Stanford University School of Medicine: Oakland Health Disparities Project
Patient-Provider Race Concordance and the Preventive Health Seeking Behavior of Black Men
What we are asking: Does Patient Provider Race Concordance effect the health-seeking behavior of black men?
Why this is important: Black men in the US consistently rank the lowest on a broad array of health outcomes. A small but growing body of qualitative literature suggests that factors such as deep mistrust of healthcare institutions and racism by providers explain some of these patterns. A rigorous evaluation of the impact of patient-provider concordance on preventative health seeking behavior of black men has not been performed.
The Problem: Racial health disparities in the US are profound and disproportionately affect black men. We will provide evidence about the effect of policies that increase the availability of black providers on the utilization of preventive care by black men, with the ultimate goal of improving health equity and demonstrating the importance of diversity in healthcare.
Our objective: The decision to seek medical care is complex, ultimately comprised of multiple factors and made under uncertainty about the potential benefit of the care to be received. In this study, we plan to experimentally manipulate the race of the provider to see if this influences take-up of preventive care services such as blood pressure screening and influenza vaccination.
Who is investigating?
- Marcella Alsan MD, PhD is a physician-economist at Stanford University. She received her MD from Loyola University, and her PhD in Economics from Harvard University. Dr. Alsan is Board Certified in both Internal Medicine and Infectious Disease. Her research focuses on health and socioeconomic disparities.
- Owen Garrick, MD, MBA currently serves as President and Chief Operating Officer of Bridge Clinical Research. Dr. Garrick earned is MD from Yale University, and his MBA from Wharton School of Business. His research focuses on minority health.
Preliminary Achievements: This ongoing project is planned to run through October 2016, however several early stage phases have already been completed. A summary of the completed stages is below:
- Barbershop Recruitment: Black men in the Oakland area were recruited via community barbershops to participate in small focus groups.
- Focus groups: 4 individual black men’s health focus groups were executed, each focus group consisting of 7-15 black men aged 18-67.
- Developed Research methodologies
- Obtained Barbershop SupportPreliminary Data
- A hierarchy of provider trust was identified with black doctors being the most trusted, followed by Latino, Asian and White physicians was identified in the focus groups.
- Our focus groups also revealed that fear and misunderstanding among black men was strongest around influenza vaccination and, to a lesser extent, HIV testing.Community Support
- Bridge Clinical Research
- Local Barbershops
Next Steps
Specific Aims
- To determine whether acceptance of preventive healthcare screening is higher among black men who are subsidized to visit a black provider compared to those who are subsidized to visit a white provider by using random assignment.
- To measure whether the treatment effect of a patient-provider race concordance varies across individuals with different levels of education, income or prior experience with the healthcare sector.
- To determine whether, conditional on showing up for the blood pressure screening, acceptance of a preventive care service, such an influenza vaccination, is higher when the service is offered by a black provider.
Research Design
Potential Impact: This is the first study that examines the impact of provider race on the utilization of health resources by a minority group. The results could have enormous policy implications within healthcare, as well as broader implications for our understanding the importance of diversity for relationships involving asymmetric or incomplete information.
Intersection of ethnicity and socioeconomic status and willingness to participate in clinical research
Willingness to participate in clinical research has often been cited as a source for lack of representation of minority groups in clinical trials. Many studies have also looked into willingness and attitudes towards clinical research by social class and income, however there is a lack of data that looks into differences in attitudes within the intersection of ethnicity and socioeconomic class. Our study seeks to identify differences in willingness to participate in research within ethnic groups of varying income levels. For instance, several studies have cited distrust in the research community by African Americans, which correlates with their underrepresentation in trials. Our objective is to analyze the intersection of ethnicity and income and its effects on ones willingness to participate in clinical research. This will be executed by conducting surveys in the community at health fairs, and community health fairs in the Oakland area.
Project Objective: Determine willingness to participate in clinical research as it relates to ones ethnicity and socioeconomic class.
Methods:
- Created surveys capturing the persons ethnic identity, age, income level, willingness and attitudes towards clinical research.
- 200 Participants from two community health fairs, and one community health center in Oakland, CA completed the surveys.
- Analyzed data
Importance of findings
Differences in willingness to participate in clinical research may exist by socioeconomic class within ethnic groups. For instance, African Americans are generally less willing to participate in trials that their white counterparts, however high income African Americans may have an increased willingness to participate in clinical research than low-income African Americans. These differences help clinical researchers and investigators to better understand a portion of their patient population, and create policy and recruitment methods that address these disparities.
Video summarizing the project:
Award: January 24, 2017
Bridge Clinical Research Receives Stanford University Community Partner Award.
- “The Community Partner Award is a reflection and acknowledgement of the commitment that community partners have made to Stanford and our students, as a true model for mutually-beneficial community-campus partnerships. Stanford’s Office of Community Engagement’s 15th Annual Community Health Symposium honors Bridge Clinical Research for its strong partnership with Dr. Marcela Alsan, Assistant Professor at Stanford University. This study seeks to address health disparities due to a shortage of black health care professionals and the incorporation of students as leaders in the implementation of this collaborative research study was inspiring. We applaud Bridge Clinical Research as an outstanding community partner,” said Rhonda McClinton-Brown, Executive Director of Office of Community Health at Stanford University School of Medicine.
- “The work is important as it highlighted the role of diversity in medicine and helped identify barriers to obtaining preventative care. Partnering with Dr. Garrick and Bridge Clinical Research was crucial to the success of the pilot project and we hope to be able to continue and scale our work in the future,” said Dr. Alsan.