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discrimination, health protective behavior, health services access, prejudice



  1. Facione, Noreen C. PhD, RN, FAAN
  2. Facione, Peter A. PhD


Background: The literature documents significant claims of experienced prejudice in healthcare delivery in relationship to ethnicity, race, female gender, and homosexual orientation. Studies link perceived prejudice with negative healthcare outcomes, particularly in hypertension, heart disease, depression, and human immunodeficiency virus or acquired immune deficiency syndrome.


Objectives: To examine the impact of perceived prejudice in healthcare delivery on women's early cancer detection behavior and women's decisions to seek care for illness symptoms.


Methods: Community women stratified by age, income, education, and race or ethnicity were surveyed regarding healthcare visits and cancer detection behavior. Perceived and experienced prejudice in healthcare delivery was measured by the Perceived Prejudice in Health Care Scale and follow-up interview.


Results: Experienced prejudice in healthcare delivery was linked significantly with failed adherence to cancer screening guidelines and fewer provider visits for serious illness. After controlling for demographics, experienced prejudice explained significant variance in perceived access to care. Although many who experienced prejudice in relationship to their race, income level, sexual orientation, or a combination of these returned for healthcare services, others were alienated sufficiently to decrease their health protective behavior.


Discussion: Subjective perceptions of prejudice are a significant influence in women's health protective behaviors. These findings demonstrate that policies requiring healthcare teams to be trained in professional ethics and cultural competence are vital to the goal of quality in care delivery and are needed to achieve optimal healthcare outcomes for women.