Q. What is stereotype threat?
A. Stereotype threat is the threat of being judged by or personally confirming a negative stereotype about a group you belong to. So this group could be your ethnic group, it could be your gender, it could have to do with sexual orientation—any type of socially recognized group.
Where else does it play in (besides healthcare)?
Stereotype threat has primarily been studied in academics, other kinds of performance domains, like leadership and, to some degree, athletics. So the primary stereotype threat study that generated this line of research actually studied African-Americans as compared to Caucasians, or Whites, in academic settings, specifically when taking the SAT or other types of standardized tests.
So students perform poorly because they think that they’re expected to perform poorly?
Exactly, and what’s really amazing is that something as subtle as having to check a box having to identify your ethnicity can create this experience of stereotype threat. And this isn’t happening at the conscious level, yet this experience is being created and leads to poorer performance. Now some people will say, ‘well these people would’ve performed poorly no matter what,’ and maybe it is just lack of ability, but if you take out that variable of having to identify or belong to that social group, then you don’t see the gap in performance on academic tests.
Who were the subjects of this healthcare study?
So we started just looking at African-American women compared to Caucasian women, we actually just completed two more studies, that haven’t been peer reviewed yet, but they include both African-American and Caucasian males and females. So we are able to replicate and extend these findings to males and then in subsequent work, we’d like to look at other ethnic groups, including Latinos.
What was your method, and what did you find?
We utilized a virtual healthcare setting, where we asked people about how they were feeling when they were waiting in the virtual waiting or examination room to see a hypothetical doctor, Dr. Campbell. We provided a photograph and a bio of Dr. Campbell, so everyone would have the same doctor in mind, and Dr. Campbell was the stereotypical physician in that he was a middle-aged Caucasian male. And we let people know how much experience he had practicing medicine. So with that information, we were standardizing the perceived competence of Dr. Campbell, because we don’t want that to effect how anxious people feel.
Then we asked people, “How anxious do you feel, waiting to speak Dr. Campbell?” At the same time, the women who were in the experimental condition - which is the stereotype threat condition - were exposed to images of negative stereotypes of African American women’s health. For example, on the wall in the waiting room, there was a poster that had a picture of an African American baby and said she has her father’s eyes, and her mother’s AIDS. That was to invoke the stereotype of HIV and AIDS being more common among the African-American population, and the sort of behaviors that that subsumes. And the African American women who highly identified as being African American, and who were in the stereotype threat conditions - therefore exposed to these negative stereotypical images - reported far more anxiety about seeing Dr. Campbell than the African American women who did not highly identify as being African-American, and/or were in the neutral condition and were not exposed to any stereotypical images. And then, of course, when compared to all of the Caucasian women.
So what does this mean for black women when it comes to healthcare? What kind of conclusions can you draw? Is there evidence of African-American women under utilizing healthcare?
There is really mixed evidence about whether African-Americans and other minorities under utilize healthcare. In some studies we find that to be the case, and then in other studies, it’s not. I think that there are a lot of other variables that have to be taken into account before you can make sort of a general assumption like that. One of the most powerful tools and one of the most powerful implications of this line of research is education. Just knowing that the possibility of stereotype threat exists, even if you think that you’re not susceptible to it, is powerful because then you can consciously counter an inclination to make decisions or engage in behaviors that don’t benefit you, either in the short run or the long term, if you know that there’s more to it than just feeling anxious in this moment. I think on the part of physicians and medical establishments or healthcare providers, also being aware of that stereotype threat exists so that they don’t do anything to kind of set off the experience of stereotype threat, and so that we can help to create stereotype-safe environments. One of the ways that we might be able to create stereotype-safe environments is by diversifying healthcare settings.
In the study that we just completed - which hasn’t gone under peer review yet - we manipulated the race of Dr. Campbell because we wanted to know if Dr. Campbell is an African-American man, instead of a Caucasian man, and we controlled all the other factors that might influence someone’s perception of a white versus black doctor. So we controlled for the level of perceived competence, the level of perceived warmth, the level of perceived attractiveness, the number of years of experience practicing medicine. We controlled for all of these things by carefully selecting the images of the doctors and provided a bio of the doctors. We found that African-Americans experienced far less healthcare-specific stereotype threat when they are matched to an African-American physician, as opposed to a Caucasian physician. That tells us that one way we can create stereotype-threat safe healthcare settings is to diversify those settings, while controlling for the quality of the healthcare setting of course, and then matching minority patients to minority healthcare providers.
One really interesting thing that we took away from this study was how these messages and images - that are meant to help educate and protect people - actually seem to be invoking stereotype threat. It’s really common to use public service, public health campaigns that try to target certain groups of people by using images that are most relevant to them, that have people that look like them, but actually these images can be creating situations where people are more likely to experience stereotype threat. So what is actually very well intentioned, may be harmful and we need to really think outside of the box and think of creative ways to still get these messages across without creating more stereotype threat which may make people even less likely to utilize healthcare, which may make people experience more anxiety when they are seeking healthcare and so with repeated experiences of stereotype threat, with repeated experiences of anxiety, people may start to avoid healthcare settings and ultimately that has a lot of consequences for physical, and potentially mental health.
Dr. Abdou’s study was published by the American Psychological Association in July 2014, and can be found here.
Originally published July 29, 2014.
Dr. Cleopatra M. Abdou
Cleopatra Mariam Abdou is an assistant professor in the Leonard Davis School of Gerontology and Department of Psychology at the University of Southern California (USC). Most recently, Dr. Abdou co-authored a first of it’s kind study that “found evidence that the persistent health disparities across race may, in part, be related to anxiety about being confronted by negative racial stereotypes while receiving healthcare.” Prior to joining the faculty at USC, Abdou completed a postdoctoral fellowship in social epidemiology and population health as a Robert Wood Johnson Foundation Health and Society Scholar at the University of Michigan. Abdou received her Ph.D. in social and health psychology, minoring in statistics, from UCLA in 2008. In 2000, she graduated magna cum laude from the University of Miami with a degree in psychology and art.