With or without intent: how racial disparities prevent effective implementation of care.

BACKGROUND: The limited affects of translation within the United States remains a central issue for the medical profession. Racial disparities are noted as a significant factor contributing to this problem.

OBJECTIVE: This pilot study sought to explore how racial barriers limit the effective implementation of health care by examining the barriers that affect health care among African-Americans in Dayton, Ohio through their expression of experiences on the subject.

METHOD: This qualitative study relied on the focus group method to accomplish its objective. Both African-American (Black) and White (non-Hispanic White) individuals were invited to participate in the focus group to facilitate comparison between the experiences of the two groups and identify experiences that are uniquely African-American. Of the 18 individuals who participated in the study, 16 were African-American and 2 were White. Participants were selected using the purposive sampling method which drew participants from a list of individuals who had received health services from a public health clinic in Dayton, Ohio, and who had not returned for care during a 12-18 month period prior to their participation in the study. These participants represent some of the most vulnerable members of US society when it comes to access to health care. The focus group conversation was audio taped, recorded on flip charts, and transcribed by an observer to ensure data accuracy. Focus group participants had immediate access to the flip chart notes and were asked to correct inaccurate recordings. The data was analyzed using the grounded theory approach.

RESULTS: According to participants, the key barriers they experienced to effective health care were economic factors; the quality of care they received and the disrespect of medical practitioners; accessibility to health services based on location, cost, and decentralized services; lower literacy and education levels; and cultural differences and the related factors of discrimination and racism embedded in the health system.

CONCLUSION: This study suggests that without addressing racial, cultural and ethnic disparities in health care, efforts at translation will continue to be thwarted. Moreover, physicians' efforts at translation must be matched by changes to the institutional arrangements within health care systems.