , Societies, Medical , Health Status Disparities , Social Discrimination/legislation & jurisprudenceABSTRACT
AIM: To qualitatively assess the impact of disability-based discrimination in healthcare on the parents of children with medical complexity (CMC). METHOD: In this qualitative study, we conducted in-depth, semi-structured interviews with the parents of CMC. Data collection and analysis occurred iteratively; constant comparison methods were used to identify themes describing the impact of disability-based discrimination in pediatric healthcare on the parents of CMC. RESULTS: Thirty participants from 15 US states were interviewed. Four themes were developed regarding the impact of disability-based discrimination in healthcare on parents. The themes were: (1) discrimination leads to a loss of trust in healthcare providers; (2) discrimination increases the burden of caregiving; (3) discrimination impacts parental well-being; and (4) racism and poverty-based discrimination amplifies disability-based discrimination. INTERPRETATION: The experience of discrimination toward their child results in loss of trust and therapeutic relationship between provider and parent, causes increased burden to the family, and contributes to decreased parental well-being. These experiences are magnified in minoritized families and in families perceived to have a lower socioeconomic status based on insurance type.
Subject(s)
Parents , Qualitative Research , Humans , Parents/psychology , Female , Male , Child , Adult , Disabled Children , Racism , Trust , United States , Adolescent , Social Discrimination , Disabled Persons , Middle Aged , PovertyABSTRACT
Stigma-related stressors are central to understanding psychopathology, distress, and coping in stigmatized groups; individuals who experience attractions to children are a highly stigmatized group. Currently, few validated self-report measures exist to assess stigma-related stressors in minor attracted people (MAPs) and the current research describes the development and initial validation of two measures of internalized stigma and experiences of discrimination. A sample of MAPs (n = 289; mean age = 31.8 years, SD = 12.2) was recruited online and completed a set of self-report measures assessing stigma-related stress, negative mental health outcomes, substance use, and coping. Exploratory factor analyses of the two newly developed stigma-related stress measures were conducted and convergent associations with other constructs were examined for validity evidence. Exploratory factor analyses indicated a two-factor solution to both the measure of internalized stigma and experiences of discrimination. The total scale scores and factors scores generally demonstrated the anticipated patterns of correlations with mental health concerns, distress, coping, and substance use. Clinical intervention with MAPs may benefit from an exploration of stigma-related stressors in clients' lives to improve mental health outcomes. The relatively large sample that was recruited from multiple online forums is a strength of the current study. The use of a self-report measurement modality for all measures used in the study weakens that strength of the validation evidence presented here. These results provide initial validity evidence for the measures of stigma-related stress in MAPs and the promise of stigma processes in understanding negative outcomes in this population.
Subject(s)
Adaptation, Psychological , Social Stigma , Humans , Male , Female , Adult , Self Report , Stress, Psychological/psychology , Middle Aged , Young Adult , Adolescent , Reproducibility of Results , Surveys and Questionnaires , Psychometrics , Social Discrimination/psychologyABSTRACT
BACKGROUND: The exploration of discrimination, social acceptance, and their impact on the psychological well-being of older men who have sex with men (MSM) is a critical area of study within the broader field of LGBTQ+ research. This demographic, comprising individuals who identify as both male and homosexual and are aged in the older spectrum of the population, faces unique challenges that intersect age, sexual orientation, and societal attitudes. Objectives This study aimed to explore the relationship between social acceptance and isolation with discrimination and the impact on the psychological well-being of older MSM. METHODS: A cross-sectional survey was administered among older MSM residing in three distinct regions: the People's Republic of China (PRC), Hong Kong, and Taiwan, with a total sample size of N = 453 participants, evenly distributed with N = 151 individuals from each region. The survey included the General Health Questionnaire-12 (GHQ-12), the Discrimination and Self-Stigma Evaluation Scale (DSSES), and the Perceived Acceptance Scale (PAS) which measures the perceived social acceptance from friends, mother, father, and family. The data were analyzed using descriptive statistics, ANOVA, and regression analysis. RESULTS: The mean scores of the GHQ-12 indicated that the participants had a moderate level of psychological distress, with a mean score of 6.38 (SD = 2.55). The DSSES mean score was 27.78 (SD = 8.73), indicating that participants experienced discrimination in their everyday lives. The PAS mean score was 3.08 (SD = 0.48), indicating that participants had a moderate level of perceived social acceptance. These results suggest that discrimination and social acceptance differ among older MSM in different areas in PRC, Hong Kong, and Taiwan. CONCLUSIONS: The study highlights the impact of discrimination and social acceptance on the psychological well-being of older MSM. The findings suggest that interventions aimed at reducing discrimination and promoting social acceptance may improve the psychological well-being of older MSM. These results have important implications for healthcare providers and policymakers in developing strategies to promote social acceptance and reduce discrimination towards older MSM.
Subject(s)
HIV Infections , Sexual and Gender Minorities , Male , Humans , Female , Aged , Homosexuality, Male , Cross-Sectional Studies , Psychological Well-Being , Social Status , HIV Infections/psychology , Social Stigma , Social DiscriminationABSTRACT
Over 250 million individuals live with chronic hepatitis B (CHB) infection worldwide. A significant proportion of these people often face discrimination defined as the unjust, unfair, or prejudicial treatment of a person on the grounds of their hepatitis B status. Hepatitis B related discrimination has not been widely documented in the literature. This study aims to describe the lived experience of discrimination, document its impact, and shed light on its consequences. A hepatitis B discrimination registry was launched to record self-reported discrimination associated with hepatitis B. The registry included brief demographic questions (age, gender, country of origin), discrimination-specific questions (where, when, and how discrimination occurred), and open-ended questions to detail specific experiences. The registry was distributed to hepatitis B patient/people-focused listservs, social media networks, and community-based organizations around the globe. Descriptive data were analyzed including comparative analysis by country and type of discrimination occurring along with qualitative data (open-ended responses) which were analyzed using thematic analysis techniques A total of 569 individuals responded to the survey between May 2021 and December 2023. Individuals identified as residing in the Philippines (34%; N = 194), Nigeria (11%; N = 60), Pakistan (8%; N = 45), India (6%, N = 34), Uganda (5%; N = 31), the United States of America (4%, N = 26), Ghana (3%; N = 15), Ethiopia (2%; N = 14), and other countries in smaller number with a total of 65 countries reported discrimination at least by one individual. Of these, 461 individuals shared details about their experiences of discrimination with most relating to restrictions on access to work visas, followed by in-country hepatitis B-related employment restrictions, educational-based discrimination, discrimination within the community and health facilities, and the emotional impact of hepatitis B discrimination. This is the largest primary collection of hepatitis B-associated discrimination events and highlights how hepatitis B discrimination clearly has a significant impact on individuals' lives and limits economic opportunities regardless of physical symptoms. Such impacts likely act as barriers to diagnosis and engagement in care, so need to be addressed to achieve the global hepatitis B elimination goals. The data highlight a need for global, national responses and more systematic responses to discrimination experienced by people with hepatitis B.
Subject(s)
Global Health , Hepatitis B, Chronic , Humans , Male , Female , Adult , Middle Aged , Hepatitis B, Chronic/psychology , Registries , Young Adult , Social Discrimination , Adolescent , Surveys and QuestionnairesABSTRACT
BACKGROUND: Discriminatory practices against minority populations are prominent, especially in the workplace. In particular, lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience several barriers and stressors more often than individuals who do not identify as LGBTQ+. Mistreatment is common among these individuals in their personal and professional lives. However, representation and perceptions of discrimination and bullying among attendings, residents, medical students, and other professionals who identify as LGBTQ+ and are "out" (openly acknowledging and expressing one's sexual orientation or gender identity) is seldom studied in orthopaedic surgery. QUESTIONS/PURPOSES: (1) How often are orthopaedic trainees and professionals who identify as LGBTQ+ out in their workplaces? (2) What proportion of these individuals report experiencing discrimination, bullying, or differential treatment? (3) Is there regional variation in these reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals in the LGBTQ+ community? METHODS: Individuals registering for Pride Ortho, a community of LGBTQ+ individuals and their allies established in 2021 to provide mentorship, networking, and a sense of community among its members, completed an internet-based survey developed by organization leadership. A total of 156 individuals registering for the Pride Ortho community were eligible to participate in the internet-based survey. In all, 92% (144 of 156) fully completed the survey, 6% (10 of 156) partially completed it, and 1% (2 of 156) did not complete any part of the survey. Most respondents (64% [100 of 156]) identified as being LGBTQ+, with 77 members at the attending level of their careers. More than half of LGBTQ+ members (56% [56 of 100]) identified as cisgender women (individuals who identify as women and who were born female). Demographic information was privately collected and deidentified, and included sex assigned at birth, gender expression or identity (the social constructed role that an individual chooses to inhabit, regardless of that individual's assigned sex at birth), sexual orientation, self-identified race, location, level of training, and orthopaedic subspecialty. RESULTS: Ninety-four percent (94 of 100) of LGBTQ+ respondents reported being out at their workplace, with nearly one-third of respondents indicating they were only partially out. Most (74% [74 of 100]) respondents reported either "yes" or "maybe" to perceived experiences of bullying, discrimination, or being treated differently. All individuals who partially completed the survey were straight or heterosexual and did not answer or answered "not applicable" to being out in their workplace. These individuals also all answered "no" to experiencing bullying, discrimination, or being treated differently. There was no geographic variation in reported experiences of bullying and discriminatory behaviors by orthopaedic trainees and professionals. CONCLUSION: Most LGBTQ+ orthopaedic trainees and professionals are out in their workplaces, although they report experiencing discrimination and bullying more than do non-LGBTQ+ individuals. Bullying and discrimination can deter individuals from beginning and completing their training in orthopaedic surgery. We recommend that orthopaedic institutions not only enforce existing antidiscrimination legal mandates but also increase the visibility of LGBTQ+ faculty and residents. This effort should include the implementation of diversity and sensitivity training programs, strengthened by a structured process of monitoring, reporting, and integrating feedback from all members in the workplace to continuously refine policy adherence and identify the root cause of the reported perceptions of bullying and discrimination. CLINICAL RELEVANCE: To deepen our understanding of the experiences faced by sexual and gender minorities in orthopaedic surgery settings, it is crucial to quantify reports of perceived bullying and discrimination. Addressing these issues is key to creating a more diverse and empathetic workforce within orthopaedic institutions, which in turn can lead to improved patient care and a better work environment. Recognizing and understanding the specific contexts of these experiences is an essential starting point for developing a truly inclusive environment for both trainees and attending physicians.
Subject(s)
Bullying , Sexual and Gender Minorities , Humans , Bullying/statistics & numerical data , Sexual and Gender Minorities/psychology , Male , Female , Adult , Surveys and Questionnaires , Workplace/psychology , Attitude of Health Personnel , Orthopedics , Social Discrimination , Middle Aged , Orthopedic Surgeons/psychologyABSTRACT
Introduction: Type 2 diabetes undermines diabetes-related health outcomes among African Americans, who have a disproportionately high incidence of the disease. Experiences of discrimination are common among African Americans and compound diabetes-related stress, exacerbating poor health outcomes. Appropriate use of coping strategies may mitigate the detrimental effect of discrimination on diabetes-related outcomes, but examining associations between coping strategies and health outcomes is needed to inform potential interventions. This study assessed the factor structure of the Coping with Discrimination Scale (CDS) among African American adults with type 2 diabetes and examined associations of CDS subscales with measures of diabetes control, mental distress, and psychosocial resources. Methods: The CDS was administered primarily through churches to African Americans with type 2 diabetes residing in Austin, Texas, and surrounding areas. Data were collected from August 2020 through April 2023. We conducted principal axis factor analysis of the CDS and determined internal consistency for each factor. We computed bivariate and partial correlations between CDS subscales and indicators of diabetes control (hemoglobin A1c, diabetes self-management), mental distress (diabetes distress, perceived stress, depressive symptoms), and psychosocial resources (resilience, social support, self-efficacy). Results: The 284 African American adults (204 women, 80 men) ranged in age from 23 to 86 years (mean [SD] = 62 [11] y). We identified 4 factors: education/advocacy, internalization, strong response, and detachment. Scores were highest for education/advocacy items and lowest for strong response items. Education/advocacy was associated with higher scores on psychosocial resources, whereas detachment was associated with lower scores. Internalization and strong response were associated with higher mental distress. Strong response was associated with higher hemoglobin A1c, and education/advocacy was associated with enhanced diabetes self-management. Conclusion: We suggest health care professionals create culturally tailored interventions that aid individuals in educating others, advocating for themselves, or recognizing situations outside one's control and detaching from responsibility, rather than internalizing experiences of discrimination or engaging in strong responses that upon reflection are detrimental to one's health.
Subject(s)
Coping Skills , Diabetes Mellitus, Type 2 , Social Discrimination , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Black or African American/psychology , Diabetes Mellitus, Type 2/epidemiology , Glycated Hemoglobin , Health BehaviorABSTRACT
BACKGROUND: Discrimination and sexual harassment are prevalent in higher education institutions and can affect students, faculty members and employees. Herein the aim was to assess the extent of discriminatory experiences and sexual harassment of students and lecturers at one of the largest teaching hospitals in Europe. We analyze whether there are differences between lecturers and students, different study programs as well as sex/gender differences. METHODS: In an interdisciplinary, iterative process, a semi-standardized questionnaire was developed and sent to N = 7095 students (S) of all study programs and N = 2528 lecturers (L) at Charité-Universitätsmedizin Berlin, Germany. The study was conducted from November 2018 to February 2019. Besides a broad range of questions on sociodemographic background allowing for diversity sensitive data analysis, they were asked if they had witnessed and/or experienced any form of discrimination or sexual harassment at the medical faculty, if yes, how often, the perceived reasons, situational factors and perpetrators. RESULTS: The response rate was 14% (n = 964) for students and 11% (n = 275) for lecturers. A proportion of 49.6% of students (L: 31%) reported that they have witnessed and/or experienced discriminatory behavior. Sexual harassment was witnessed and/or experienced by 23.6% of students (L: 19.2%). Lecturers (85.9%) were identified as the main source of discriminatory behavior by students. Directors/supervisors (47.4%) were stated as the main source of discriminatory behavior by lecturers. As the most frequent perceived reason for discriminatory experiences sex/gender (S: 71%; L: 60.3%) was reported. Women and dental students experienced more discriminatory behavior and sexual harassment. CONCLUSIONS: Discriminatory behavior is experienced by a significant number of students and lecturers, with power structures having a relevant impact. Dental students and women appear to be particularly exposed. Specific institutional measures, such as training programs for lecturers and students are necessary to raise awareness and provide resources. Furthermore, national preventive strategies should be thoroughly implemented to fight discrimination and harassment at the workplace.
Subject(s)
Faculty, Medical , Sexual Harassment , Students, Medical , Humans , Sexual Harassment/statistics & numerical data , Female , Male , Students, Medical/psychology , Adult , Surveys and Questionnaires , Young Adult , Germany , Sexism , Social DiscriminationABSTRACT
BACKGROUND: The criteria-oriented assessment of the population with a migration background that is common in Germany is currently being criticized from a social science and methodological perspective, among others. In particular, its usefulness as an indicator of perceived discrimination against the population with a migration background can be critically questioned based on the current state of research METHOD: Based on a population-representative data set (N=1,989) for the city of Berlin, the subjective perception of a migration background based on self-attribution and anticipated external attribution of a migration background was recorded in addition to the objective assessment of a migration background. Furthermore, socio-demographic and migration-specific characteristics as well as perceived discrimination were assessed. Using descriptive and inferential statistical methods, differences between the objective and subjective assessment of a migration background and their relationship with perceived discrimination were analyzed. RESULTS: Less than half (38%, 154/400) of the respondents identified as having a migrant background using the criterion-oriented approach reported describing themselves as migrants. 36% (144/405) reported that they believed that others in Germany described them as a person with a migrantion background. Respondents with a migration background are significantly more likely to experience discrimination on grounds of skin color, religion or country of origin compared to respondents without a migration background. Furthermore, it was found that both the self-attribution and the anticipated attribution by others as a migrant are positively associated with experiences of discrimination and racism. DISCUSSION: The results suggest that migration-sensitive research should not simply differentiate between people with and without a migration background according to official criteria. Rather, the subjective perceptions of one's own attribution as a migrant seem more suitable as indicators of discrimination and should be taken into account in future research or surveys on experiences of discrimination.
Subject(s)
Racism , Humans , Racism/psychology , Male , Female , Adult , Middle Aged , Germany , Aged , Young Adult , Prejudice , Adolescent , Transients and Migrants/psychology , Emigrants and Immigrants/psychology , Social Perception , Socioeconomic Factors , Social Discrimination/psychology , Surveys and QuestionnairesABSTRACT
People surviving COVID-19 may experience social stigma related to their condition even after clinical recovery. This study aimed to: (1) investigate COVID-19-related experienced discrimination and internalized stigma, and (2) explore their association with symptoms of anxiety, depression, and insomnia. We conducted an online survey of people who survived COVID-19. Perception of stigma was assessed using the COVID-19 Experienced Discrimination Scale and the COVID-19 Internalized Stigma Scale. Depression, anxiety, and insomnia were assessed using, respectively, the Patient Health Questionnaire-9, the General Anxiety Disorder Scale-7, and the Insomnia Severity Index. Multivariable logistic regression analyses for each psychopathological domain were performed. A total of 579 participants participated in this study. Overall, 25% reported some degree of experienced discrimination, and 23% reported some degree of internalized stigma. Adjusted odds ratio showed that scoring higher on internalized stigma related significantly to higher symptoms of depression (2.14; 95% confidence interval [CI], 1.35-3.39), anxiety (2.30; 95% CI, 1.48-3.59), and insomnia (2.54; 95% CI, 1.64-3.95), whereas experienced discrimination was associated to anxiety (1.55; 95% CI, 1.06-2.28) and insomnia (1.82; 95% CI, 1.24-2.69). Experiences of social stigmatization are frequent among people surviving COVID-19 and seem to be associated with levels of psychological disturbances. Further research is required to elucidate the direction of these relationships to implement effective treatment strategies.
Subject(s)
Anxiety , COVID-19 , Depression , SARS-CoV-2 , Sleep Initiation and Maintenance Disorders , Social Stigma , Humans , COVID-19/psychology , COVID-19/epidemiology , Female , Male , Sleep Initiation and Maintenance Disorders/psychology , Sleep Initiation and Maintenance Disorders/epidemiology , Adult , Middle Aged , Depression/psychology , Anxiety/psychology , Surveys and Questionnaires , Aged , Young Adult , Social Discrimination/psychologyABSTRACT
INTRODUCTION: Weight stigma, or weight bias, refers to biased beliefs and negative opinions towards people with excess weight. This phenomenon manifests in prejudice and negative attitudes towards people with obesity, including disrespectful treatment, bullying, discrimination and even abuse, and leading to long-term negative consequences on physical and mental health. The purpose of the current review was to examine the relationship between gender and manifestations of weight stigma. Studies listed in this review show that the phenomenon of weight stigma is more common and severe among women, in numerous life areas, which include education, employment, the healthcare system, social media, sports industry, and interpersonal relationships. Possible reasons for such differences include the existing discrimination against women in various areas of life, and the emphasis on external appearance and the ideal of thinness, which relates mainly to women. In light of the serious consequences of weight stigma on public health and individual well-being, efforts must be made to prevent weight stigma, including the education of the general population, changing policies of healthcare, education and media systems, and legislation to prevent weight-based discrimination.
Subject(s)
Obesity , Social Stigma , Humans , Obesity/psychology , Female , Sex Factors , Male , Prejudice/psychology , Sexism/psychology , Body Weight , Weight Prejudice/psychology , Public Health , Social Discrimination/psychology , Interpersonal RelationsABSTRACT
SUMMARY: We measured COVID-19-related stigma and discrimination and its drivers using a concurrent mixed-methods design in Punjab. The simple random sampling was used to select blocks, subcenters, and urban primary healthcenters from each of the four selected districts. The systematic random sampling was used to select households. A sample of 423 adults was interviewed using a structured questionnaire and 10 in-depth interviews were conducted using an interview guide. Binary logistic regression was performed to find the predictors. Stigma prevalence was mild 18%, moderate 45%, and severe 37%. Logistic regression indicated that stigma was lower in the rural compared to the urban population (P < 0.01). Hospitalized patients faced discrimination more often compared to those who were treated/quarantined at home. People feared police (71%), testing (69%), and contracting the infection (65%). Fear of screening, disclosure of status, and transmission of the virus were the drivers of stigma and discrimination. Co-occurrence of labeling, stereotyping, and cognitive separation was observed.
Subject(s)
COVID-19 , Social Stigma , Humans , COVID-19/epidemiology , COVID-19/psychology , India/epidemiology , Male , Female , Adult , SARS-CoV-2 , Middle Aged , Stereotyping , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Social Discrimination , Young AdultSubject(s)
Data Collection , Gender Identity , Sexual Behavior , Humans , Data Collection/standards , Data Collection/methods , United States , Sexual Behavior/statistics & numerical data , Patient-Centered Care/standards , Patient-Centered Care/statistics & numerical data , Social Discrimination/prevention & control , Healthcare Disparities , Social Stigma , DisclosureABSTRACT
This Viewpoint describes digital redlining as racialized inequities in access to technology infrastructure, including access to health care, education, employment, and social services.
Subject(s)
Delivery of Health Care , Digital Divide , Residence Characteristics , Social Determinants of Health , Social Discrimination , Socioeconomic Factors , United States , Racism , Poverty , Mass Screening , Public PolicyABSTRACT
BACKGROUND: Health-related stigma, including cancer-related stigma, can lead to discrimination that contributes to health inequities and poor health-related outcomes. OBJECTIVES: This article provides a scholarly foundation to acknowledge and address health-related stigma in clinical oncology care. METHODS: This comprehensive clinical literature review is based on peer-reviewed articles identified through targeted searches in CINAHL®, PubMed®, and Google Scholar™ databases. FINDINGS: This review provides an updated scholarly foundation about stigma in clinical oncology practice. The review highlights stigma in clinical oncology research, identifies a framework for examining multilevel health-related stigma and discrimination, examines stigma measurement instruments, and reviews stigma reduction interventions.
Subject(s)
Medical Oncology , Social Stigma , Humans , Social Discrimination , Healthcare DisparitiesABSTRACT
OBJECTIVES: Black women are at high risk for discrimination and cognitive impairment in late life. It is not known if discrimination is a risk factor for cognitive decline in Black women and if so, what factors are protective against the adverse cognitive effects of discrimination. Using the biopsychosocial model of gendered racism, we determined if discrimination is associated with poorer cognition in midlife Black women and if social support and/or spirituality would protect against the deleterious effects of discrimination on cognition. METHODS: Participants were midlife Black women (Nâ =â 669) from the Study of Women's Health Across the Nation. Discrimination was measured by the Everyday Discrimination scale. Cognitive outcomes included episodic memory, processing speed, and working memory. Total social support, emotional support, instrumental support, and spirituality were assessed as protective factors. RESULTS: Contrary to expectations, structural equation modeling indicated that discrimination was associated with better immediate recall. For women with more emotional support, greater discrimination was associated with better immediate recall than for women with lower emotional support. Spirituality was not a significant moderator in the association between discrimination and cognition. DISCUSSION: Discrimination had unexpected positive associations with learning and attention-based cognitive skills for midlife Black women. Discrimination might enhance vigilance, which could be facilitated by higher levels of emotional support. There is an opportunity for clinical and public health interventions for cognitive health and discrimination focused on Black women to better incorporate emotional support as a coping resource.
Subject(s)
Black or African American , Cognition , Social Discrimination , Social Support , Spirituality , Female , HumansABSTRACT
OBJECTIVE: Many have found racial differences in clinician-patient communication using validated codebooks that represent effective communication. No codebooks used for examining racial differences, however, have included patient input. In this paper, we describe creating codebook with Black patient advocates to determine if we could reliably code discriminatory/valuing communication and assess racial differences in these behaviors. METHODS: We created a codebook for discriminatory/valuing communication behaviors with the input of Black patient advocates. We used the codebook to analyze data from 101 audio recorded encounters between White cardiologists and Black and White patients. We examined the differences in the prevalence of behaviors in cardiology encounters. RESULTS: In comparison to White patients, cardiologists made fewer tailoring statements to their Black patients (68% vs. 49%, p = 0.07). Coders found 4 instances of stereotyping behaviors and only Black patients (p = 0.12). We found no significant associations between any of the other outcomes and patient race. Black patients had a lower incidence of tailoring statements (p = 0.13), lower incidence of interrupting statements (p = 0.16), and higher rushed global score (p = 0.14). CONCLUSION AND PRACTICE IMPLICATIONS: We found that coders can reliably identify discriminatory/valuing behaviors in cardiology encounters. Future work should apply these codes to other datasets to assess their validity and generalizability.
Subject(s)
Cardiology , Communication , Physician-Patient Relations , Social Discrimination , Humans , Black or African American , WhiteABSTRACT
Introduction: Perceived workplace discrimination is a complex phenomenon involving unfair treatment in the workplace based on personal characteristics such as age, ethnicity, gender, or disability. The objective of this study is to explore the association of perceived workplace discrimination with health and occupational outcomes. Methods: Following the PRISMA-ScR guidelines and the Joanna Briggs Institute methodology, a scoping review of articles published between 2000 and 2022 was conducted in databases such as Pubmed, Scopus, and PsyInfo. Inclusion criteria focused on studies exploring perceived workplace discrimination among workers, excluding those on patients, students, or the general population, and articles not written in English or Spanish. Results: Of the 9,871 articles identified, 102 met the criteria and were analyzed. Research showed a progressive increase in the study of perceived workplace discrimination, with a majority of studies in North America and Europe and a predominance of cross-sectional designs. Most studies did not clearly define the concept of perceived workplace discrimination nor report the psychometric characteristics of the measurement instruments. A significant association was found between perceived discrimination and negative outcomes in workers' mental and physical health, as well as a negative impact on job satisfaction and an increase in absenteeism. Additionally, sociodemographic characteristics such as race/ethnicity, gender, and age influenced the perception of discrimination. Conclusions: This review confirms that perceived workplace discrimination significantly impacts the health and job satisfaction of workers, with particular detriment in minorities and women. Despite an increase in research over the last two decades, there remains a lack of consistency in the definition and measurement of the phenomenon. Most studies have used cross-sectional designs, and there is a notable absence of research in the Latin American context.
Introducción: La discriminación laboral percibida es un fenómeno complejo que implica un trato injusto en el lugar de trabajo, basado en características personales como edad, etnia, género o discapacidad. El objetivo de este estudio es explorar cómo ha sido investigada la discriminación laboral percibida, en el contexto de investigaciones acerca de su asociación con salud y resultados ocupacionales. Métodos: Siguiendo la guía PRISMA-ScR y la metodología del Instituto Joanna Briggs, se realizó una revisión panorámica de artículos publicados entre los años 2000 y 2022 en bases de datos como PubMed, Scopus y PsycInfo. Los criterios de inclusión se centraron en estudios que exploraron la discriminación laboral percibida en trabajadores, excluyendo aquellos en pacientes, estudiantes o población general, y artículos no escritos en inglés o español. Resultados: De los 9871 artículos identificados, 102 cumplieron con los criterios y fueron analizados. La investigación mostró un aumento progresivo en el estudio de la discriminación laboral percibida, con una mayoría de estudios en América del Norte y Europa y un predominio de diseños transversales. La mayoría no definió claramente el concepto de discriminación laboral percibida ni reportó las características psicométricas de los instrumentos de medición. Se encontró una asociación significativa entre la discriminación percibida y resultados negativos en la salud mental y física de los trabajadores, así como un impacto negativo en la satisfacción laboral y un aumento en el ausentismo. Además, las características sociodemográficas como raza/etnia, género y edad influyeron en la percepción de discriminación. Conclusiones: Esta revisión confirma que la discriminación laboral percibida impacta considerablemente la salud y satisfacción laboral de los trabajadores, afectando más a minorías y mujeres. A pesar de un incremento en su investigación en las últimas dos décadas, persiste una carencia de consistencia en la definición y medición del fenómeno. La mayoría de los estudios han utilizado diseños transversales, y se observa una notable ausencia de investigaciones en el contexto latinoamericano.