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Study offers real world perspective on how Black patients experience mental healthcare

September 15, 2020

INDIANAPOLlS - In a novel study the authors hope will contribute to improved patient care, Richard L. Roudebush Veterans Affairs Medical Center and Regenstrief Institute researchers examine how Black patients with mental health concerns evaluate verbal and non-verbal communication during treatment.

Drawing upon information gathered in interviews with 85 Black patients that revealed significant fear of being negatively judged based on stereotypes, the authors evaluate how perceptions of racial bias influence patient engagement with their providers. The researchers also provide suggestions on how to create environments for Black and other patients in racial and ethnic minority groups that foster delivery of person-centered care as well as outlining organizational structures that reduce providers' burnout.

"This study is one of the first to explore the actual perceptions of Black patients with mental health concerns and provides a new lens to help identify and address biases," said Johanne Eliacin, PhD, a research scientist with Regenstrief Institute and the U.S. Department of Veterans Affairs, who led the research. "Nuanced verbal and non-verbal cues - for example, a patient's perception that a physician is subtly talking down to him or her because of the patient's race or social class -- can generate patient negativity resulting in damaging consequences.

"There is a long history of hurt, distrust and perceived injustice in this country, so it's normal for minority patients to have their guard up when interacting with the healthcare system," said Dr. Eliacin. "This paper is significant because of its subject matter and especially relevant as we work to provide equitable healthcare for all."

Patients' perceptions of bias in healthcare are known to be associated with suboptimal care, delays in obtaining medical care, underutilization of preventive and mental health care, less adherence to recommended therapy and poorer treatment outcomes

Perceptions of bias also negatively impact the patient-provider relationship, a relationship that influences both patients' engagement in care and quality of healthcare outcomes.

"Most healthcare providers are committed to providing good and equitable treatment to all patients regardless of their race or sexual-orientation but doctors, nurses and other clinicians are not immune to social and cultural influences that can lead to stereotyping and implicit racial bias -- major contributors to healthcare disparities," said Dr. Eliacin. "We aren't asking providers to walk on egg shells, we are encouraging them to engage in two-way communication in order to better understand the people they serve and, ultimately, to promote health equity."
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"Veterans' perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication" is published in the September 2020 print issue of Patient Education and Counseling. Authors, in addition to Dr. Eliacin, are Marianne Matthias, PhD, a research scientist with Regenstrief Institute and the U.S. Department of Veterans Affairs; Brooke Cunningham, M.D., PhD, of University of Minnesota Twin Cities and Diana J. Burgess, PhD, of the Veterans Affairs Medical Center, Minneapolis.

Support for the study was provided by the U.S. Department of Veterans Affairs.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Regenstrief Institute is celebrating 50 years of healthcare innovation. Sam Regenstrief, a successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute's research mission.

Johanne Eliacin, PhD

In addition to being a research scientist at Regenstrief Institute, Johanne Eliacin, PhD, is a core investigator at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center. She is also a research scientist at the Indiana Alzheimer's Disease Research Center.

Marianne S. Matthias, PhD

In addition to her role as a research scientist at Regenstrief, Marianne S. Matthias, PhD, is a core investigator for the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center. She is also an associate research professor of medicine at Indiana University School of Medicine.

Regenstrief Institute

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