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Motivating Providers to Reduce Racial Healthcare Disparities: The role of providers' prior beliefs on their receptivity to different narrative frames.

Burgess DJ. Motivating Providers to Reduce Racial Healthcare Disparities: The role of providers' prior beliefs on their receptivity to different narrative frames. Paper presented at: VA Richard L. Roudebush VAMC HSR&D Center for Health Information and Communication Work in Progress Monthly Seminar; 2016 Sep 14; Indianapolis, IN.




Abstract:

Background/Rationale: While current strategies to reduce racial health care disparities involve engaging the workforce, there is scant research on how to communicate effectively to providers to motivate them to address disparities in VHA care. Objectives: To examine VA provider responses to narratives about healthcare disparities, using a mixed-method approach. Study 1 (qualitative) explored the role of pre-existing beliefs about the causes of healthcare inequality on providers' responses to persuasive narratives that differed in their framing of the issue. Study 2 used a factorial experiment to systematically test the predictions, derived from Study 1, about which types of narratives would resonate with which types of providers. Methods: Study 1 consisted of 53 semi-structured individual interviews with providers from 3 VAMCs who had completed a prior survey assessing beliefs about disparities. Providers were stratified by the degree to which they believed that provider factors (e.g., factors external to the patient), contributed to healthcare inequality (Low External versus High External). Each provider read and discussed two narratives about race in healthcare, which varied in how the issue was framed. Raters coded all transcripts for indicators of acceptance of or resistance to the narratives, blinded to providers' classification. Study 2 consisted of an intranet-based experiment with providers from 4 different VAMCs, who were randomly assigned to either a non-narrative control or 1 of 2 narratives. The present analysis examined the extent to which providers who were assigned to 1 of the 2 narratives (N = 320) were "transported" by the narrative they read (assessed by a 4-item scale). Findings/Results: In Study 1, Low External providers tended to accept narratives in which issues of race were successfully resolved by the provider in the narrative, through a patient-centered communication approach ("Personal Breakthrough"). They resisted narratives in which problems faced by the minority patient were more explicitly linked to issues of race and racism and remained unresolved ("Race Conscious"). Both types of narratives resonated with High External providers. In Study 2, we found a significant narrative type by provider type interaction (p < 0.02), such that Personal Breakthrough narratives led to greater transportation relative to Race Conscious narratives among Low External providers (p < 0.0001), whereas both were equally effective among High External providers (p = 0.19). Conclusion/Impact: Personal breakthrough narratives may be more universally effective than race conscious narratives for framing educational initiatives and engaging providers in initiatives to reduce disparities.





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