Health Care Stereotype Threat

Warning: Stereotypes may be harmful to patients’ health.

A national study led by USC Dornsife’s Cleopatra Abdou found that people who encountered the threat of being judged by negative stereotypes related to weight, age, race, gender or social class in health-care settings reported the experience of adverse health effects.

The researchers found those people were more likely to have hypertension, to be depressed and to rate their own health more poorly. They were also more distrustful of their doctors, felt dissatisfied with their care and were less likely to use highly accessible preventive care, including the flu vaccine.

“Health care stereotype threat” stems from common stereotypes about unhealthy lifestyle choices or inferior intelligence that may be perpetuated, often unintentionally, by health-care professionals or even by public health campaigns.

Mixed messages

Although health messages are intended to raise awareness of health issues or trends that may affect specific communities, one implication of this study is that these messages can backfire, said Abdou, assistant professor in the Department of Psychology at USC Dornsife and at the USC Davis School of Gerontology. Abdou was lead author on the study, which was published Oct. 20 in the American Journal of Preventive Medicine.

Assistant Professor of Psychology Cleopatra Abdou. Photo courtesy of USC Media Relations.

“An unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of people,” Abdou said. “As a result, they may inadvertently increase experiences of what we call ‘health care stereotype threat,’ which can affect health-care efficacy and even prompt some patients to avoid care altogether.”

Abdou has been investigating health care stereotype threat in this study and prior research. She cited campaigns about reproductive health in African-American women and other women of color, sexual health in the LGBTQ community, depression among women, and memory problems in older adults as examples of the negative health effects.

“It’s not that there aren’t real health concerns in specific communities that we need to do more — much more — to address, but how we communicate these concerns is key,” she said.

Study details

Abdou and her team surveyed an estimated 1,500 people, ages 50 and older, as part of the U.S. Health and Retirement Study.

More than 17 percent of the respondents said they felt vulnerable to prejudice with regard to racial or ethnic identity, gender, socioeconomic status, weight or age in health-care settings. People who felt threatened based on several identities were worse off, health-wise, than people who felt threatened based on just one identity.

Abdou said the challenge now is to find ways to inform all people, including people at heightened risk, about how to live healthier, happier and longer lives while also minimizing the experience and effects of health care stereotype threat.

“It’s time for us to implement policies that enhance medical school training in cultural competency and increase the diversity of our physicians and broader health-care workforce,” Abdou said. “Hospitals and other health-care institutions with inclusive policies that welcome diversity and celebrate tolerance, both symbolically and explicitly, hold great promise for reducing health care stereotype threat and the short- and long-term health disparities that we are now learning result from it.”

More than half the study’s respondents were women, and most respondents — 82 percent — were white. Abdou also said the study focused on people who reported having seen a doctor sometime within the two years before the study. She noted that because of these limitations, health care stereotype threats were probably underreported by the sample of subjects. Such stereotype threats are probably experienced by young people, too, not just by people who are aging, Abdou said.

Co-authors on the study included doctoral student Felicia Wheaton of USC Davis, Adam Fingerhut of Loyola Marymount University and James Jackson of the University of Michigan.

The research was funded by the National Institutes of Health, the Woodrow Wilson National Fellowship Foundation and a Hanson-Thorell Family Research Award.