How Stereotypes Hurt

Assistant Professor Cleopatra Abdou
Assistant Professor Cleopatra Abdou

Warning: Stereotypes may be harmful to patients’ health.

A national study led by a USC researcher found people who encountered the threat of being judged by negative stereotypes related to weight, age, race, gender, or social class in health care settings reported experiencing adverse health effects.

The researchers found those people were more likely to have hypertension, to be depressed, and to rate their own health more poorly. They were also more distrustful of their doctors, felt dissatisfied with their care, and were less likely to use highly accessible preventive care, like the flu vaccine.

“Healthcare stereotype threat” stems from common stereotypes about unhealthy lifestyle choices or inferior intelligence that may be perpetuated, often unintentionally, by health care professionals or even by public health campaigns.

Mixed messages

Although health messages are intended to raise awareness of health issues or trends that may affect specific communities, one implication of this study is that these messages can backfire, said lead author Cleopatra Abdou, an assistant professor at the USC Leonard Davis School of Gerontology and Department of Psychology at the USC Dornsife College of Letters, Arts and Sciences.

“An unintended byproduct of public health campaigns is that they often communicate and reinforce negative stereotypes about certain groups of people,” Abdou said. “As a result, they may inadvertently increase experiences of what we call ‘healthcare stereotype threat,’ which can affect health care efficacy and even prompt some patients to avoid care altogether.”

As examples of the negative health effects of health-related stereotypes, Abdou cited campaigns about reproductive health in African-American women and other women of color, sexual health in the LGBTQ community, depression among women, and cognitive deficits in older adults.

Such messages can reinforce and magnify the negative lens through which these groups of people are commonly viewed in society, she said.

“It’s not that there aren’t real health concerns in specific communities that we need to do more— much more— to address, but how we communicate about these concerns is key,” Abdou said.

Abdou’s healthcare stereotype threat research is groundbreaking. Abdou, with her collaborator, Dr. Adam Fingerhut, of Loyola Marymount University, is the first person to empirically demonstrate the existence of healthcare stereotype threat. Their first experiment documenting the phenomenon of healthcare stereotype threat examined the health consequences of negative stereotypes of African-American women’s reproductive health in a virtual healthcare setting.

As the authors expected, the first-of-its-kind study found that strongly identified African-American women experienced more anxiety than all other women (i.e., African-American women in the Control Condition and White women in both the Experimental and Control Conditions) in a virtual healthcare setting when primed with negative stereotypes of African-American women’s reproductive health. Abdou and Fingerhut are now studying healthcare stereotype threat in diverse populations and with respect to diverse health outcomes, finding that its effects are far-reaching.

Study details

Abdou and her team surveyed an estimated 1,500 people, ages 50 and older, as part of the U.S. Health and Retirement Study.

More than 17 percent of the respondents said they felt vulnerable to prejudice with regard to racial or ethnic identity, gender, socio-economic status, weight or age in health care settings. People who felt threatened based on several identities were worse off, health-wise, than people who felt threatened based on just one identity.

Abdou said the challenge now is to find ways to inform all people, including people at heightened risk, about how to live healthier, happier, and longer lives while also minimizing the experience and effects of health care stereotype threat.

“It’s time for us to implement policies that enhance medical school training in cultural competency and increase the diversity of our physicians and broader health care workforce,” Abdou said. “Hospitals and other health care institutions with inclusive policies which welcome diversity and celebrate tolerance, both symbolically and explicitly, hold great promise for reducing health care stereotype threat and the short- and long-term health disparities that we are now learning result from it.”

More than half the study’s respondents were women, and most respondents – 82 percent – were White. Abdou also said the study focused on people who reported having seen a doctor sometime within the two years before the study. She noted that because of these limitations, healthcare stereotype threats were probably underreported by the sample of subjects. Such stereotype threats are probably experienced by young people, too, not just by people who are aging, Abdou said.

The study was published online on Oct. 20 in the American Journal of Preventive Medicine. The study co-authors were Adam Fingerhut of Loyola Marymount University in Los Angeles, James Jackson of the University of Michigan, and Felicia Wheaton of the USC Leonard Davis School of Gerontology.

The research was funded by the National Institutes of Health, the Woodrow Wilson National Fellowship Foundation, and a Hanson-Thorell Family Research Award.

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