Ethnic disparities and (non)adherence in standardized treatment: implications through an equity lens

In order to achieve optimal outcomes for patients, standardized treatment has gained traction in recent years. By unifying care based on the best available evidence, standardized treatment has been described as a means to mitigate health disparities. Despite this aim, ethnic and racial disparities are well-described. Standardized treatment depends on adherence from patients. However, how staff position patients' health behavior and assess, adapt, and intervene to improve adherence is underexplored. In this article, we aim to investigate how ethnically minoritized patients' health behavior is positioned under a gaze of (non)adherence.

This is an ethnographic study based on nine months of fieldwork in two orthopedic departments in Denmark. The work of both departments is based on the standardized concept of Enhanced Recovery After Surgery (ERAS). The participants include patients (n = 13), relatives (n = 6), and hospital staff (n = 79). The data were analyzed using abductive analysis.

The analysis shows that when ethnically minoritized patients were positioned as nonadherent, the staff drew on essentialist and stereotypical problematizations of ethnicity to accommodate perceived differences. In this manner, ethnicity was connected to ideas of cultural food habits, collectivist family structures and un-stoic and exaggerated pain behavior.

This paper advances knowledge on how inequitable care and treatment manifests in clinical practice, illustrating how dominant understandings and conceptualizations at the intersections of health, ethnicity, and (non)adherence produce marginalization in standardized pathways. Ultimately, perceived non-adherence has important consequences for minoritized patients, as we find that it causes potential inaccessibility to standardized pathways due to ideas of ineligibility, undertreatment of pain, as well as underrepresentation of minorities in patient seminars and even same-day surgeries.