Background/Purpose: Prior research has shown that when making choices about the risks and benefits of medications, women from minority ethnic groups tend to be more risk averse compared to their Caucasian counterparts. We conducted a qualitative study to better understand how young women of three racial groups: non-Hispanic Blacks, non-Hispanic Whites and Hispanics approach trade-offs between the risks and benefits of medications.

Methods: Participants were drawn from inpatient wards and infusions centers at a large academic hospital. Women age 20-45 years, able to speak English or Spanish, who self-identified as Hispanic Black, non-Hispanic White orHispanic were eligible to particpate. We performed individual in-depth interviews following a semi-structured interview guide. In the initial prompt, all participants were asked why they think minority ethnic groups tend to be more risk averse. Interviews were audiotaped and subsequently transcribed verbatim. Transcripts were analyzed using the constant comparative method of grounded theory. Coding ended with thematic saturation (36 interviews).

Results: We coded 36 transcripts (30.6% non-Hispanic Blacks, 33.3% non-Hispanic Whites and 36.1% Hispanics). The participants’ mean age (SD) was 34.8 (6.8); 66.7% had a college education or higher, 58.3% had annual income $40k or more; 41.7% were employed full-time, and 55.6% were married. The four main themes that emerged from the transcripts were the impact of 1) constrained resources (limited means, responsibilities of work and family, lack of knowledge or information); 2) deep-rooted health beliefs (familial narratives, religious beliefs, mistrust); 3) perceived discrepancies in access to high quality healthcare (access to type of care, relationship with doctors, lack of communication and disclosure) and 4) erroneous illness perceptions (perceived susceptibility to side effects, inaccurate medication beliefs) on attitudes towards treatment. References were made towards constrained resources, family responsibilities and perceived susceptibility by both African American and Hispanic women. African American women made more references to mistrust and medical experimentation and lack of education whereas Hispanic women were most often influenced by beliefs in home remedies. White women endorsed the impact of constrained resources in the minority ethnicities. Examples of illustrative quotations are provided in the table below.

Conclusion: Decision making is influenced by factors far beyond the risks and benefits of proposed medications – and this is particularly true for minority women. An increased awareness of these factors is likely to improve shared decision making in clinical practice.

 

Emerging Themes	Illustrative Quotes
Impact of constrained resources	“They don’t want to be sitting, lying around somewhere recovering. They want to be able to go to work and pay their bills, take care of their families!” “We are not that risky because in the end we really cannot afford what a lot of white people can afford.”
Impact of deep-rooted health beliefs	“Maybe it is the way we are raised or something”, “like your grandmother use to give you these old remedies to try instead of going to the doctor.” “Homemade remedies don’t give side effects.”
Impact of perceived discrepancies in access to high quality healthcare	“…clinic doctors don’t look you in the face …They don’t mention the side effects. They don’t mention what could happen” “A lot of times doctors don’t have time like they use to because of the current health care system of factory working, kind of pushing people out, getting them in and out.”
Impact of erroneous illness perceptions	“There is a lot to lose. I rather hear that there is no fix, stay in pain, use my knee and avoid those side effects like not being able to use it or move it.” “more minorities have health problems….worse health problems than the white people seem to”, “I am going to be that odd number because we are that odd number for everything else.”

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/examing-why-minority-women-are-risk-averse-a-qualitative-study/