• Johanne Eliacin, Marianne S Matthias, Brooke Cunningham, and Diana J Burgess.
• VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC; ACT Center of Indiana, Psychology Department, IUPUI, Regenstrief Institute, Inc., Indianapolis, IN, USA. Electronic address: johanne.eliacin@va.gov.
• Patient Educ Couns. 2020 Sep 1; 103 (9): 1798-1804.

ObjectivesDrawing from social identity threat theory, which posits that stigmatized groups are attuned to situational cues that signal racial bias, we examined how African-American veterans evaluate verbal and non-verbal cues in their mental health encounters. We also explored how their evaluations of perceived racial bias might influence their healthcare engagement behaviors and communication.MethodsWe interviewed 85 African-American veterans who were receiving mental health services from the US Department of Veterans Affairs (VA), examining their views and experiences of race in healthcare. We analyzed the data using a constructivist grounded theory approach.ResultsParticipants identified several identity threatening cues that include lack of racial diversity representation in healthcare settings, and perceptions of providers' fears of Black patients. We describe how participants evaluated situational cues as identity threats, and how these cues affected their engagement behaviors and healthcare communication.ConclusionOur findings revealed situational cues within clinical encounters that create for Black veterans, fear of being negatively judged based on stereotypes that have characterized African-Americans.Practice ImplicationsWe discuss the implications of these findings and provide suggestions on how to create identity safe environments for minority patients that include delivery of person-centered care, and organizational structures that reduce providers' burnout.Published by Elsevier B.V.

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