Cultural Identities and Perceptions of Health Among Health Care Providers and Older American Indians

BACKGROUND: Differences in provider‐patient health perceptions have been associated with poor patient outcomes, but little is known about how patients' cultural identities may be related to discordant perceptions. OBJECTIVE: To examine whether health care providers and American‐Indian patients disagreed on patient health status ratings, and how differences related to these patients' strength of affiliation with American‐Indian and white‐American cultural identities. DESIGN: Survey of patients and providers following primary care office visits. PARTICIPANTS: One hundred and fifteen patients ≥50 years and 7 health care providers at a Cherokee Nation clinic. All patients were of American‐Indian race, but varied in strength of affiliation with separate measures of American‐Indian and white‐American cultural identities. MEASUREMENTS: Self‐reported sociodemographic and cultural characteristics, and a 5‐point rating of patient's health completed by both patients and providers. Fixed‐effects regression modeling examined the relationships of patients' cultural identities with differences in provider‐patient health rating. RESULTS: In 40% of medical visits, providers and patients rated health differently, with providers typically judging patients healthier than patients' self‐rating. Provider‐patient differences were greater for patients affiliating weakly with white cultural identity than for those affiliating strongly (adjusted mean difference=0.70 vs 0.12, P =.01). Differences in ratings were not associated with the separate measure of affiliation with American‐Indian identity. CONCLUSIONS: American‐Indian patients, especially those who affiliate weakly with white‐American cultural identity, often perceive health status differently from their providers. Future research should explore sources of discordant perceptions.