How demographic factors influence perception of care

Perceptions of care are influenced by disrespect from staff and clinicians because of racial, ethnic, and socioeconomic factors, according to a recent study.

Experience of care is directly associated with quality of health care, as positive patient experience has been linked to improved safety and clinical outcomes, improved adherence to treatment plans, and less use of health care. Provider communication experience has a significant impact on outcomes.

Race, ethnicity, primary language, and insurance status have direct impacts on patient experience in both adult and pediatric populations. Patients have reported feeling misunderstood, not receiving proper communication or time devoted from clinicians, or lack of culturally effective care from clinicians.

To understand how families of different racial, ethnic, and socioeconomic backgrounds experience pediatric outpatient care, investigators conducted a study consisting of semi-structured interviews.

Participants included parents or guardians of pediatric patients who had received care at primary care, medical subspecialty, or surgical subspecialty clinics in the past 3 months. There were 80 interviews lasting 40 to 60 minutes during the study period, with participants from a variety of racial and ethnic groups, insurance statuses, and languages.

The participant sample included 19 Asian parents, 18 Black, 13 Hispanic and English speaking, 12 Hispanic and Spanish speaking, and 18 White, properly balanced through the 3 clinics and among insurance status. Along with visiting a clinic in the past 3 months, children were also expected to have visited a clinic at least once in the prior year to be eligible.

Inductive and deductive analysis was used to evaluate interview data and expand on themes from prior research. Clinicians, a qualitative researcher, and research assistants participated in data analysis.

Interview data indicated an overarching theme of “discrimination and disrespect,” seen in every stage of care. Three primary themes were also observed. The first was mitigation of system issues, where overall perception of care was impacted by parents’ experience with clinicians or staff working to mitigate system issues.

The second theme was the role of personal interactions, where negative experiences were mitigated by positive relationships between families and clinicians. The third theme was effective explanations, where patient confidence in care was significantly affected by clear and detailed explanations by clinicians.

Negative experiences in these 3 themes were more common in those with public insurance, except for effective explanations. Asian parents with public insurance reported the greatest proportion of negative sentiments.

Assumptions on family culture, financial status, or background most often led to disrespect or discrimination. Black parents and Hispanic parents experienced the greatest proportion of negative comments, followed by Asian parents.

Negative assumptions often resulted in parents feeling targeted by clinicians or staff based on culture or background. One instance in the study saw a parent offered informational materials in Vietnamese feeling that assumptions were being made about her family’s proficiency in speaking English. Similar experiences were seen based on socioeconomic status.

These results show how racial, ethnic, and socioeconomic factors can affect perception of care. Insurance status was a notable factor in how perceptions of care differed between participants. Overall, the study shows the importance of interactions between family and clinicians in creating a positive experience.

Reference

Luff D, Buscher SW, Ward VL, Ballal SA, Holden P, Pierre R, et al. Understanding racial, ethnic, and socioeconomic differences in the ambulatory care experience. Pediatrics. 2022;150(6). doi:10.1542/peds.2021-056001