Dissertation
Is practitioner appraisal of facial expressivity and emotional engagement in Parkinson’s disease affected by race?
University of Iowa
Doctor of Philosophy (PhD), University of Iowa
Summer 2024
DOI: 10.25820/etd.007773
Abstract
Black people are diagnosed with Parkinson’s disease (PD) at half the rate as White people. The reasons for this large disparity in the prevalence of PD between these racial groups are not well understood. One unexplored possibility is that racial bias in practitioners, specifically when appraising motor signs of PD such as hypomimia (reduced facial expressivity), may cause delays or even errors in the diagnosis of PD in Black versus White people. Specifically, practitioner bias surrounding facial expressivity in Black people versus White people may lead practitioners to appraise Black patients with hypomimia as having higher levels of facial expressivity. Furthermore, practitioner bias may cause them to characterize reduced facial expressivity as being due to negative personality traits, as opposed to a medical sign, in Black patients with hypomimia. The current study included 175 practitioners/primary care providers such as medical doctors, nurse practitioners and physician assistants. First, analyses were conducted to explore the association between practitioners’ demographic attributes such as race, gender, occupation and years of patient experience and their appraisal of facial expressivity, hypomimia, pathology, emotional engagement and need for referral, in Black versus White people with or without hypomimia. Hypomimia severity and medical history were similar in these Black and White people, within the same condition. Then, a multi-level modeling approach was used to compare the practitioners (1) appraisal of facial expressivity (2) perception of pathology (3) impression of emotional engagement and (4) perception of necessity for referral, in the same Black versus White people with and without hypomimia. A model also explored whether race of the individual and practitioners’ ratings of pathology predicted their ratings of emotional engagement in Black versus White people.
Firstly, preliminary results revealed that practitioners’ gender, occupation, and years of experience influenced their ratings of pathology, emotional engagement and likelihood of making a referral for Black and White patients with and without hypomimia. These attributes were included in the main multi-level models. Next, the multi-level models showed that practitioners rated facial expressivity higher in Black versus White people with no hypomimia. Race did not influence practitioners rating of any other construct/outcome variable, for Black and White people in the no hypomimia condition. In addition, race did not significantly impact practitioners rating of any of the constructs, in Black versus White people with hypomimia. Further, hypomimia condition significantly predicted practitioners’ ratings for each outcome variable. Lastly, more years of patient experience was associated with higher pathology rating by practitioners, for Black and White people with hypomimia.
These results suggest that patient race and practitioners’ demographic attributes, such as years of experience, can influence practitioners’ clinical evaluation of Black versus White people without and with hypomimia, respectively. In spite of these findings, practitioners racial bias does not influence their ability to appraise people with more objective signs of hypomimia or to make important clinical decisions for these patients. However, it is likely that the sample was underpowered and/or the study measurements were not sensitive enough to detect a significant racial effect on practitioners’ ratings for each construct. Therefore, it is crucial to continue to explore ways in which practitioner bias and related factors are contributing to health disparities for Black patients with PD and other diseases. Thus, future researchers should investigate whether practitioners have a racial bias when evaluating other motor or non-motor signs of PD, while using measures that are validated to assess clinical appraisals and decision-making in primary care practitioners.
Details
- Title: Subtitle
- Is practitioner appraisal of facial expressivity and emotional engagement in Parkinson’s disease affected by race?
- Creators
- Shana Harris
- Contributors
- Daniel Tranel (Advisor)Isaac Petersen (Committee Member)Molly Nikolas (Committee Member)Natalie Denburg (Committee Member)Steven Anderson (Committee Member)
- Resource Type
- Dissertation
- Degree Awarded
- Doctor of Philosophy (PhD), University of Iowa
- Degree in
- Psychology (Clinical Psychology)
- Date degree season
- Summer 2024
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.007773
- Number of pages
- xii, 159 pages
- Copyright
- Copyright 2023 Shana Harris
- Language
- English
- Date submitted
- 11/14/2023
- Description illustrations
- illustrations (some color)
- Description bibliographic
- Includes bibliographical references (page 91-120).
- Public Abstract (ETD)
This research is relevant to public health because it promotes the understanding of factors that may result in health disparities for Black patients with Parkinson’s disease. This research is especially timely and relevant to neurologists and practitioners/primary health care providers due to its emphasis on exploring factors (i.e., racial bias) that contribute to delays in the diagnosis and treatment of Black people with early signs of Parkinson’s disease, which has strong implications for disease prognosis, quality of life and outcomes in these patients. Racial bias is a modifiable factor and is a feasible target for intervention. Thus, this research would provide significant and relevant knowledge to health care clinicians and administrators that would help them to implement and promote effective policies to improve the accuracy of evaluative procedures and diagnosing of Black patients with signs of PD.
- Academic Unit
- Psychological and Brain Sciences
- Record Identifier
- 9984698055202771
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