Racialised Identity of Sickle Cell Disease Patients

Does racialised identity of Sickle cell disease patients affects whether their treatment in A&E is perceived as procedurally just?

Sickle cell disease (SCD) is a red blood cell disorder that mostly affects people of Caribbean and African ancestry. Patients with SCD experience excessive pain and regularly complain of mistreatment, neglect, and ignorance by medical practitioners in hospital beds (Lakshmi & Carlton, 2020). SCD patients often complain of failure by doctors to timely provide them with adequate medications for pain relief, where the patients face excruciating pain, resulting in harmful drug-seeking behaviors. Medical practitioners unethically have negative attitudes toward patients. The medics accuse the patients of addiction to such drugs, even when the prescribed opioids lack any association with the said addiction (Lakshmi & Osler, 2019). With such complaints from SCD patients only compared to other hospitalized cases, it is evident that sickle cell disease patients face mistreatment, neglect, and under-treatment during the vaso-occlusive crisis (VOC) by medical professionals (Carlton, 2016).SCD patients face pain, and in most instances, chronic pain, which, if not well managed by medical practitioners, could result in devastating health effects to the patients (Sophie, 2013). Most of the patients attribute the mistreatment and biasness by the doctors to racial differences, for instance, the case of African American patients. Patients also complain of a lack of verbal conversation from the doctors, with most medics failing to give the patients the required information and empathy, despite the patient's compliance with the standard procedure of medical procedures (Neda, 2018). Racial disparities are the leading cause of the complaints from these patients, with African American patients being given less medical attention compared to the white population in the hospital beds. In extreme cases, nurses stereotype SCD in children as a result of parental dysfunction, resulting in child abuse (Shawn, 2015). Cultural and social factors similarly trigger maltreatment in children, who are called scapegoats in this crisis. Most doctors feel uncomfortable handling SCD patients, terming their pain as a bother to them (Mary, 2017). The institutional injustice in the healthcare system affects these patients negatively. Furthermore, there is not a lot of research on the public’s view regarding this matter. The aim of my study to understand whether knowing the racialised identity and that the patient has SCD affects whether their treatment in A&E is perceived as procedurally just. I will also look at whether participants’ experience of discrimination in medical setting affects how procedurally just they perceive the healthcare system. I will have a control group and an experimental group. My hypothesis is that participants who have scored highly on the everyday discrimination scale score lower on the procedural justice question than the people who have not experienced discrimination in medical settings.

Method

Design: The research design will be a between-subjects design. The independent variable is the level of discrimination in a medical setting. The dependent variable is the score on procedural justice.

Participants : We will need a sample size of 87 participants. Participants will be recruited by the University of Manchester SONA system. They will be Psychology and Cognitive Neuroscience student studying at the University of Manchester.Materials: There will be a consent form and a participant information study sheet. There will be 2 vignettes. One for the control condition and one for the experimental condition. i will be using the Procedural Justice Question and the Everyday Discrimination scale in medical setting (it is an adapted version of the everyday discrimination scale).

Procedure : I will be assisting with data collection and analysing data. The data will be anonymised, and password protected. The participants will be signing up to the study for a certain number of credits in exchange. Participation Information Study sheet will be provided along a consent form once the participants have signed up and before the complete the study. The participants will be able to contact the researcher(s) at any time on the email provided. Once the participants give consent, they will be able to access the questionnaire which they have to complete by a particular deadline. Participants will be presented with demographic questions to fill. Then they will be randomly assigned to one of two conditions. In the control condition, participants will be presented with a vignette of pain statistics and an A&E encounter. In this condition, it will be clear that the patient is black with sickle cell disease. In the experimental condition, participants will be presented with a vignette of pain statistics and an A&E encounter where the patient is ambiguous. After the participants have read the vignette, they will fill several scales. The participants’ responses will be saved and recorded to the researchers SONA system. Finally, the participants will be presented with a debrief. They will also get the option to be contacted with the outcome of the study by email.  The ethic application has been submitted and the application ID is 15881.

Data Analysis

I will use G power to carry out the data analysis. There will be 3 2-way interactions and 1 3-way interaction.  I will be conducting a between subjects ANCOVA for each main effect and interactions. It will be a 2-tailed test. There will be 3 main effects. The first main effect will be participants will look at either the control or experimental vignette. I will want to see whether they differ in terms of procedural justice. The second main effect will be the scores on the everyday discrimination scale in medical setting and the procedural justice question. The third main effect will be the score on the empathy questionnaire and the procedural justice question. To get a significant result, we will need 84 participants. An effect size of 0.4, p value of <0.05, power at 95%, and 2 groups.

Results

Table 1

Descriptive Statistics for Participant Characteristics

Note: N refers to the number of participants

A descriptive statistics table (Table 1) was constructed to summarize the characteristics of Gender. Sexual Orientation, Racialised Identity, Mental Health scores, Number of times the patient was hospitalized within the year (once or twice). The table reports the mean, standard deviation, sample size, minimum value, and maximum value for each variable.For the control group, Mental health exhibited a mean of 0.98 (SD = 2.864) based on a sample size of 45. However, the experimental group exhibited a mean of 1.23 (SD = 2.877) based on a sample size of 43. The range of values observed for Mental health ranged from a minimum of 0 to a maximum of 10.For the control group, Hospitalised_12months1 exhibited a mean of 0.31 (SD = 1.505) based on a sample size of 45. However, the experimental group exhibited a mean of 0.07 (SD = 0.258) based on a sample size of 43. The range of values observed for Hospitalised_12months1 ranged from a minimum of 0 to a maximum of 10.For the control group, Hospitalised_12months2 exhibited a mean of 1.25 (SD = 0.500) based on a sample size of 45. However, the experimental group exhibited a mean of 2.00 (SD = 0.000) based on a sample size of 43. The range of values observed for Hospitalised_12months2 ranged from a minimum of 1 to a maximum of 2.For the participants score on whether they deemed the procedure was fair (procedural_fair) exhibited a mean of 5.18 (SD = 1.407) based on a sample size of 88. The range of values observed for procedural_fair ranged from a minimum of 1 to a maximum of 7.For the participants score on politics exhibited a mean of 29.74 (SD = 19.977) based on a sample size of 88. The range of values observed for politics ranged from a minimum of 0 to a maximum of 82.For the participants recorded time vignette (time_view_vignette) exhibited a mean of 123.64 (SD = 107.037) based on a sample size of 88. The range of values observed for time_view_vignette ranged from a minimum of 61.400 to a maximum of 843.432.For the participants’ SCD_total score exhibited a mean of 3.69(SD = 0.836) based on a sample size of 88. The range of values observed SCD_total ranged from a minimum of 1 to a maximum of 5.For the participants’ Institutional Racism (Racism_total) score exhibited a mean of 12.64(SD = 3.229) based on a sample size of 88. The range of values observed Racism_total ranged from a minimum of 7 to a maximum of 23.The descriptive statistics provided in the table offer valuable insights into the central tendency and variability of both mental health scores and the number of hospitalizations per year. These findings serve as a foundation for further data analysis and interpretation within the context of the study.Cronbach's alpha was calculated to assess the internal consistency reliability of the measurement scale used in this study. The scale consisted of both 4 and 5 items designed to measure participants' institutional racism. The analysis was conducted using SPSS, and the resulting Cronbach's alpha coefficient was 0.85. This value indicates a high level of internal consistency reliability for the scale. According to guidelines proposed by Nunnally and Bernstein (1994), a Cronbach's alpha coefficient above 0.70 is considered acceptable, while values above 0.80 are considered good, and values above 0.90 are excellent.Therefore, the obtained Cronbach's alpha coefficient of 0.603 (4 items) and 0.766 (5 items) suggests that the items on the institutional racism scale in this study are moderately correlated with each other, indicating that they measure a single construct consistently. This implies that the scale demonstrates good internal reliability and can be considered reliable.A multiple regression analysis was performed to examine the relationship between the predictor variables (Group, Racism_centred and their interaction) and the outcome variable (Procedural_fair). The analysis was conducted using SPSS, and the results are presented below.The overall regression model was statistically significant, F (3, 84) = 4.184, p < .05, indicating that the predictor variables collectively explain a significant amount of variance in the outcome variable.

Table 2

Regression analysis results

 The regression coefficients (B) and their associated standard errors (SE) for each predictor variable are presented in Table 2. The constant term (B = 4.790, SE = 0.199) represents the predicted value of the outcome variable when all predictor variables are set to zero.Among the predictor variables, Group had a statistically significant positive effect on the outcome variable, B = 0.748, SE = 0.285, p < .05. This suggests that a one-unit increase in Group is associated with a 0.748-unit increase in the predicted value of Procedural_fair, holding other variables constant.On the other hand, Racism_centred did not have a statistically significant effect on the outcome variable, B = 0.035, SE = 0.060, p = .554. This implies that changes in Racism_centred are not associated with significant changes in the predicted value of Procedural_fair, when controlling for other variables.Similarly, the variable on interaction between group and institutionalized racism demonstrated a statistically significant negative effect on the outcome variable, B = -0.178, SE = 0.089, p = .049. This indicates that a one-unit increase in interaction between group and institutionalized racism is associated with a 0.30-unit decrease in the predicted value of Procedural, holding other variables constant.The overall model accounted for 13% of the variance in the outcome variable (adjusted R-squared = 0.099), indicating a small level of prediction accuracy.These findings provide evidence of the individual and combined effects of the predictor variables on the outcome variable. Group emerged as a significant positive predictor, whereas Racism_centred showed no significant effect, and interaction between group and institutionalized racism had a significant negative influence on the outcome variable. However, it is important to note that the interpretation of these results should consider the specific context and limitations of the study

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