Perceived racial discrimination in health care and its association with patients' healthcare experiences: does the measure matter?

OBJECTIVES Examine whether three measures of perceived racial discrimination in health care detect similar rates of discrimination and show similar associations with patients' healthcare experiences. DESIGN Cross-sectional observational study involving telephone surveys and medical record reviews. SETTING Veterans Affairs Pittsburgh Healthcare System. PARTICIPANTS 50 White and 50 African American veterans with diabetes. MAIN OUTCOME MEASURES Three types of measures of perceived racial discrimination in health care were compared: single-item and multi-item measures assessing personal experiences of discrimination in healthcare settings, and a measure assessing general racism in the healthcare system. Associations of each measure with patient-reported problems with their medical care and receipt of recommended preventive screenings were also explored. RESULTS More African American than White veterans reported perceived discrimination on all measures (personal discrimination, single-item: 42% vs 6%, P<.001; personal discrimination, multi-item: 42% vs 18%, P=.01; general racism: 74% vs 40%, P=.001). In the total sample, discrimination was more likely to be reported on the general racism measure than on the single-item (OR=36.53, 95% CI=7.95-167.89) or multi-item measures (OR=20.28, 95% CI=5.12-80.34) of personal discrimination. The multi-item measure of personal discrimination (OR=3.96, 95% CI=1.29-12.18) and general racism measure (OR=3.61, 95% CI=1.34-9.71) were significantly associated with patient-reported problems with their care. Receipt of recommended screenings was not associated with any of the discrimination measures. CONCLUSIONS Different measures of perceived racial discrimination in healthcare settings yield different rates of discrimination and show variable associations with patients' perceptions of care.