*281. The Value and Implications of Research and Theory on Social Cognition and Interaction for Research and Intervention in Race/Ethnicity Inequities in Health Care

Michelle van Ryn, Center for Chronic Disease Outcomes Research

Objectives: 1) Provide a theoretical framework to guide inquiry and intervention on non-financial causes of race/ethnicity disparities in treatments received.

2) Propose research questions and methodologies based on the combination of current findings regarding race/ethnicity disparities and current theory and research on social cognition and interaction.

3) Discuss the implications of research on social cognition, stereotype activation and application, and social interaction for interventions in race/ethnicity disparities in treatments received.

Methods: Findings from a number of studies, including those conducted by the author, provide substantial evidence of significant race/ethnicity disparities in treatments received for a wide range of conditions and illnesses both within and outside of VA. These studies indicate that a significant portion of disparities persist independent of while payer and treatment site. Although there has been limited study of the provider, patient and encounter factors contributing to these treatment disparities, there is growing evidence that provider referral and recommendation patterns are contributing to the documented inequities in treatment.

Results: As one example to be provided in this paper, the authors’ earlier presentation and article described findings indicating that physician referral was the major contributor to disparities in access to revascularization. After controlling for appropriateness for revascularization, payer, age, and physician characteristics, physician referral to revascularization was found to be associated with physician perceptions of patients’ social and behavioral characteristics.

Conclusions: The substantial body of research and theory on social cognition and interaction provides a useful framework for guiding inquiry into influence of patient race/ethnicity on providers’ assessment of patients and clinical decision-making. This body of research points to a number of mechanisms through which patient demographic characteristics may influence encounters and encounter results. As one example to be discussed, social cognition research indicates that all social interactions are "expectancy-tinged". The term "social expectancies" refers to beliefs about another’s personality, abilities, likely behaviors, and motives. There is ample evidence that others are perceived through the lens of expectancies, that these expectancies influence the behavior of all parties to an interaction as well as how others’ behavior is interpreted. In addition, these expectancies often exist below conscious awareness and are automatically activated without conscious choice. They then influence interactions through a number of mechanisms. Social cognition and interaction research suggests that physicians’ expectations of, beliefs about, and predictions of future behaviors of patients are at least partially determined by their social expectancies. Supporting this, there is evidence that patient demographic characteristics are associated with physician affect, assessment of competencies, beliefs about, and predictions of patients’ future behavior which in turn may influence physician affect, behavior, and treatment decisions.

Impact: The large body of research on social cognition and interaction can service as a useful frame for inquiry into race/ethnicity disparities in care. In addition, it has major implications for the design of effective interventions and the likely value of cultural competency programs. Thus, discussion of this literature in the context of the research on disparities in care will be of service to VA researchers and providers interested in addressing such disparities.