Veterans' perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication

Patient Educ Couns. 2020 Sep;103(9):1798-1804. doi: 10.1016/j.pec.2020.03.017. Epub 2020 Mar 18.


Objectives: Drawing from social identity threat theory, which posits that stigmatized groups are attuned to situational cues that signal racial bias, we examined how African-American veterans evaluate verbal and non-verbal cues in their mental health encounters. We also explored how their evaluations of perceived racial bias might influence their healthcare engagement behaviors and communication.

Methods: We interviewed 85 African-American veterans who were receiving mental health services from the US Department of Veterans Affairs (VA), examining their views and experiences of race in healthcare. We analyzed the data using a constructivist grounded theory approach.

Results: Participants identified several identity threatening cues that include lack of racial diversity representation in healthcare settings, and perceptions of providers' fears of Black patients. We describe how participants evaluated situational cues as identity threats, and how these cues affected their engagement behaviors and healthcare communication.

Conclusion: Our findings revealed situational cues within clinical encounters that create for Black veterans, fear of being negatively judged based on stereotypes that have characterized African-Americans.

Practice implications: We discuss the implications of these findings and provide suggestions on how to create identity safe environments for minority patients that include delivery of person-centered care, and organizational structures that reduce providers' burnout.

Keywords: Healthcare communication; Minority patients; Patient engagement behaviors; Qualitative research.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Black or African American / psychology*
  • Black or African American / statistics & numerical data
  • Female
  • Healthcare Disparities / ethnology*
  • Humans
  • Interviews as Topic
  • Male
  • Mental Health Services / statistics & numerical data*
  • Middle Aged
  • Minority Groups
  • Patient Participation / psychology*
  • Patient Satisfaction / ethnology*
  • Patient-Centered Care
  • Physician-Patient Relations*
  • Qualitative Research
  • Racism*
  • Retention in Care*
  • Stereotyping
  • United States
  • United States Department of Veterans Affairs
  • Veterans / psychology*
  • Veterans / statistics & numerical data