April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Characterizing Equity in Patient-Provider Interactions With Patients of Color: A Systematic Literature Review
Health inequities abound. Evidence demonstrates that the patient-provider interaction is a critical nexus in the perpetuation of these inequities. There is increasing recognition that health inequities are the product of social and structural factors that determine health and wellness differently at different social intersections. Yet, health communication scholarship is disproportionately focused on individual factors that determine health outcomes. Given the determinants of inequities are social and structural in nature, a focus on individual determinants of behavior will never address these inequities, per se. The purpose of this study was to summarize the contemporary patient-provider interaction literature to characterize the quality and scope of scholarship in communication science about health equity as it relates to the patient-provider interaction. Developing systematic efforts to undermine health inequities that are borne out in the patient-provider interactions requires theoretically-grounded knowledge about the systematic ways marginalized communities receive relatively poorer healthcare in these interactions. We conducted a systematic review of the recent body literature concerning communication in the patient-provider relationship in order to characterize the state of the literature and identify fruitful future directions for research and practice to improve health equity through the patient-provider interaction.
Method: Between January 2022 - June 2023, we collected 400 non-duplicative empirical research articles centering on patient-provider interactions. Search terms included patient-provider, communication and an indication of racial equity related considerations (e.g., inequity, racism, racial groups; stigma; disparity, bias). Databases included Academic Search Premier, Google Scholar, Science Direct, PubMed, PubMed. The articles were coded by a team of two co-investigators and a team of research assistants. Articles (N = 280+ articles were coded and retained) were coded for coded for: journal name, primary/secondary data, inequity of the topic of study (gender, gender identity, race, socioeconomic), context of inequity (detection, prevention, treatment, other), presence and application of theory, method, demographic characteristics, sample size and type (i.e., clinician, patient), and the extent of focus on health equity (i.e., equity in abstract, in rationale, in sample, in measures/analyses/results, in discussion). After discussion and resolution of disagreements, Krippendorf’s alpha = .93.
Results:
Theme 1: The body of scholarship is largely atheoretical. Most studies neglected to mention a guiding theoretical perspective. Among those who did, most mentioned a theory in passing, but did not apply the theory throughout the data collection, analysis and discussion.
Theme 2: Most studies focus exclusively on the patient (n =233). Whereas, fewer addressed the provider experience (n = 72). Only 41 studies included both patients and providers in their sample.
Theme 3: Study design was largely reliant on survey data, with notable exceptions, including focus groups and coded interactions.
Theme 4: Equity is frequently represented by including people of color in the sample, without interrogation of the factors that shape (in)equitable outcomes for people of color. That is, equity is typically mentioned in the literature review and included as an indicator of racial identity, but the treatment of equity in this body of research is akin to “waving the marshmallow over the fire” rather than “roasting the marshmallow.”
Method: Between January 2022 - June 2023, we collected 400 non-duplicative empirical research articles centering on patient-provider interactions. Search terms included patient-provider, communication and an indication of racial equity related considerations (e.g., inequity, racism, racial groups; stigma; disparity, bias). Databases included Academic Search Premier, Google Scholar, Science Direct, PubMed, PubMed. The articles were coded by a team of two co-investigators and a team of research assistants. Articles (N = 280+ articles were coded and retained) were coded for coded for: journal name, primary/secondary data, inequity of the topic of study (gender, gender identity, race, socioeconomic), context of inequity (detection, prevention, treatment, other), presence and application of theory, method, demographic characteristics, sample size and type (i.e., clinician, patient), and the extent of focus on health equity (i.e., equity in abstract, in rationale, in sample, in measures/analyses/results, in discussion). After discussion and resolution of disagreements, Krippendorf’s alpha = .93.
Results:
Theme 1: The body of scholarship is largely atheoretical. Most studies neglected to mention a guiding theoretical perspective. Among those who did, most mentioned a theory in passing, but did not apply the theory throughout the data collection, analysis and discussion.
Theme 2: Most studies focus exclusively on the patient (n =233). Whereas, fewer addressed the provider experience (n = 72). Only 41 studies included both patients and providers in their sample.
Theme 3: Study design was largely reliant on survey data, with notable exceptions, including focus groups and coded interactions.
Theme 4: Equity is frequently represented by including people of color in the sample, without interrogation of the factors that shape (in)equitable outcomes for people of color. That is, equity is typically mentioned in the literature review and included as an indicator of racial identity, but the treatment of equity in this body of research is akin to “waving the marshmallow over the fire” rather than “roasting the marshmallow.”