Unconscious biases: Racial microaggressions in American Indian health care

Purpose: this article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by american indian (ai) adults with type 2 diabetes mellitus (t2dm). methods: this community-based participatory research project includes two ai reservation communities. data were collected via in-person article-and-pencil survey interviews with 218 ai adults diagnosed with t2dm. results: greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. reports of microaggressions were correlated with self-reported history of heart attack,worse depressive symptoms,and prior-year hospitalization. depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. conclusions: microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for ais living with a chronic disease. providers should be cognizant of these subtle,often unconscious forms of discrimination. (j am board fam med 2015;28:231-239.) © 2015,american board of family medicine. all rights reserved.