“Black people don’t go to therapy, Joan; we go to church.” So says one woman to her struggling friend on the TV sitcom Girlfriends after her friend admits that she wants to find a therapist. This moment captures an important insight: Identities, like race, gender, and socioecomonic status, are linked to health behaviors. The behaviors that people choose to engage in to promote their health are shaped by what identities come to mind and the strategies for improving health that are linked to those identities.
As Neil Lewis Jr. described in the SPSP Annual Convention symposium “Misperceptions and Missed Connections: Mechanisms that Perpetuate Health Disparities,” we may be able to leverage the power of identity to help improve health for disadvantaged populations. In one study, Lewis and his colleagues found that black participants were less likely to pay attention to information about HIV when they watched a video about this topic alone. However, this pattern changed when black participants saw another black person paying attention to the video. When another person with the same racial identity engaged with health information, participants became more engaged with this information themselves. This suggests that creating a connection between an important identity and health can make people more open to potentially threatening health information.
Veronica Derricks shed additional light on how identity can shape health. Healthcare providers often employ a strategy called information targeting, in which they disseminate health information to groups that are at high risk of disease with the goal of reducing health disparities. In a survey of medical practitioners, Derricks and her colleagues found that medical practitioners had high expectations about information targeting, believing that it is useful and efficient, shows patients that providers care about them, and increases patients’ attention to the information.
But, as Derricks’ research suggests, information targeting may backfire. In one study, Black participants were given information about HIV or the flu. Some participants were told that this information was being given to them because of their demographics, and some were told that they were receiving information by chance alone. Black participants who were told that the information was targeted to them reported paying less attention to that information, and said that the providers of this information were less honest and trustworthy. These effects were particularly strong for participants who received information about HIV, which disproportionately affects Blacks in the United States.
Why did black participants have negative responses to targeted health information? A follow up study suggests that receiving targeted information increases the concern that you are being judged on the basis of stereotypes. Black participants who received targeted information were more likely to believe that they received the health information because they were being unfairly judged. Interestingly, these same negative effects of information targeting surfaced when Black participants were simply asked demographics before, instead of after, receiving targeted health information, suggesting that even subtle signals that make racial identity salient can prompt these effects
Importantly, in the survey of medical practitioners, providers indicated that they didn’t think that information targeting would harm relationships or increase distrust. There may be a mismatch between what providers think is helpful for at-risk patients and how these patients actually feel, and this mismatch could ultimately undermine at-risk patients’ trust in the healthcare system. Considering how critical identity is for health behavior can allow providers to design effective interventions to reduce persistent disparities in health.
Lauren Howe is a 6th year PhD candidate in social psychology at Stanford University and the Shaper Family Stanford Interdisciplinary Graduate Fellow. Her research interests include social acceptance and social rejection, trust in experts, and patient-physician interactions.
The talks were part of Misperceptions and Missed Connections: Mechanisms that Perpetuate Health Disparities, held during the 18th Annual Society for Personality and Social Psychology Annual Convention.
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