UCLA

Black Americans presently and have historically faced disproportionately negative experiences in the U.S. healthcare system, as spotlighted by the COVID-19 pandemic. In my dissertation, I employ diverse methodologies, including quantitative analyses of nationally representative data, qualitative analyses of focus groups, and experimental methods aiming to understand and illuminate potential ways to address Black Americans’ experiences of injustice in healthcare. The introduction (Chapter 1) builds upon previous research to illustrate a model which emphasizes the importance of individuals and systems (and the histories of individuals and systems) to better understand racial injustice in healthcare. In Chapter 2, I provide a narrative review of the present and historical experiences of Black Americans in the healthcare system. Next, in Chapter 3, across two studies (N=13,054), including a nationally representative sample of Black and White Americans during the COVID-19 pandemic, Black (relative to White) Americans reported less positive experiences in healthcare, which explained early COVID-19 vaccination hesitancy and lower medical system trust. Current knowledge of the Tuskegee Syphilis Study was not related significantly to medical trust or vaccination intention, however. In Chapter 4, qualitative data and thematic analysis were used to interrogate the quality of healthcare provider-Black patient interactions in a sample of 37 Black American women who had been diagnosed with breast cancer. In a community-academic collaboration, three focus groups were conducted across California. Results demonstrated that participants experienced discrimination, stereotyping, and hostility from healthcare providers and within the healthcare system which undermined their medical trust. Further, participants offered suggestions for improving the healthcare experiences of Black women diagnosed with breast cancer. A critical step toward dismantling racial injustice is acknowledging its existence. Thus, in Chapter 5, I tested specific ways to shift dominant group members’ perceptions to recognize both individual and systemic racism and how to increase behavioral intentions to combat injustice in healthcare. Results from this online experiment conducted with 1853 adults suggested that when White Americans learned about critical Black history in healthcare (i.e., history of injustice) vs. celebratory Black history (i.e., history of achievement) or control information, they reported significantly more perspective-taking with Black Americans, which in turn predicted more individual and systemic racism recognition and support for anti-racist policies in healthcare. Ultimately, my dissertation studies highlight specific experiences of injustice that Black Americans face in healthcare and identifies a mechanism to increase White Americans’ recognition of and support for addressing injustices toward Black Americans.