Pope C; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 26.

Community and Preventive Medicine, University of Rochester, 601 Elmwood Ave, Rochester, NY 14642; Tel: (585) 275-0470; Fax: (585)461-4532; E-mail: charlene_pope@urmc.rochester.edu

RESEARCH OBJECTIVE: 1) To demonstrate the application of conversation analysis with a random sample from a quantitative health service research investigation, as a useful qualitative means to examine communication patterns during health service delivery. 2) To use Communication Accommodation Theory to generate a taxonomy to investigate racial disparities in health communication STUDY DESIGN: Case comparisons of Black teens and White teens who spoke with the same White physicians are compared for evidence of disparity patterns in ambulatory visits. POPULATION STUDIED: First, a secondary analysis was performed of racial differences in health promotion advice to 436 teens from 15 to 18 years of age from the University of Rochester study "Measuring Adolescent Preventive Services" (MAPS), principal investigator, Jonathan Klein. From this sample, detailed conversation analysis was used to generate side-by-side comparisons of randomly selected and matched pairs of Black and White teens of similar age, gender, and private insurance in talk with the same White physicians. PRINCIPAL FINDINGS: First, statistically significant differences were found in health promotion advice by race in the group of 436 teens. Then, in transcript analysis and teen focus group feedback, all teens experience authoritarian physician styles, gender-specific practices, teasing, restricted questions, comments of social bias, and heterosexual assumptions. All teens receive less health promotion advice than recommended by the American Medical Association Guidelines, but Black teens receive less than White teens, with less positive affect, time, talk, humor, White physician self-disclosure, and participation. Black teens receive more selective attention, close-ended questions, missed cues, stereotypes, threats, power-oriented interruptions, and White withdrawal from experiences with racism. Differences in ethnic vernacular are not associated with racial differences in process and outcomes. CONCLUSIONS: Though labor-intensive, conversation analysis methods can be applied in a targeted fashion to produce results that illuminate the subtleties of racial/ethnic disparities in health services. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Evidence-based patterns from populations with demonstrated racial/ethnic disparities can be used as the basis for quality audits, patient service evaluations (report cards), and continuing education for both physicians and patients to improve health encounter interactions. PRIMARY FUNDING SOURCE: National Science Foundation

Publication Types:

• Meeting Abstracts

Keywords:

• Adolescent
• African Americans
• African Continental Ancestry Group
• Case-Control Studies
• Communication
• Continental Population Groups
• Delivery of Health Care
• European Continental Ancestry Group
• Humans
• Insurance, Health
• Interpersonal Relations
• Physicians
• Prejudice
• economics
• utilization
• hsrmtgs

Other ID:

• GWHSR0002049

UI: 102273725

From Meeting Abstracts