Racial and ethnic differences in receipt and use of health information in encounters between patients and physicians.

The exposure of racial and ethnic disparities in healthcare quality as a public health problem has catalyzed inquiry into all possible causes of these disparities. A body of research has demonstrated critical barriers at the healthcare system (eg, organizational quality, facility experience) and provider (knowledge, technical or interpersonal skills, bias or stereotyping behavior) levels that differ across patient race/ethnicity. The study by Wiltshire et al in this issue of Medical Care explored the hypotheses that black and Hispanic women are less likely than white women to acquire health information from a source other than their physician, less likely to report such health information during encounters with their physicians, and less likely to have a test, procedure or medication ordered based on the information that they report to their physician. The results of the study are mixed. Using data from the Community Tracking Survey (CTS), Wiltshire et al found that middle-aged black women were less likely to acquire health information and to report that information to their physician than middleaged white women; however, black and white women were equally likely to believe that their physician made use of information when reported. The study also found that middle-aged Hispanic and white women were equally likely to acquire and report health information; however, Hispanic women were more likely to believe that their physician made use of reported information than white women. Thus, by the measures used in the study, black women fared somewhat worse than white women, while Hispanic women fared somewhat better. Each of the study’s findings deserves separate consideration. First, with respect to the acquisition of health information, the study reports that black women appeared to be less likely to look for or get health information overall than white women. Of the possible sources of information, black respondents in this study were less likely to receive information from the Internet and more likely to receive information from books and magazines than were white respondents. This adds to the evidence base that the so-called ‘digital divide’ exists, with differences in access to or use of the Internet based on race/ethnicity. However, it is important to note, when interpreting these findings and before drawing conclusions about black women being less likely to seek health information, that the item which asked respondents to report possible sources of information excluded physicians as a source. Therefore, women who received information from their own doctor would appear to be noninformation-seeking according to the measures used in the study. Given data which suggests that older black women perceive physicians as their preferred source of information, it is plausible that middle-aged black women satisfy most of their health information needs in this way. It is particularly important, then, not to characterize blacks as less interested in or able to get health information than whites. Fatalistic attitudes, fear of illness, or disengagement in response to discrimination are important concerns, but there are other possible explanations.