Unconscious biases: Racial microaggressions in American Indian health care

Melissa L. Walls, John Gonzalez, Tanya Gladney, Emily Onello

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


Purpose: This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM). Methods: This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM. Results: Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. Conclusions: Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination. (J Am Board Fam Med 2015;28:231-239.)

Original languageEnglish (US)
Pages (from-to)231-239
Number of pages9
JournalJournal of the American Board of Family Medicine
Issue number2
StatePublished - Mar 1 2015
Externally publishedYes


  • Cross-Cultural care
  • Patient-Centered care
  • Populations
  • Underserved

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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