Affective interactions in medical visits: ethnic differences among American Indian older adults

Objective: Investigate influence of ethnicity on older American Indian patients’ interpretations of providers’ affective behaviors. Method: Using data from 115 older American Indian patients, random effects ordered logit models related patient ratings of providers’ respect, empathy, and rapport first to separate measures of American Indian and White American ethnicity, then to “ethnic discordance,” or difference between providers’ and patients’ cultural characteristics. Results: In models accounting for patients’ ethnicity only, high scores for American Indian ethnicity were linked to reduced evaluations for providers’ respect; high scores on White ethnicity were associated with elevated ratings for empathy and rapport. In models accounting for provider–patient ethnic discordance, high discordance on either ethnicity scale was associated with reduced ratings for the same behaviors. Discussion: Findings support “orthogonal ethnic identity” theory and extend “cultural health capital” theory, suggesting a pathway by which ethnicity becomes relevant to experience of health care among older adults.