A new study co-authored by a Boston University School of Public Health (BUSPH) researcher has found that, in contrast to prior studies, providers were more likely to attribute inequalities to social and economic conditions than to individual patient or provider behaviors. The findings, published in Inquiry, have broad implications for the best way to engage providers in disparities reduction.The researchers delivered a short survey and conducted qualitative interviews with 53 health care providers at three Veterans Health Administration sites to understand providers’ perceptions of causes of racial healthcare disparities. Qualitative analysis identified differences in how providers defined the casual factors for racial inequalities.
The researchers found that providers attributed the causes of disparities more to social and economic conditions than to patients’ or providers’ behaviors. Moreover, participants who believed that providers contributed to the disparities were more likely to confront issues of racism, identify mechanisms of how disparities emerge, and look at patient-level factors in context, while others focused more on the contribution of social and behavioral attributes of patients. This suggests that certain providers may resist efforts to directly name and confront race and structural racism in health care and points to the need for further research to understand how to offer these providers insights into the experiences of patients of color.
“Overall, providers view racial/ethnic healthcare disparities as having multi-level causes, including social and economic conditions, provider behavior, and the healthcare system,” says co-author Dr. Barbara Bokhour associate professor of health law, policy & management at BUSPH. “These findings suggest an openness among providers to a multi-level strategy to disparities reduction, which incorporates organizational, provider-focused, and systemic approaches, especially when these approaches are contextualized in terms of the social determinants of health.