Unconscious biases: racial microaggressions in American Indian health care

J Am Board Fam Med. 2015 Mar-Apr;28(2):231-9. doi: 10.3122/jabfm.2015.02.140194.


Purpose: This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM).

Methods: This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM.

Results: Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models.

Conclusions: Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.

Keywords: Cross-Cultural Care; Patient-Centered Care; Populations; Underserved.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Chronic Disease
  • Community-Based Participatory Research*
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / therapy
  • Female
  • Health Services Accessibility / trends*
  • Humans
  • Indians, North American*
  • Male
  • Middle Aged
  • Patient-Centered Care / methods*
  • Prevalence
  • United States / epidemiology