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Abstract: Objectives. To examine African American patient perceptions of racial discrimination in clinical encounters. General barriers to hypertension management were also investigated. Methods. Six focus groups with 37 African American hypertensive patients were conducted and the transcribed sessions were analyzed for content. Results. Patients valued providers who shared information regarding self-care behaviors to manage hypertension and those who provided information regarding treatment options. Provider assumptions about patient inability to afford services, and provider apathy in reaching diagnoses were perceived as racially discriminatory. Patients discussed providers' avoidance of touch during physical exams as overtly discriminatory. Patients reacted to discriminatory experiences by not keeping appointments with providers perceived as racially discriminatory. Barriers to hypertension management were associated with family responsibilities and lifestyle factors, but were not attributed to provider racial biases. Conclusion. Perceiving racial discrimination in clinical encounters may be an important barrier to appointment attendance for African American hypertensive patients.
Key words: African Americans, racial discrimination, hypertension, appointment adherence.
African Americans have greater risk for fatal and non-fatal stroke than White Americans nationally.1 In South Carolina, African Americans were nearly 35% more likely to die from stroke and other hypertension-related diseases in 2004 than their White counterparts, who had an average mortality rate of 60 deaths per 100,000 for the same year.2 Despite the life-threatening consequences of hypertension for African Americans in South Carolina and other states, mounting research evidence reveals a myriad of disparities in diagnoses and treatment of cardiovascular diseases between members of this population and non-Hispanic Whites.3-4 Recent studies demonstrate that African Americans are less likely than White Americans to be prescribed preventive medications for elevated blood pressure, and are often not referred for aggressive medical interventions, such as cardiac catheterization.5-6
Patient health behaviors, low levels of health insurance coverage, and limited access to care contribute to health disparities.7 Studies on patient choice suggest that African Americans are more likely to reject provider recommendations and are less likely than White Americans to follow through with referrals for treatment.8-9 However, treatment preferences and rejection rates for medical services do not fully explain racial health disparities, and neither do factors such as health insurance.10 Rather, as discussed in the Institute of Medicine (IOM) report, health care providers' display of racial discrimination during clinical encounters...