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J Gen Intern Med. 2006 Feb;21(2):111-6. Epub 2005 Dec 22.

Cultural identities and perceptions of health among health care providers and older American Indians.

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  • 1Department of Sociology, Boston College, Chestnut Hill, MA, USA.

Abstract

BACKGROUND:

Differences in provider-patient health perceptions have been associated with poor patient outcomes, but little is known about how patients' cultural identities may be related to discordant perceptions.

OBJECTIVE:

To examine whether health care providers and American-Indian patients disagreed on patient health status ratings, and how differences related to these patients' strength of affiliation with American-Indian and white-American cultural identities.

DESIGN:

Survey of patients and providers following primary care office visits.

PARTICIPANTS:

One hundred and fifteen patients > or =50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American-Indian race, but varied in strength of affiliation with separate measures of American-Indian and white-American cultural identities.

MEASUREMENTS:

Self-reported sociodemographic and cultural characteristics, and a 5-point rating of patient's health completed by both patients and providers. Fixed-effects regression modeling examined the relationships of patients' cultural identities with differences in provider-patient health rating.

RESULTS:

In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients' self-rating. Provider-patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P=.01). Differences in ratings were not associated with the separate measure of affiliation with American-Indian identity.

CONCLUSIONS:

American-Indian patients, especially those who affiliate weakly with white-American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions.

Comment in

PMID:
16390503
[PubMed - indexed for MEDLINE]
PMCID:
PMC1484651
Free PMC Article

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