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Health disparities, particularly in African-Americans, have been identified in a variety of settings. A secondary qualitative analysis of focus group data sought to describe African-American's perceptions of health disparities. Using an interpretive descriptive approach, three main levels of interaction within the health-care setting were identified that contained barriers to receiving the best possible care. The issue of finances was the major barrier that involved the insurance company, while racism, attitude, setting, and waiting were the major obstacles involved in the interaction in the health-care facility. The barriers present during the interaction with a personal provider were racism, a language barrier, and being rushed. Additionally, five ideals for patient-provider interaction were identified, as well as three approaches that the participants used to address the barriers within the health-care setting. A broad framework was developed incorporating these major themes. [ABSTRACT FROM AUTHOR]

The existence of racial and ethnic disparities in healthcare in the United States is well recognized. However, often overlooked in the planning and design of initiatives to address those disparities are the patient perspectives regarding the issues of racial and ethnic disparities that directly affect them. The objective of this study was to identify the patient priorities and to provide recommendations for action to improve minority health-care quality. A secondary objective was the qualitative analysis of the Institute of Medicine (IOM) focus group data. Six focus groups were conducted with nine participants in each. These included an African-American focus group in Washington, D.C., an African-American focus group in Los Angeles, an Asian focus group in Los Angeles, an Hispanic focus group in Washington, D.C., an Hispanic focus group in Los Angeles, and a Native American focus group in Albuquerque, NM. The barriers and priorities for action included difficulty in making informed choices when identifying and selecting providers, poor service delivery from medical office staff, the inefficiency of medical visits, provider communication and cultural competence barriers, and stressful treatment settings. Patient recommendations targeted provision of tools to empower patients throughout the process of care, provider and staff training in communication and cultural competence, alternate models of service delivery, and accessible mechanisms for evaluation and oversight. This study concluded that patient-identified priorities and recommendations warranted modification of current explanatory models for minority health-care quality and the provision of greater clarity regarding directions for policy and behavioral initiatives and criteria for performance evaluation be advanced. [ABSTRACT FROM AUTHOR]