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Protocol - Discrimination in Health Care

Description

The DMS scale is a 7-item instrument that assesses a person’s prior experiences of mistreatment while getting health care that were attributed to race, ancestry, national origin, sex, disability, or age. Each question is rated on a 5-point Likert scale (1-never, 2-rarely, 3-sometimes, 4-most of the time, 5-always).

Specific Instructions

The working group (WG) notes that the DMS scale has been validated for Black/African-American populations, but further testing is warranted among other racial and ethnic groups.

Availability

Protocol

Discrimination in Medical Settings Scale

Think of your prior experiences while getting health care when answering these questions.

1. You are treated with less courtesy than other people.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

2. You are treated with less respect than other people.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

3. You receive poorer service than others.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

4. A doctor or nurse acts as if he or she thinks you are not smart.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

5. A doctor or nurse acts as if he or she is afraid of you.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

6. A doctor or nurse acts as if he or she is better than you.

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

7. You feel like a doctor or nurse is not listening to what you were saying

[ ] 1 Never
[ ] 2 Rarely
[ ] 3 Sometimes
[ ] 4 Most of the time
[ ] 5 Always

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Self-administered questionnaire

Lifestage

Adult

Participants

Adults aged 21 years or older

Selection Rationale

The DMS scale builds upon other widely used scales of discrimination. Findings indicate that the DMS scale has a single factor (factor analysis) solution, good internal consistency, and test-retest reliability, as well as good convergent validity.

Language

English

Standards

Standard	Name	ID	Source

Derived Variables

None

Process and Review

Not Applicable

Protocol Name from Source

Discrimination in Medical Settings (DMS) scale

Source

Peek, M. E., Nunez-Smith, M., Drum, M., Lewis, T. T. (2011). Adapting the everyday discrimination scale to medical settings: reliability and validity testing in a sample of African American patients. Ethnicity & Disease, 21(4), 502-509.

General References

Bird, S. T., & Bogart, L. M. (2001). Perceived race-based and socioeconomic status(SES)-based discrimination in interactions with health care providers. Ethnicity & Disease, 11(3), 554-563.

Thorburn, S., & Lindly, O. J. (2022). A systematic search and review of the discrimination in health care measure, and its adaptations. Patient Education and Counseling, 105(7), 1703-1713. https://doi.org/10.1016/j.pec.2021.10.008

Protocol ID

280901

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX280901_Discrimination_Health_Care_Doctor_Nurse_Act_Afraid
	PX280901050000	A doctor or nurse acts as if he or she is more afraid of you. show less	N/A
PX280901_Discrimination_Health_Care_Doctor_Nurse_Act_Better
	PX280901060000	A doctor or nurse acts as if he or she is more better than you. show less	N/A
PX280901_Discrimination_Health_Care_Doctor_Nurse_Act_Not_Listen
	PX280901070000	You feel like a doctor or nurse is not more listening to what you were saying show less	N/A
PX280901_Discrimination_Health_Care_Doctor_Nurse_Act_Thinks_Not_Smart
	PX280901040000	A doctor or nurse acts as if he or she more thinks you are not smart. show less	N/A
PX280901_Discrimination_Health_Care_Less_Courtesy
	PX280901010000	You are treated with less courtesy than more other people. show less	N/A
PX280901_Discrimination_Health_Care_Less_Respect
	PX280901020000	You are treated with less respect than other more people. show less	N/A
PX280901_Discrimination_Health_Care_Poorer_Service
	PX280901030000	You receive poorer service than others.	N/A

Individual Social Determinants of Health

Measure Name

Discrimination in Health Care

Release Date

December 14, 2022

Definition

Discrimination within the health care system can be defined as negative actions or lack of consideration given to an individual or group that occurs because of a preconceived and unjustified opinion and plays an important role in perpetuating health disparities.

Purpose

Evidence suggests that perceived racial discrimination in health care is associated with several important health outcomes, including lower satisfaction with care, reduced adherence to care, lower quality patient/provider communication, underutilization of preventive health services, prolonged symptom duration before diagnosis, and poor overall self-reported health.

Keywords

Discrimination, health care, racism, race, prejudice, health care discrimination, health care delivery, Health Disparities, ethnicity, Access to Health Care

Measure Protocols

Protocol ID	Protocol Name
280901	Discrimination in Health Care

Publications

Burnett-Bowie, S. A. M., et al. (2024) The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. Journal of Bone and Mineral Research. 2024 May; 39(5): 517-530. doi: 10.1093/jbmr/zjae048

Bartholomew, T. S., et al. (2024) Project CHARIOT: study protocol for a hybrid type 1 effectiveness-implementation study of comprehensive tele-harm reduction for engagement of people who inject drugs in HIV prevention services Addiction Science & Clinical Practice. 2024 March; 19(1). doi: 10.1186/s13722-024-00447-9