ABSTRACT

Background

The disparities that Black/African-American women experience in health care are persistent and staggering. Findings from health outcomes research continue to demonstrate poorer outcomes for African-American women compared to women of other race/ethnicity in several conditions. These racial/ethnic and gender health disparities observed are complex, heavily nuanced and multi-factorial. To understand these, there is a need to apply an ‘intersectionality’ lens. Intersectionality refers to the experience of persons with multiple intersecting statuses. The objective of this exploratory study was to gain insight into the healthcare experiences of low-income African-American women.

Methods

In-depth one-on-one interviews were conducted with 22 women and 2 focus group discussions with community leaders and advocates. Investigators conducted a thematic analysis of the transcripts.

Results

The thematic analysis revealed four major themes, which tell the story of the intersectional invisibility experienced by low-income AA women in the healthcare system. These included (1) the perception of ‘not feeling heard’; (2) patient as ‘expert of her own body’; (3) disregard of patient preferences; and (4) the need for self-advocacy.

Conclusions

Black/African-American women, and particularly those with socioeconomic disadvantage, experience intersectional invisibility resulting from provider implicit bias, stereotypical assumptions, and systemic structures that enable discriminatory practices in healthcare delivery. Healthcare provider education that more explicitly addresses these biases and stereotypes should be complemented with system-level interventions that aim to dismantle the structural racism inherent in healthcare policies and practices.

中文翻译：

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低收入非洲裔美国妇女在医疗保健遭遇中的交叉隐形经历

摘要

背景

黑人/非裔美国女性在医疗保健方面所经历的差异持续存在且令人震惊。健康结果研究的结果继续表明，在几种情况下，与其他种族/族裔的女性相比，非裔美国女性的结果较差。观察到的这些种族/民族和性别健康差异是复杂的、非常细微的和多因素的。要理解这些，需要应用“交叉性”镜头。交叉性是指具有多种交叉状态的人的经历。这项探索性研究的目的是深入了解低收入非洲裔美国女性的医疗保健经历。

方法

对 22 名女性进行了深入的一对一访谈，并与社区领袖和倡导者进行了 2 次焦点小组讨论。调查人员对成绩单进行了专题分析。

结果

主题分析揭示了四个主要主题，讲述了低收入 AA 女性在医疗保健系统中所经历的交叉隐形的故事。这些包括（1）“感觉不到被听到”的感觉；(2) 病人是“自己身体的专家”；(3) 无视患者偏好；(4) 自我宣传的需要。

结论

黑人/非裔美国女性，特别是那些社会经济处于劣势的女性，由于提供者的隐含偏见、陈规定型假设和系统结构导致医疗保健服务中的歧视性做法，而经历交叉隐形。更明确地解决这些偏见和刻板印象的医疗保健提供者教育应该与旨在消除医疗保健政策和实践中固有的结构性种族主义的系统级干预相辅相成。