Mobilizing class resources and presenting the self: The differential healthcare experiences of black middle class womenedit
Evidence of racial disparities in health care is remarkably consistent across a range of illnesses and health care services. Treatment differences persist after controlling for socioeconomic status, indicating minorities who are middle class may be treated differently based on race. Although a substantial subset of the African American population have college degrees and middle class incomes, most research on disparities does not address the health care experiences of African Americans who are not poor but remain at risk of receiving non-standard treatment. Most of the research literature also omits strategies patients may use to get better treatment such as using positive self-presentation strategies, e.g., conducting research on their health condition prior to the visit, trying to connect on a personal level with the provider, wearing certain clothes, etc. Using grounded theory as the main analytic strategy, this study used focus groups and indepth interviews of 30 middle class African American women to explore their perceptions of bias in healthcare, and strategies they use to mitigate potential bias, including using positive selfpresentation strategies or seeking a race and/or gender concordant provider. The study found that respondents overwhelmingly endorsed the importance of positive self-presentation strategies, including physical presentation (dress), making a personal connection with the provider, and conducting research on their health condition, to mitigate differential treatment. Importantly, respondents noted that implementing the strategies was often burdensome but necessary to secure appropriate healthcare treatment. Many women reported specific incidents, particularly related to reproductive healthcare, in which providers made inappropriate treatment recommendations based on the respondent’s race and gender. As a result, women reported using positive self-presentation strategies to counteract pervasive stereotyping of African American women in healthcare settings. The study provides important information about the health care experiences of a substantial, but understudied, segment of the population. African-American middle-class women have many resources but are still vulnerable to differential treatment. They have their own strategies for mitigating bias through emphasizing their education, profession, or other aspects of social class. However, the process of self-presentation can be exhausting and may negatively affect the patient-provider relationship. Interventions designed to reduce racial disparities in health care must also consider how socioeconomic status, race, gender, sexual orientation, skin color, and other factors affect the healthcare encounter.