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The Healthcare Discrimination Experience Scale: Assessing a Variable Crucial for Explaining Racial/Ethnic Inequities
Keith Sanford1, Alexandra E Pizzuto2
1Department of Psychology and Neuroscience, Baylor University, One Bear Place #97334, Waco, TX, 76798-7334, USA. Keith_Sanford@baylor.edu.
Journal of Racial and Ethnic Health Disparities
|June 22, 2022
Summary
A new Healthcare Discrimination Experience Scale reveals that discrimination significantly impacts patient health and activation, particularly for racial/ethnic minorities. This validated tool is more sensitive to disparities than existing measures.
Area of Science:
- Health Services Research
- Health Equity
- Psychometrics
Background:
- Racial/ethnic inequities persist in patient activation and health outcomes.
- Existing scales for healthcare discrimination lack robust psychometric properties and broad construct definitions.
- Healthcare discrimination is a hypothesized driver of these health disparities.
Purpose of the Study:
- To develop and validate a new Healthcare Discrimination Experience Scale (HDES).
- To compare the psychometric properties and sensitivity of the HDES against an existing measure.
- To assess the role of healthcare discrimination in explaining racial/ethnic inequities in health.
Main Methods:
- Development and validation of the HDES across two studies with 975 patients (hypertension/diabetes).
- Utilized confirmatory factor analysis and item response theory analysis for psychometric evaluation.
- Compared the HDES's ability to detect group differences (People of Color vs. White) with an existing scale.
Main Results:
- The new HDES demonstrated superior detection of differences between People of Color and White individuals compared to the existing scale.
- Confirmatory factor analysis and item response theory analyses supported the scale's validity and reliability.
- The HDES mediated the impact of racial/ethnic identity on patient-practitioner relationships, treatment adherence, general health, blood pressure, and life stress.
Conclusions:
- The developed Healthcare Discrimination Experience Scale is a valid and reliable instrument for assessing a broad construct of healthcare discrimination.
- The HDES is more sensitive to racial/ethnic group differences in healthcare experiences than existing measures.
- Healthcare discrimination plays a significant role in explaining racial/ethnic inequities in patient activation and health, underscoring the need for validated measurement tools.
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