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Health services research
Research
Understanding negative feedback from South Asian patients: an experimental vignette study
  1. Jenni Burt1,
  2. Gary Abel2,
  3. Natasha Elmore1,
  4. Cathy Lloyd3,
  5. John Benson4,
  6. Lara Sarson5,
  7. Anna Carluccio5,
  8. John Campbell6,
  9. Marc N Elliott7,
  10. Martin Roland1
  1. 1Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
  2. 2University of Exeter Medical School, Exeter, UK
  3. 3Faculty of Health and Social Care, The Open University, Milton Keynes, UK
  4. 4Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
  5. 5Ipsos MORI, London, UK
  6. 6University of Exeter Medical School, Exeter, UK
  7. 7RAND Corporation, Santa Monica, California, USA
  1. Correspondence to Dr Jenni Burt; jab35{at}medschl.cam.ac.uk

Abstract

Objectives In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care.

Design Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP–patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16.

Setting Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling.

Participants 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach.

Main outcome measure Mean differences in communication score (on a scale of 0–100) between White British and Pakistani participants, estimated from linear regression.

Results Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor.

Conclusions Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.

  • communication
  • healthcare disparities
  • minority groups
  • physician-patient relations
  • PRIMARY CARE

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjopen-2016-011256

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