The Effects of Race/Ethnicity and Gender on Medical Perceptions of News Stories
by
Taylor Majidi
A Capstone Project
Presented to the Faculty of the School of Communication in Partial Fulfillment of the
Requirements for the Degree of Masters of Arts in Strategic Communication
Supervisor: Dr. Joseph Erba
American University
May 1, 2014
2 COPYRIGHT
Taylor Majidi
2014
3 Abstract:
The current study deals with the phenomenon of stereotyping and discrimination in the medical
field. The relationship between race/ethnicity and gender, and perception of a potential patient
and their prospective treatment plan was explored. The current study served the purpose of
enhancing communication knowledge of medical discrimination. Priming theory was utilized in
a 3 x 2 experimental method. There were 91 participants in the experiment including the general
public; 29 participants in the first study including medical professionals; and 11 participants in
the revised study including medical professionals. Significant differences were not found among
racial/ethnic and gender primes. However, participants of every profession agreed that a
racial/ethnic minority was both more favorable and expected to be treated most accordingly to
the symptoms of a heart attack. Since the findings were not consistent with previous research,
this study provides reason for further exploration of the topic.
4 Table of Contents
List of Tables……………………………………………………………………………………..6
Introduction ………………………………………………………………………………….......7
Literature Review………………………………………………………………………...............8
African Americans, Latinos, and Women.…………………………………………...…..10
Physicians’ Perceptions of Patient…...………………………………………..……........12
Treatment of Patients…………………………………………………………………….13
Media Representation……………………………………………………………………15
Theoretical Framework…………………………………………………………………..18
Hypotheses ………………………………………………………..………………………….….21
Methods
Overview…………………………………………………………………………………22
Participants……………………………………………………………………………….23
Recruitment………………………………………………………………………………24
Current Study…………………………………………………………………………….25
Measurement……………………………………………………………………………..26
Consent…………………………………………………………………………………..26
Privacy……………………………...……………………………………………………27
Data Storage……………………………………………………………………………..27
Ethical Concerns…………………………………………………………………………27
Validity…………………………………………………………………………………..27
Results……………………………………………………………………………………………29
Discussion..………………………………………………………………………………………33
Limitations……………………………………………………………………………….35
Conclusion……………………………………………………………………………………….37
Future Research………………………………………………………………………….37
References………………………………………………………………………………………..39
Appendices
Stimulus-Caucasian Man…………………………………………………………...……45
Stimulus-Caucasian Woman………………………………………………………….….45
Stimulus-African American Man………………………………………………………...46
5 Stimulus-African American Woman…………………………………………………….46
Stimulus-Latino Man…………………………………………………………………….46
Stimulus-Latina Woman…………………………………………………………………47
Questionnaire…………………………………………………………………………….47
6 List of Tables
Table 1………………………………………………………………………………...…36
Table 2…………………………………………………………………………………...37
7 Introduction
The need to understand and explore the phenomenon of discrimination is
incontrovertible. Discrimination affects many people in various ways. People can be
discriminated against for their race/ethnicity, gender, age, socio-economic status, religious
affiliation, political affiliation, sexual orientation, and any other variable that can cause an
individual, when associated with the variable, to be considered as part of an out-group.
Individuals can be discriminated against in many different settings. One setting where a
disparity between individuals is evident is in the health care system. This disparity can have
ripple effects throughout an individuals’ life; from detection of an illness to treatment of an
illness to quality of care afterward. Understanding discrimination in the health care field is a
necessity.
The current study called upon past research and priming theory to guide an exploration of
racial/ethnic and gender discrimination in the health care setting. The study yielded results
inconsistent with past research; and created the need for future research on this topic.
8 Literature Review
Physicians discriminate against racial/ethnic minorities and women (Blair et al., 2013;
Burgess et al., 2006; Moskowitz, 2011; Moskowitz, Stone, & Childs, 2012; van Ryn & Burke,
2000). For example, not only do physicians perceive various races/ethnicities and genders
differently, but it is also the case that a physician will sometimes diagnose and treat a patient
differently based on their race/ethnicity and gender (Blair et al., 2013; Ferber, 2007; Gollust &
Lynch, 2011; Green et al.,2007; Moskowitz et al., 2011; Moskowitz et al., 2012; Travis,
Howerton, & Szymanski, 2012; van Ryn & Burke, 2000) A possible contributing factor to this
phenomenon is media consumption (Travis et al., 2012). Not only are women and minorities
underrepresented in the media, but when they are depicted, the portrayal is far from reality
(Atuel, Seyranian, & Crano, 2006; Briley, Shrum, & Wyer, 2007; Collins, 2011; Comas, 2012;
Ferber, 2007, Travis et al., 2012). Stevens and Hull (2013) describe the impact of news media
best by positing that “the way news is reported has implications for audience understanding” (p.
354). If physicians were to use media as a reference when interacting with patients, it would be
likely that they relied on stereotypes to guide that interaction (Travis et al., 2012).
This is problematic due to the fact that the population of minorities (Latinos, African
Americans, and Asians) according to the 2010 United States Census has risen to 33.8% and the
number continues to climb. In accordance with the 2010 United States Census the amount of
women in the United States has reached 50.9%. With this many individuals who are women
and/or racial/ethnic minorities, physicians do not have the option to discriminate against their
patients.
9 Researchers argue that discrimination and racism against African Americans and Latinos
in the health care setting is not blatant, but subtle (Mazzocco & Brunner, 2012; Travis et al.,
2012). To demonstrate this concept, Mazzocco and Brunner (2012) presented participants with a
cue that either prompted them to answer a question with race in mind or to answer a question
without a racial prime; the researchers found that the participants who did not receive the racial
prime provided more prejudiced answers to the question. This is explained by the fact that people
are willing to correct for common biases in judgment; however, if blunt racism is discussed,
people are more likely to produce adverse results (Mazzocco & Brunner, 2012). Due to this fact,
discrimination can go unnoticed by individuals other than the patient, even to the physician, the
stereotyping and biases can be unconscious (Blair et al., 2013; Green et al., 2007; Moskowitz et
al., 2012). This is made evident by the fact that physicians often do not express racial/ethnic bias
while still delivering care that is influenced by unrecognized bias (Blair et al. 2013).
When physicians discriminate against racial/ethnic minorities, it can lead to
dissatisfaction with the interaction, incorrect treatment course, and bad personal feelings (Blair et
al., 2013; Burgess, van Ryn, Crowley-Matoka, & Malat, 2006; Chapman, Kaatz, & Carnes,
2013; Green et al., 2007; Lutfey et al., 2010; MacIntosh, 2013; Moskowitz et al., 2012; Travis et
al., 2012). The current study will explore what the relationship between race/ethnicity, gender
and physicians’ perceptions of patients and their potential treatment plan. First, discrimination,
perception of patients, treatment, media representation, and the theoretical framework used to
conduct this study, priming, will be discussed. However, a note to remember is that not all
medical professionals are guilty of discrimination; and of the medical professionals that do
discriminate, Caucasian males are not the only offenders.
10 African Americans, Latinos, and Women
Racial/ethnic discrimination is prevalent in the United States (Ferber, 2007; van Ryn &
Byrke, 2000). African Americans are often seen as having less desirable traits than Caucasian
individuals, such as being lazy, irrational and overall less pleasant than their Caucasian
counterpart (Gollust & Lynch, 2011; van Ryn & Burke, 2000). One problem African Americans
face is that despite their actual attained level of education, they will often be seen as less
intelligent as their Caucasian counterpart and they are often discriminated against in employment
settings (Ferber, 2007; van Ryn & Burke, 2000). The overall rate for discrimination of Latinos is
30% (Pérez, Fortuna, & Alegría, 2008). However, Latinos who report a strong ethnic identity do
not report discrimination as often as Latinos who do not have a strong ethnic identity (Pérez et
al., 2008).
It is well understood that racial/ethnic disparities are prevalent in the health care setting
(Lillie-Blanton et al., 2000; MacIntosh et al., 2013; Mazzocco & Brunner, 2012). One major
disparity for minorities in the health care setting is level of treatment (MacIntosh et al., 2013).
Minorities report significantly more discrimination and dissatisfaction with the level of care they
receive form health care professionals then Caucasian individuals do (MacIntosh et al., 2013).
Findings suggest that the discrimination faced by minorities in health care settings is subtle
(Mazzocco & Brunner, 2012; Travis et al., 2012).
In addition to this, the majority of Americans are aware of the disparity between minority
and Caucasian individuals in health care settings (Lillie-Blanton et al., 2000). The fact that
African Americans are twice as likely to be uninsured as Caucasians and that Latinos are two and
a half times as likely to be uninsured as Caucasians, is a believable and often known fact to many
11 Americans (Lillie-Blanton et al., 2000). There are currently 4.3 million uninsured Caucasian
individuals, 6.8 million uninsured African Americans and 10.2 million uninsured Latinos (HHS,
2014).
As for gender discrimination, anti women bias has gone down over time, yet however is
still prevalent in the health care setting (Kehn & Ruthig, 2013; Travis et al., 2012). An
explanation for discrimination against women in these cases is the use of stereotypes by
physicians (Travis et al., 2012). Researchers have found that physicians rely on heuristics,
namely the representativeness heuristic, when dealing with both minority and women patients
which can lead to discrimination of the patients (Travis et al., 2012). Heuristics involve using
pre-conceived notions to evaluate a situation. Travis et al. (2012) explain this by writing:
This heuristic may prove useful in everyday life; however, it may lead to biases in certain
situations. For example, when determining the probability of a heart attack, a physician
might rely on the degree to which the patient matches the standard text book case. As
standard heart patients are often represented as male in advertisements and textbooks,
women may not be readily seen as at risk for a heart attack (p. 211).
This can be a problem because there is not a standard textbook case for all patients
(Travis et al., 2012). While the symptoms of a heart attack are generally similar, men and women
can present different symptoms (Travis et al., 2012). Women express feelings of nausea more
than men and men profusely sweat more than women (Travis et al., 2012). This can allow for
more use of heuristics on the physicians’ part due to the fact that men and women often display
different symptoms of illnesses (Travis et al., 2012).
12 Racial/ethnic minority women face discrimination as well (Broome, 2007). African
American and Latina women both are more prone to certain diseases than others. The most
common disease among both groups of women is Hypertension (Broome, 2007). Due to this fact,
and accessibility to higher incomes and insurance, the system can create more health disparities
for African American and Latina women (Broome, 2007).
Physicians’ Perceptions of Patients
Physicians are known to perceive racial/ethnic minority patients less favorably than
Caucasian patients (Blair et al., 2013; Moskowitz et al, 2011; van Ryn & Burke, 2000). In health
care settings, Caucasian physicians tend to perceive minority patients as less intelligent, rational,
and pleasant (van Ryn & Burke, 2000). Physicians are also likely to have the idea that minority
patients are likely to be at risk for substance abuse, have a less active lifestyle, and will not be as
compliant with treatment procedures as Caucasian patients (Moskowitz et al., 2012; van Ryn &
Burke, 2000). The only explanation offered for the origin of these perceptions is the individual
physicians’ subjective assessment of the patient which is most likely based on stereotypes
(Moskowitz, 2011).
Due to these perceptions of minority patients, physicians tend to have less trust in
marginalized patients (Moskowitz et al., 2011). Moskowitz et al. (2011) tested and confirmed
that all minority patients scored lower on the “Physician Trust in the Patient Scale” than their
Caucasian counterparts. Many researchers attribute the phenomenon occurring when physicians
perceive minorities less favorably than Caucasian individuals to stereotypes and unconscious
bias (Blair et al., 2013; Green et al., 2007; Moskowitz et al. 2011; Moskowitz et al., 2012; Travis
et al., 2012). This can affect patient satisfaction as well (Blair et al. 2013). Physicians’ implicit
13 preference for Caucasian patients was consistently correlated with lower ratings from African
American patients (Blair et al. 2013). This can also be a problem when stereotyping and
unconscious bias affect how a physician treats a patient (Burgess et al., 2006; Green et al., 2007;
Lutfey et al., 2010). This can be seen in cases such as breast cancer (Freeman, 2014). African
American women are 40% more likely to die from breast cancer than Caucasian women
(Freeman, 2014). This is because of African American women’s lack of accessibility to cancer
detection and treatments (Freeman, 2014).
Physicians are also known to have less favorable perceptions of other commonly
discriminated against groups such as women (Blackstock et al, 2012; Lutfey et al., 2010; Travis
et al., 2012). Blackstock et al. (2012) found that physicians often perceive women as less
educated, rational, responsible, compliant, independent, and direct than their male counterparts.
This phenomenon is explained by Travis et al. (2012) as being the product of physicians using
available heuristics when encountering female patients to use stereotypes to quickly assess the
state a patient is in rather than getting to the real cause of the problem. Women are also more
likely to have mood and anxiety disorders which lead physicians to believe they would be better
treated by psychologists or psychiatrists to treat their emotional maladies (Gohier et al., 2013;
Travis et al., 2013).
Treatment of Patients
The perceptions that physicians have of patients does not only span as far as physicians
trust in the individual; the reach extends to how a patient is treated (Blair et al., 2013; Green et
al., 2007; Moskowitz et al., 2012; Travis et al., 2012). Treatment of patients can be defined either
as how a patient is cared for while staying in the hospital or as the decision a physician has made
14 for course of action to ameliorate the patients’ problem (Green et al., 2007; MacIntosh et al.,
2013; Moskwowitz, Stone, & Childs, 2012; Travis et al., 2012)
Physicians’ decisions to treat patients can be based on their demographic information
such as gender and race/ethnicity (Lutfey et al., 2010). Physicians tend to believe that Caucasian
individuals have more socially desirable characteristics which influences their treatment
decisions (Burgess et al., 2006). Physicians are less likely to treat minorities in situations such as
Thrombolysis and pain treatment (Burgess et al., 2006; Chapman et al., 2013). Lutfey et al.
(2010) found that the physician participants correctly diagnosed the patients most of the time, but
based on demographic characteristics, such as race, the treatment they received was different.
This is similar to a study done by Green et al. (2007), the researchers wanted to examine clinical
decisions and how stereotypes affected them. Researchers found that with two patients, one
African American and one Caucasian that have the same medical problem (Thrombolysis) are
not likely to get the same treatment from a physician with bias (Green et al., 2007).
The pervasiveness of stereotyping suggests that health care providers sometimes activate
and apply stereotypes when making sense of patients, regardless of level of commitment
to equality and desire to make decisions on the basis of clinically relevant attributes of
the individual patient (Burgess et. al., 2006, p. 120).
Researchers found that physicians rely on stereotypes when diagnosing African American
patients (Moskowitz, Stone, & Childs, 2012). The researchers found that there were
“stereotypical” diseases that physicians associated with African American patients and by
diagnosing them using these stereotypes, the treatment plan is made (Moskowitz, Stone, &
Childs, 2012). There were diseases that had genetic components, which were considered valid
15 stereotypes, but there were other diseases which came from stereotyping a behavioral component
of the individuals. These included: HIV, obesity, and drug abuse. (Moskowitz, Stone, & Childs,
2012). These stereotypes can be created by the media (Atuel, 2006; Ferber, 2007).
Media Representation
Media can influence how physicians treat patients (Travis et al., 2012). In general,
minority groups have historically been underrepresented in the media as compared to
Caucasians; however their appearance in the media has increased in recent years (Atuel et al.,
2006; Briley et al., 2007; Collins, 2011).
The way minorities are represented in the media is not based on reality (Atuel, 2006;
Ferber, 2007). This can be seen in American news sources when the majority of all news stories
about any minority group deals with social issues as opposed to political issues or other
headlines including different types of identity adjectives (Atuel et al., 2006). Atuel et al. (2006)
found that in different parts of the United States, where minority populations are denser, there is
no change in the way minorities are portrayed in the media. In this particular study, news
headlines from Midwestern states and California were examined and it was shown that the
majority of all minority headlines (55%) dealt with social issues (Atuel 2006). In addition to this,
the content of the article displayed more ethnic themes than anything else (Atuel et al., 2006).
Atuel (2006) found that due to the ethnic composition of the cities the study was done in,
specifically the high population of Latinos in California, minority group headlines contained
more ethnic adjectives to describe the piece.
In a content analysis of HIV/AIDS coverage, where researchers assessed national news
outlets and 22 most widely circulated local news outlets, it was found that despite the fact that
16 the disease ran rampant in the African American community; more media coverage was given to
other populations (Stevens & Hull, 2013). Although this problem gained little media coverage
for African Americans, the attention it did receive marked the African American community as
an at-risk group; this means that they are more prone to the disease to do behavior and genetics,
other at-risk groups included homosexuals and drug users (Stevens & Hull, 2013). The reason
this is important is because the African American political leaders became activists for this cause
(Stevens & Hull, 2013). Due to the involvement of political leaders, attention for the African
American community increased (Stevens & Hull, 2013). The increased attention for African
American health problems can lead to physician discrimination (Moskowitz et al., 2012; Stevens
& Hull, 2013). This can be seen in a study done by Moskowitz et al. (2012) HIV/AIDS was one
of the most common answers that physicians gave when asked what diseases are most common
to African Americans, they answered HIV/ AIDS along with obesity, sickle cell anemia, stroke,
hypertension, and sarcoidosis.
In addition to this, Gruenewald, Chermark, and Pizarro (2013) found when analyzing
news coverage of homicides in Newark, New Jersey from 1997 to 2007 that stereotypes are
perpetuated. For example, African American crimes are more often reported when they involve
drugs, gangs, and robberies whereas Latino crimes are most likely to be reported when they are
of a domestic nature (Gruenewald, Chermark, & Pizarro, 2013). Crimes within races were often
less reported than crimes involving people of different races/ethnicities (Gruenewald, Chermark,
& Pizarro, 2013).
Moreover, the portrayal of African Americans in the media is far from reality (Ferber,
2007). African Americans are often portrayed as criminals, thugs, and welfare queens (Ferber,
2007). In addition to this, when viewing television clips of Latinos and Caucasian individuals,
17 Caucasian participants are more likely to give in to stereotypes such as perceiving the Latino
character as unable to achieve academic success while perceiving the Caucasian character to be
academically successful (Mastro, Behm-Morawitz, & Kopacz, 2008).
Racial minorities are not the only people who are depicted poorly in the media (Collins,
2011; Comas, 2012).Women are underrepresented in the media and often not portrayed
accurately (Collins, 2011; Comas, 2012). When they are depicted in the media, they are
generally shown in traditional, subservient, or sexual roles (Collins, 2011; Comas, 2012).
One particular barrier minority groups and women face with the media is the hegemonic
messages that are already set in place (Ferber, 2007; Walsh, 2009). Hegemony is what drives
racial formations and allows for social change (Walsh, 2009). It is the link between social
structure and culture, it allows for changing racial formations, it affects who gains power and
causes political shifts (Walsh, 2009). Current hegemonic messages are geared toward Caucasian
male power in America (Ferber, 2007). Hegemony can be seen in action when examining how
many racial minorities are currently in congress (Murse, 2014). There are 78 minority members
out of the 433 members in congress (Murse, 2014). These hegemonic messages can be seen in
action in the Atkin and Fife (1993) found that Caucasian males are four times as likely to be the
main individual in a news story as Caucasian females. Similarly, African American females are
significantly underrepresented as compared to their male counterparts (Atkin & Fife, 1993).
An example of this is in the health care setting (Travis et al., 2012). Travis et al., (2012)
found that women are discriminated against by physicians. The researchers attributed this to the
fact that physicians rely on heuristics when dealing with patients (Travis et al., 2012). One
reason they said women are discriminated against is because the medical textbooks and
18 advertisements that physicians are used to seeing depict male patients and due to this women are
less likely to be diagnosed with the same illness, specifically heart related diseases (Travis et al.,
2012).
Racial/ethnic minorities have problems that stem from stereotyping in the media (Atuel,
2006; Collins, 2011; Comas, 2012; Ferber, 2007; Gruenewald et al., 2013; Travis et al., 2012).
To evaluate racial/ethnic and gender stereotypes, experiments using priming theory are utilized
(Lutfey et al., 2010; Mastro et al., 2009).
Theoretical Framework
The theoretical base for this experiment is the priming theory. “Priming occurs when one
encounters stimuli in the media which activate existing mental constructs which then (largely
unconsciously) influence later evaluations of a target (Mastro et al., 2009, p. 616). This means
that a prime given to participants can increase their prejudice against the content of the prime
(Standing & Duchesneau, 2011). Priming theory is used with an experimental method (Lutfey et
al., 2010; Mastro et al., 2008; Mastro et al., 2009; Monahan et al., 2005; Siu, 2007; Smeesters,
Yzerbyt, Corneille, & Warlop, 2009). Priming theory is utilized by presenting participants with a
stimulus (racial/ethnic or gender) and providing them with a questionnaire to answer after
exposure to the stimulus (Lutfey et al., 2010; Mastro et al., 2008; Mastro et al., 2009). If the
prime is effective, participants will answer the items in accordance with the prime (Monahan et
al., 2005). Priming is a versatile theory (Siu, 2007). It provides information about the extent to
which decisions are made, it calls for the accessibility of specific and general words and
concepts, and it can affect social behavior (Lutfey et al., 2010; Siu, 2007; Smeesters et al., 2009).
Priming in some cases affects relative construct accessibility and can affect personal perception
19 (Siu, 2007). Priming can affect discrimination in individuals, at least for a short period of time
(Standing & Duchesneau, 2011).
Priming racial/ethnic categories often results in straightforward stereotyping (Mastro et
al., 2008). In one instance when Priming was used to examine racial prejudice toward African
American women, Monahan et al. (2005) found that when participants were primed with African
American women as welfare queens they were more likely to have negative attitudes and lower
expectations for that individual.
In a study about Latinos in the media, participants were primed with stereotyped
characters of Latinos and Caucasian individuals to elicit responses to see if any prejudice arose
from the prime (Mastro et al., 2008). They found that participants appeared to be more
discriminatory when characters had distinctively ethnic names (Mastro et al., 2008). For
example, when the Latino character had the name “Juan Rodriguez” and the Caucasian character
had the name “John Rodgers,” participants were more likely to have negative perceptions of the
Latino character such as perceiving that he would not graduate from high school whereas the
Caucasian character would (Mastro et al., 2008). Similarly, Mastro et al. (2009) primed
Caucasian individuals with news story primes of African American and Caucasian criminals to
see how forgiving and willing to overlook the crime both men and women were based on the
criminals’ race. The researchers found that men are least sympathetic to African American
males, assigning them the hypothetical longest prison sentence; and women are most
sympathetic, assigning the shortest hypothetical prison sentence, to Caucasian individuals
(Mastro et al., 2009).
20 With respect to the health care field, Lutfey et al. (2010) primed physicians to consider a
Coronary Heart Disease diagnosis for a potential patient. Participants received primes of patients
with different attributes (age, gender, race, socio-economic status) (Lutfey et al., 2010). An
overwhelming majority of participants who were primed correctly diagnosed their patient
(Lutfey et al., 2010).
The current study will make use of an experimental design. In an experimental design,
participants are given a prime and then asked to either perform a task or answer questions based
on the prime; however, the difference in their answers is assumed to be due to the primes (Healy
& Burt, 2003; Mastro et al., 2008; Standing & Duchesneau, 2011). The current study will
evaluate the relationship between race/ethnicity and gender, and perception of a patient and their
prospective treatment plan using priming experiment.
21 Hypotheses
H1a: The race/ethnicity and gender of the patient in the news story will affect participants’
perception of the patient.
H1b: Participants will view the Caucasian man more favorably than the African American man,
African American woman, Latino man, Latina woman, and Caucasian woman.
H2: The race/ethnicity and gender of the patient in the news story will affect participants’ belief
about how medical professionals would treat the patient.
H3a: The race/ethnicity and gender of the patient in the news story will affect participants’
perception of the patient.
H3b: Participants will view the Caucasian man more favorably than the African American man,
African American woman, Latino man, Latina woman, and Caucasian woman.
H4: The race/ethnicity and gender of the patient in the news story will affect participants’
treatment plan for the patient.
22 Method
Overview
The phenomenon I explored was the stereotyping and discrimination that the lay person
may believe is present when an employee in the medical field is introduced to individuals of
different races, ethnicities, and genders; in addition to exploring the discrimination among
medical professionals when they are introduced to patients of different races, ethnicities, and
genders. A major limitation that previous research has not addressed is the issue of evaluating
data from participants of different races. While in this study the majority of the participants are
Caucasian, data from African Americans, Latinos, and Asian Americans was also analyzed. In
multiple studies, the only categories that were available for data analysis were White and nonwhite; rather than displaying data from multiple races/ethnicities (MacIntosh et al., 2013; van
Ryn & Burke, 2000). In one study the researchers did address this issue by collecting data for
African-Americans, Latinos and White Americans however they collapsed the data for analysis
in to the categories White and non-White (Moskowitz, 2011). In a study done by van Ryn and
Burke (2000) the researchers operated under the idea that research needed to be expanded in to
evaluating to what degree perceptions of health care providers are related to difference races of
patients; this is the crux of my proposed research question. The research question was as follows:
What is the relationship between medical patients’ race/ethnicity and gender, and health care
providers’ perception of the patients and their diagnosis for future treatment? This research
question will be a beneficial contribution to the communication field because it gives new insight
into discrimination in the medical field.
23 This study is grounded in the Priming theory. Priming involves the process of exposing
participants to different stimuli to measure their reactions. This theory is best tested using an
experiment.
The method that was used in the current study was a series of experiments. Three
different experiments were created for the purpose of this study. Participants were primed with
different messages depicting various individuals of different races and genders. These
individuals included an African American male, African American female, Latino male, Latina
female, Caucasian male, and Caucasian female. In the messages, which were presented in the
form of news stories, each of the fictitious individuals displayed the same problematic medical
condition. Participants then completed a questionnaire that examined their attitudes toward the
fictitious patient and the recommended treatment plan.
Participants
The participants involved in the initial two experiments were exclusively medical
professionals. The participants were any individual who has the proper education or certification
to treat patients in the medical field. Participants from the initial two experiments were mainly
nursing professionals and physicians. The purpose of the second experiment was to launch a
version of the questionnaire that was more appropriate for medical professionals. During the
launch of the first study, a prominent figure in the medical field from New York suggested
changes to create a more medical professional-friendly questionnaire. Finding a large enough
sample size of medical professionals proved to be difficult, so, for the final experiment the
participants were from the general public. The questionnaire given to them after the primes, were
changed accordingly. The experiment is a 3 x 2 design. There were three levels of the first
24 independent variable, race/ethnicity (Caucasian, African American and Latino), and two levels of
the second independent variable, gender (man and woman). There were a total of 29 participants
for study one, 11 participants for study two, and 91 participants for study three. The participants
for the experiment involving the general public were overwhelmingly Caucasian (72.0%). The
gender make-up of all of the participants was closely split with 55.4% being men and 44.6 %
being women. The majority of the medical professionals for the first experiment were also
Caucasian (62.0%). The gender make up of these participants were also closely split with 46.2%
being men and 53.8% being women. The majority of the participants from the second experiment
involving medical professionals were evenly split between African American, Latino, Caucasian,
and Other, with 25% for each group. The gender make-up was 25% men and 75% women. Seven
individuals completed this experiment without reporting their race/ethnicity or gender.
Recruitment
The recruitment strategies were snowballing and networking. Recruitment for the first
two experiments started with limited contacts, about five or six, nursing professionals and
physicians; from there the contacts recruited more participants. A short description of the study
was given to potential participants. The description first introduced the researcher and then told
potential participants that their participation in this research would contribute to the researcher’s
completion of her Master’s degree. Participants were told that the experiments were about
medical professionals perceptions of news stories and that participants could come from any
medical profession. It was explicitly stated that the study would take no more than 15 minutes to
complete. Recruitment for the third experiment included snowballing, networking, using email
blasts, and utilizing online chat rooms.
25 Current Study
In the proposed study a 3 x 2 experimental design was used. Participants were primed
with stimuli depicting African American, Latino, or Caucasian men and women. Each individual
stimulus depicted one of the individuals mentioned above having medical symptoms, most likely
pointing to a heart attack, after a fire in their apartment building. Each stimulus displayed a
different individual but the same text. The stimuli included characters that were a Caucasian man
named Alexander Smith, a Caucasian woman named Alexandra Smith, an African American
man named Jayden Johnson, an African American woman named Jayla Johnson, a Latino man
named Juan Rodriguez, and a Latino woman named Juana Rodriguez. These names were chosen
because they were the most stereotypical names for each race (Butler, 2013; Lack, 2014; Mastro
et al., 2008) Symptoms displayed from a heart attack were chosen because heart attacks,
Thrombolysis, and pain are the three main medical problems that are the most common for
minorities and women to be treated differently than Caucasian men (Burgess, van Ryn, CrowleyMatoka, & Malat, 2006; Chapman, Kaatz, & Carnes, 2013; Lutfey et al., 2010; Travis,
Howerton, & Szymanski, 2012). The experiment was done via Qualtrics and participants were
able to be a part of the experiment from any computer or mobile device with Internet access.
Participation required no more than fifteen minutes of any individuals’ time. Data was recorded
online via Qualtrics and analyzed using SPSS. Upon completion of the online questionnaire,
participants were debriefed by a screen explaining how the purpose of the experiment was to test
for discrimination and biases in the medical field.
26 Measurement
The first dependent variable, perception of the patient, was measured using seven point
Likert-type scales. The participant was given directions at the beginning of each section of the
questionnaire that instructed them how to answer the item based on a seven point scale. Items
included “the patient has health insurance.” Also, “the patient is employed.”
The second dependent variable, prospective treatment plan, was measured using seven
point Likert-type scales. These items included “A medical professional is likely to recommend
an EKG for this patient mentioned in the news story.”
Control variables (age, gender, profession, years spent in the profession, political
affiliation, and religious affiliation) were also measured using a seven point Likert-type scale.
Open-ended answers were acceptable for items such as “age” and “professional title.” Openended answers were also acceptable for the two items asking “out of your closest same-sex
friends, how many of them are of a different race/ethnicity,” and “out of your closest oppositesex friends, how many of them are of a different race/ethnicity.”
Consent
Participants’ consent was obtained through a thorough consent form that explained all of
limited but potential risks to the study and what participating in the study entails. The form
included a description stating that the current study was about medical professionals’ perceptions
of new stories. It was explicitly stated that there would be a minimal time commitment.
Confidentiality was assured.
27 A debriefing form was given upon completion of the questionnaire. It expressed that
despite the initial purpose that was given, there was a different motive. The purpose of the
experiment (to examine the relationship between race/ethnicity and gender, and perceptions of a
patient and prospective treatment plan) was exposed.
Privacy
This study ensured the confidentiality of participant answers. There were no names or
identifiers linking participants to their answers. The only identifying variables that were reported
in the findings were age, gender, and race of the participants.
Data Storage
The data was stored on a private flash drive and saved on a personal computer. No other
individual had access to the data other than the researcher.
Ethical Concerns
The participants involved were not from any vulnerable populations. The content of the
stimuli and of the questionnaire was arguably not psychologically harmful. A case that can be
made for a psychological risk is that the items in the questionnaire were somewhat controversial.
This case can be made because some of the items measure discrimination overtly. To ameliorate
this possible situation a debriefing statement was displayed upon completion of the study.
Validity
The validity of this study was ensured through the instrument and stimuli. The instrument
was developed and given to each participant in the same way so that each individual would
experience the same study. This ensured validity because keeping everything uniform will assure
28 that the study’s integrity could not be called into question. Validity was managed by creating
definitive differences in each stimulus. Race and gender were clear in each stimulus.
Validity was also ensured through the development of the two additional questionnaires.
After receiving feedback from medical professionals about the effectiveness of the items in the
questionnaire, a second questionnaire was created. After having difficulties recruiting enough
medical professionals for those experiments, a third questionnaire was created that allowed the
general public to participate. Recruitment was successful through networking, snowballing,
email blasts, and utilizing online chat rooms.
29 Results
The data set consisted of participant answers in reaction to a news story. As mentioned above,
each participant was exposed to one condition featuring either a Caucasian man, Caucasian
woman, African-American man, African-American woman, Latino man, or a Latino woman.
Analyses of the data were conducted using SPSS. ANOVAs were used to determine the veracity
of the hypotheses. The first set of hypotheses is associated with the general public.
H1a: The race/ethnicity and gender of the patient in the news story will affect participants’
perception of the patient.
Results revealed no main effect for perception of the patient based on condition (F(5,66)
= 0.73, p > .05) as shown in table 1. Although not significant, the mean value for perception of
the patient (M = 4.00, SD = 0.09) showed that regardless of race/ethnicity and gender,
participants viewed the patient as neither particularly favorable nor particularly unfavorable. The
highest mean was associated with the Latina woman (M = 4.21, SD = 0.21) and the lowest mean
was associated with the Caucasian man (M = 3.83, SD = 0.21). H1a was not supported.
Table 1: One-way ANOVA for participants’ perceptions of the patient based on patient
race/ethnicity and gender
--------------------------------------------------------------------------------------------------------------------df
F
p
Condition
5
Error
66
0.73
0.60
30 H1b: Participants will view the Caucasian man more favorably than the African American man,
African American woman, Latino man, Latina woman, and Caucasian woman.
While there was no significant difference, results showed that the participants viewed the
Latina woman most favorably (M = 4.2, SD = 0.21), followed by the Latino man (M = 4.13, SD =
0.23). Participants viewed the African American man least favorably (M = 3.71, SD = 0.23). The
Caucasian man ranked fourth out of six (M = 3.93, SD = .21). H1b was not supported.
H2: The race/ethnicity and gender of the patient in the news story will affect participants’ belief
about how medical professionals would treat the patient.
Results revealed no main effect for perception of treatment based on condition (F(5,62) =
.92, p > .05) as shown in table 2. Although not significant, the mean value for belief about how
medical professionals would treat a patient (M = 4.21, SD = 0.14) showed that participants
believed that medical professionals would give the same kind of treatment to any race/ethnicity
or gender. The highest mean was associated with the Latina woman (M = 4.61, SD = 0.38) and
the lowest mean was associated with the Caucasian man (M = 3.75, SD = 0.33). H2 was not
supported.
Table 2: One-way ANOVA for participants’ belief of treatment based on patient race/ethnicity
and gender
df
F
p
Condition
5
0.92
0.47
Error
62
31 Two other experiments were conducted involving medical professionals as participants.
The sample size of these experiments was too small to infer causation. The samples were too
small for meaningful interpretation of statistical analysis; so, means are reported. The first
experiment that was used generated results from 29 participants; 16 participants did not complete
the questionnaire which left a data set of 13 participants.
H3a: The race/ethnicity and gender of the patient in the news story will affect participants’
perception of the patient.
Although not significant, the mean value for perception of the patient (M = 3.65, SD =
2.34) showed that the medical professionals sampled in this study tended to view patients
slightly less favorable regardless of race/ethnicity or gender. The highest mean was associated
with the Latina woman (M = 4.30, SD = 0.52) and the lowest mean was associated with the
Latino man (M = 3.00, SD = 0.64). H3a was not supported.
H3b: Participants will view the Caucasian man more favorably than the African American man,
African American woman, Latino man, Latina woman, and Caucasian woman.
While there was no significant difference, the medical professionals sampled tended to
view the Latina woman most favorably (M = 4.30, SD = 0.52) followed by the African American
man (M = 4.00, SD = 0.45). These medical professionals viewed the Latino man least favorably.
The Caucasian man ranked fifth out of six (M = 3.04, SD = 0.52). H3b was not supported.
H4: The race/ethnicity and gender of the patient in the news story will affect participants’
treatment plan for the patient.
32 Although not significant, mean values (M = 5.36, SD = .24) show that the medical
professionals sampled were slightly more likely to carry out the treatments necessary for a heart
attack, for all races/ethnicities and genders, than to not treat the patient with the same methods.
The highest mean was associated with the African American man (M = 6.80, SD = 0.65) and the
lowest mean was associated with the Caucasian woman (M = 4.80, SD = 0.65). H4 was not
supported.
The second experiment that was launched on Qualtrics also included medical
professionals. This experiment generated 11 participants. The sample size was small enough that
most tests could not be conducted on the data, including ANOVAs.
33 Discussion
The current study explored the relationship between race/ethnicity and gender, and the
perception of a patient and the prospective treatment plan for that patient. The study was
conducted using a 3 x 2 experimental design. The findings show unexpected results as in they are
not consistent with previous alike studies. Results showed that regardless of profession, be it a
medical profession or something else, race/ethnicity and gender, did not have an effect on
perception of the patient or the prospective treatment plan. However, the sample size of medical
professionals was too small to expose any cause or effect of the independent and dependent
variables; and the general public cannot be representative of medical professionals.
These findings, while contrary to previous research, do not necessarily refute previous
claims. This is because of the size of the medical professionals sample and the unrepresentative
nature of the general public.
The experiment did not acquire the participants that were necessary to infer causation of
race, ethnicity, and gender primes on perception of the patient and prospective treatment plan.
The number of medical professionals that participated in either experiment one or experiment
two was much too small to make any causation claims. The general public was used as an
alternative plan for this study and while there were a fair number of participants, they did not
represent the population that was necessary for this study.
Priming theory posits that when primed with different stimuli, in this case the
race/ethnicity, and gender of the patient in the news story, participants will react in accordance
with the prime. Previous research has shown that priming effects relative construct accessibility
(Siu, 2007). This means that when racial primes are utilized, individuals’ often rely on
34 stereotypes when reacting to following questions. Research also shows that when primed with
race or gender primes, participants have reacted significantly different when measuring implicit
bias. However, when measuring explicit bias, the difference in reaction to race and gender
primes is not explicit (Verhaeghen et al., 2011). Verhaeghen et al. (2011) used a text-only
stimulus that depicted Caucasian and African American individuals paired with bipolar
adjectives that represented stereotypes. This study is most relevant to the current study because
items measuring perception of the patient depicted explicit prejudice. More on this will be
discussed in the limitations section.
In the current study, participants were presented with different race and gender primes
and the researcher analyzed their responses about how they perceive the patient and about a
prospective treatment plan. Participants’ race/ethnicity and gender did not have a particular
effect on reaction to race and gender primes; however, since the majority of the participants in
each experiment were Caucasian, this is not a definitive statement. There were no significant
differences in participants’ reaction to the different race and gender primes when measuring the
participants’ perception of the patient. However, although not significant, the general public
viewed the Latina woman most favorably; medical professionals in the first experiment viewed
the Latina woman most favorably, and the sample of medical professionals in the second
experiment was too small to analyze this information. Although not significant, the fact that both
the general public and a small sample of medical professionals found the Latina woman to be the
most favorable character is something to be further explored.
There were also no significant differences in participants’ reaction to race and gender
primes when measuring participants’ belief in what the treatment medical professionals would
give is or what a medical professional would do for a treatment plan. Although not significant,
35 the general public believed that the Latina woman would get the most treatment that would
typically follow a heart attack; medical professionals reported that they would treat the African
American man with most treatment that would typically follow a heart attack. The amount of
participants in the second experiment was too small to analyze this information. Although not
significant, the fact that the general public and a small sample of medical professionals both
reported that a racial minority would receive the most care that would typically follow a heart
attack is something to be further explored. It is also notable that the general public believed that
the Latina woman was both most favorable and thought to receive the most care associated with
the medical issue.
While analyzing the control variables, it was found that the general public reported
higher levels of agreement with the statements that their workplace is tolerant of different
races/ethnicities, genders, socio-economic statuses, political views and religious views.
Participants also reported slightly more than average agreement with the statement that their
neighborhood is diverse. Medical professionals in the first experiment reported over average
agreement with the statements that their workplace is tolerant of different races/ethnicities,
genders, socio-economic statuses, political views and religious views. However, participants in
this experiment reported an average agreement with the statement that their neighborhood is
diverse. This could be attributed to the fact that medical professionals typically have a higher
income which leads them to live in less diverse neighborhoods.
Limitations
There were numerous limitations with this study. A limitation is that, as mentioned
earlier, the items in the questionnaire measured explicit bias. Feedback was given by a medical
36 doctor and a professor that the items were too obvious to elicit an objective answer from
participants. The medical doctor who provided feedback also expressed the need for more
explicit direction for answering the questions. This is what spawned the second experiment. With
the second experiment, more direction was given about the circumstances of the patient’s
treatment. Directions expressing that the doctor was working in an emergency room and that
emergency medical technicians had not already performed the necessary treatments.
Another limitation is that the study was not pre-tested. A pre-test could have given
insight as to which items were effective and which items were a hindrance to the questionnaire.
A limitation that is interesting came from feedback from an undergraduate student that
participated in the survey. She mentioned that the wording of some of the control questions were
not particularly clear to answer. Specifically, she noted that the question about how religious an
individual is connoted that only organized religions were recognized for this question. In
addition to this, many of the younger generation in the general public who participated noted that
the questions were too hard to answer; that it was not particularly easy to make conjectures about
a person that they have limited information about.
37 Conclusion
The findings show that there were no significant differences between participants who
read a news story of a Caucasian man, Caucasian woman, African American man, African
American woman, Latino man, and Latina woman prime and their perceptions of the patient or
their belief in what the doctor’s treatment plan will be or a medical professionals’ prospective
treatment plan for the patient. It is important to note that while there was no significance, some
patterns were found.
Participants, regardless of race, gender, and profession agreed that the Latina woman was
most favorable. The general public also believed, and the medical professionals reported, that a
minority would receive the most care that would follow a heart attack. These findings are not
consistent with previous studies; so, this is something to be further explored.
Priming theory suggests that when participants are primed with characters of different
races and genders, they will respond according to the prime they receive. In this study, there
were no significant differences between the prime an individual received and their answers
measuring the dependent variables, perception of the patient, and prospective treatment plan.
The original study is something to be replicated. With more time and more access to
medical professionals, causation may be possible to infer. This study has merit and if carried out
correctly could find different results.
Future Research
As discussed earlier, some important points to be further explored are that both the
general public and medical professionals agreed that the Latina woman was most favorable and
38 that a racial/ethnic minority would receive the most care concomitant with heart attack
symptoms. This can be explored with an experimental design.
It would be beneficial to the communication field to replicate the current study with
solely medical professionals as participants. With a large sample of medical professionals, the
findings of the experiment may differ from the results found in this experiment.
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45 Appendix
Caucasian Man Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Alexander Smith, a middle-aged Caucasian man of average height and weight, collapsed after
speaking to reporters from channel 6. The tenant was taken away to the hospital with reported
chest pain and shortness of breath. No updates on Mr. Smith or on the other tenant’s conditions
have been given at this time
Caucasian Woman Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Alexandra Smith, a middle-aged Caucasian woman of average height and weight, collapsed after
speaking to reporters from channel 6. The tenant was taken away to the hospital with reported
chest pain and shortness of breath. No updates on Ms. Smith or on the other tenant’s conditions
have been given at this time.
46 African American Man Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Jayden Johnson, a middle-aged African American man of average height and weight, collapsed
after speaking to reporters from channel 6. The tenant was taken away to the hospital with
reported chest pain and shortness of breath. No updates on Mr. Johnson or on the other tenant’s
conditions have been given at this time.
African American Woman Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Jayla Johnson, a middle-aged African American woman of average height and weight, collapsed
after speaking to reporters from channel 6. The tenant was taken away to the hospital with
reported chest pain and shortness of breath. No updates on Ms. Johnson or on the other tenant’s
conditions have been given at this time.
Latino Man Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Juan Rodriguez, a middle-aged Latino man of average height and weight, collapsed after
speaking to reporters from channel 6. The tenant was taken away to the hospital with reported
chest pain and shortness of breath. No updates on Mr. Rodriguez or on the other tenant’s
conditions have been given at this time.
47 Latina Woman Stimulus
Apartment Fire Sends Six People to Hospital
On Saturday afternoon, a fire broke out at the Center Street apartment complex consuming
over five different buildings. Firefighters arrived at the scene less than 20 minutes after they
received the call alerting them of the incident. There were no fatalities; however, six tenants
were taken to the hospital for evaluation upon leaving the flame-ridden buildings. One tenant,
Juana Rodriguez, a middle-aged Latina woman of average height and weight, collapsed after
speaking to reporters from channel 6. The tenant was taken away to the hospital with reported
chest pain and shortness of breath. No updates on Ms. Rodriguez or on the other tenant’s
conditions have been given at this time.
Questionnaire for General Public
The following statements deal with the subject of the news story who is
now a hospital patient. Please answer the following questions on a 1-7
scale.
1.
The patient is employed.
Strongly disagree - - - - - - - Strongly agree
2.
The patient has health insurance.
Strongly disagree - - - - - - - Strongly agree
3.
The patient can afford to pay for the time spent in the hospital due to the apartment fire.
Strongly disagree - - - - - - - Strongly agree
4.
The patient has a high school degree.
Strongly disagree - - - - - - - Strongly agree
5.
The patient has a college degree
Strongly disagree - - - - - - - Strongly agree
6.
The patient has a graduate degree.
Strongly disagree - - - - - - - Strongly agree
7.
The patient is likely to use drugs/alcohol.
48 Very Likely - - - - - - - Very Unlikely
8.
The patient will be cooperative.
Agree- - - - - - - Disagree
9.
The patient is in control of their life.
Agree - - - - - - - Disagree
Please answer the following questions how you think a medical
professional would react.
10. A medical professional is likely to recommend an EKG for the patient.
Very Likely - - - - - - - Very Unlikely
11. A medical professional is likely to recommend prescription pain medicine for the patient.
Very Likely - - - - - - - Very Unlikely
12. A medical professional is likely to recommend a blood thinner for the patient.
Very Likely - - - - - - - Very Unlikely
13. A medical professional is likely to recommend nitroglycerine treatment for the patient.
Very Likely - - - - - - - Very Unlikely
Please answer the following questions on a 1-7 scale.
14. My workplace is tolerant of people of different races/ethnicities.
Very Tolerant - - - - - - - Very Intolerant
15. My workplace is tolerant of people of different genders.
Very Tolerant - - - - - - - Very Intolerant
16. My workplace is tolerant of people of different socio-economic backgrounds.
Very Tolerant - - - - - - - Very Intolerant
17. My workplace is tolerant of people of different political beliefs.
Very Tolerant - - - - - - - Very Intolerant
18. My workplace is tolerant of people of different religious beliefs.
49 Very Tolerant - - - - - - - Very Intolerant
19. My neighborhood is racially/ethnically diverse.
Very Diverse - - - - - - - Not Diverse
20. Out of my closest same-sex friends, how many of them are of a different race/ethnicity than
me?
-------21. Out of my closest opposite-sex friends, how many of them are of a different race/ethnicity
than me?
-----
Please answer the following demographic questions.
Race/ethnicity: African American or Black, Latino/a or Hispanic, Caucasian American or White,
Asian American or Asian, Native American, Other
Gender: Male, Female, Other
Age: _______
Professional Title________
Years Spent in the Profession ___________
Political Affiliation:
Very Liberal - - - - - - - Very Conservative
Religious Affiliation
Very Religious - - - - - - - Not Religious At All
Type of Media most engaged with: TV, Radio, Newspaper, Internet, Popular Magazines
Professional Magazines, Medical Websites, Continuing Medical Education Materials