Clinician Communication Behaviors and Perceived Health Care Discrimination Among Black Patients
5 affiliations
- 1Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis
- 2Public Health Sciences, University of Virginia School of Medicine, Charlottesville
- 3Messianic Care, Maple Grove, Minnesota
- 4University of Minnesota School of Public Health, Minneapolis
- 5University of Iowa Carver College of Medicine, Iowa City
Abstract
Importance: Perceived racial discrimination has been shown to be associated with lower medication adherence and poorer health outcomes among Black patients. Individuals perceive discrimination when they (1) observe negative behaviors and (2) attribute these behaviors to racial bias; effectively reducing racial discrimination, therefore, entails limiting actions that patients most readily attribute to bias.
Objective: To examine behaviors associated with Black patients’ attribution of negative behaviors by health care workers to racial discrimination.
Design, Setting, and Participants: This cross-sectional survey study was conducted at 15 health-oriented events in Minneapolis and St Paul, Minnesota, in 2025. A convenience sample of non-Hispanic Black adults older than 40 years was recruited. Participants who experienced negative behaviors by health care workers were included.
Exposures: Self-reported experiences of 10 negative behaviors and level of trust in the health care system.
Main Outcomes and Measures: The primary outcome was attribution of negative behaviors to racial discrimination (ARD). Logistic regressions were used to examine associations between experiencing individual behaviors, sum of negative behaviors, and trust in the health care system with ARD.
Results: A total of 284 adults were recruited, and 152 who experienced negative behaviors were included. Six observations were removed owing to missing data on patients’ attribution for these behaviors, resulting in a final analytic sample of 146 participants (mean [SD] age, 58.7 [10.9] years; 116 female [79.5%]); 109 participants (74.7%) attributed negative behaviors to racial bias. Greater exposure to negative behaviors was associated with higher odds of ARD (odds ratio [OR], 1.42; 95% CI, 1.14-1.76). Having concerns dismissed (OR, 3.49; 95% CI, 1.57-7.79), being spoken to in a cold or impersonal manner (OR, 5.04; 95% CI, 1.82-13.90), and being stereotyped (OR, 4.22; 95% CI, 1.63-10.93) were directly associated with ARD. Trust in the health care system was not significantly associated with ARD (OR, 0.69; 95% CI, 0.46-1.04). In a multivariable analysis, total negative behaviors remained associated with ARD (OR, 1.39; 95% CI, 1.12-1.73), and trust did not.
Conclusions and Relevance: In this cross-sectional study of communication behaviors attributed to racial discrimination, experiencing dismissiveness, relational coldness, and stereotyping were associated with Black patients’ attribution of negative behaviors to racial bias. Interventions targeting these behaviors may reduce patients’ experience of health care discrimination.
Related
- Convergent Validity and Exploratory Discrimination of Two-Dimensional Facial Photographic Measures for Clinician-Rated Facial Asymmetry in Young Mongolian Adults
- The relationship between perceived social support and health-promoting behaviors among middle-aged and young patients after PCI: the mediating role of fear of disease progression
- Optimizing the Patient Experience Through Clinician Coaching or Communication Intervention: A Randomized Pilot Study
- The Need for Clinician Communication Strategies for Eating Disorders/Insulin Restriction in Type 1 Diabetes
- Communication during high-stakes ICU family–clinician interactions: a realist review protocol
BibTeX
@article{okah2026clinician,
title = {{Clinician Communication Behaviors and Perceived Health Care Discrimination Among Black Patients}},
author = {Ebiere D. Okah and Nao Hagiwara and Kelly Robinson and Elijah Johnson and Abbie Begnaud Muckler},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.41656},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856024},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinician Communication Behaviors and Perceived Health Care Discrimination Among Black Patients
AU - Ebiere D. Okah
AU - Nao Hagiwara
AU - Kelly Robinson
AU - Elijah Johnson
AU - Abbie Begnaud Muckler
PY - 2026
DA - 2026/10/01
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.41656
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2856024
AB - Importance: Perceived racial discrimination has been shown to be associated with lower medication adherence and poorer health outcomes among Black patients. Individuals perceive discrimination when they (1) observe negative behaviors and (2) attribute these behaviors to racial bias; effectively reducing racial discrimination, therefore, entails limiting actions that patients most readily attribute to bias. Objective: To examine behaviors associated with Black patients’ attribution of negative behaviors by health care workers to racial discrimination. Design, Setting, and Participants: This cross-sectional survey study was conducted at 15 health-oriented events in Minneapolis and St Paul, Minnesota, in 2025. A convenience sample of non-Hispanic Black adults older than 40 years was recruited. Participants who experienced negative behaviors by health care workers were included. Exposures: Self-reported experiences of 10 negative behaviors and level of trust in the health care system. Main Outcomes and Measures: The primary outcome was attribution of negative behaviors to racial discrimination (ARD). Logistic regressions were used to examine associations between experiencing individual behaviors, sum of negative behaviors, and trust in the health care system with ARD. Results: A total of 284 adults were recruited, and 152 who experienced negative behaviors were included. Six observations were removed owing to missing data on patients’ attribution for these behaviors, resulting in a final analytic sample of 146 participants (mean [SD] age, 58.7 [10.9] years; 116 female [79.5%]); 109 participants (74.7%) attributed negative behaviors to racial bias. Greater exposure to negative behaviors was associated with higher odds of ARD (odds ratio [OR], 1.42; 95% CI, 1.14-1.76). Having concerns dismissed (OR, 3.49; 95% CI, 1.57-7.79), being spoken to in a cold or impersonal manner (OR, 5.04; 95% CI, 1.82-13.90), and being stereotyped (OR, 4.22; 95% CI, 1.63-10.93) were directly associated with ARD. Trust in the health care system was not significantly associated with ARD (OR, 0.69; 95% CI, 0.46-1.04). In a multivariable analysis, total negative behaviors remained associated with ARD (OR, 1.39; 95% CI, 1.12-1.73), and trust did not. Conclusions and Relevance: In this cross-sectional study of communication behaviors attributed to racial discrimination, experiencing dismissiveness, relational coldness, and stereotyping were associated with Black patients’ attribution of negative behaviors to racial bias. Interventions targeting these behaviors may reduce patients’ experience of health care discrimination.
SN - 2574-3805
ER -