Clinician Communication Behaviors and Perceived Health Care Discrimination Among Black Patients

Importance Perceived racial discrimination has been shown to be associated with lower medication adherence and poorer health outcomes among Black patients. Individuals perceive discrimination when they (1) observe negative behaviors and (2) attribute these behaviors to racial bias; effectively reducing racial discrimination, therefore, entails limiting actions that patients most readily attribute to bias. Objective To examine behaviors associated with Black patients’ attribution of negative behaviors by health care workers to racial discrimination. Design, Setting, and Participants This cross-sectional survey study was conducted at 15 health-oriented events in Minneapolis and St Paul, Minnesota, in 2025. A convenience sample of non-Hispanic Black adults older than 40 years was recruited. Participants who experienced negative behaviors by health care workers were included. Exposures Self-reported experiences of 10 negative behaviors and level of trust in the health care system. Main Outcomes and Measures The primary outcome was attribution of negative behaviors to racial discrimination (ARD). Logistic regressions were used to examine associations between experiencing individual behaviors, sum of negative behaviors, and trust in the health care system with ARD. Results A total of 284 adults were recruited, and 152 who experienced negative behaviors were included. Six observations were removed owing to missing data on patients’ attribution for these behaviors, resulting in a final analytic sample of 146 participants (mean [SD] age, 58.7 [10.9] years; 116 female [79.5%]); 109 participants (74.7%) attributed negative behaviors to racial bias. Greater exposure to negative behaviors was associated with higher odds of ARD (odds ratio [OR], 1.42; 95% CI, 1.14-1.76). Having concerns dismissed (OR, 3.49; 95% CI, 1.57-7.79), being spoken to in a cold or impersonal manner (OR, 5.04; 95% CI, 1.82-13.90), and being stereotyped (OR, 4.22; 95% CI, 1.63-10.93) were directly associated with ARD. Trust in the health care system was not significantly associated with ARD (OR, 0.69; 95% CI, 0.46-1.04). In a multivariable analysis, total negative behaviors remained associated with ARD (OR, 1.39; 95% CI, 1.12-1.73), and trust did not. Conclusions and Relevance In this cross-sectional study of communication behaviors attributed to racial discrimination, experiencing dismissiveness, relational coldness, and stereotyping were associated with Black patients’ attribution of negative behaviors to racial bias. Interventions targeting these behaviors may reduce patients’ experience of health care discrimination.