Access Type

Open Access Dissertation

Date of Award

January 2015

Degree Type

Dissertation

Degree Name

Pharm.D./Ph.D.

Department

Communication

First Advisor

Katheryn Maguire

Abstract

Research has identified marginalized and minority patients as displaying fewer participatory behaviors during the clinical interaction. Using a culture-centered framework, this study examines the process by which patients with a previous history of discrimination employed agency and resistance strategies in order to influence the outcome of their clinical interactions. This study conducted a secondary analysis of the video taped interactions of 25 black primary care patients in an urban low-income clinic. Using qualitative content analysis, I identified five emergent themes for patient agency: interrupting the physician, stating observations of care, expressing needs and desires, constructing identity, and agenda/goal management. Participants also used both active and passive forms of resistance tactics in an effort to influence the diagnosis and treatment plan, including questioning the diagnosis/treatment plan, proposing a new diagnosis/treatment plan, providing values and beliefs, questioning the physician’s competence and refusing to endorse the treatment plan. Results from this study indicate that black primary care patients with a history of previous discrimination displayed highly participatory behaviors during the clinical interaction, with displays of patient agency and, in some instances, patient resistance. Future research should examine the role of patient resistance as an attempt to negotiate within the interaction.

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