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A Dissertation Entitled the Role of Physician Social Identities In A Dissertation entitled The Role of Physician Social Identities in Patient-Physician Intergroup Relations by Yopina G. Pertiwi Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Doctor of Philosophy Degree in Experimental Psychology __________________________________________ Dr. Andrew L. Geers, Committee Chair __________________________________________ Dr. Jason Rose, Committee Member __________________________________________ Dr. Jon D. Elhai, Committee Member __________________________________________ Dr. Matthew T. Tull, Committee Member __________________________________________ Dr. Revathy Kumar, Committee Member __________________________________________ Dr. Cyndee Gruden, Dean College of Graduate Studies The University of Toledo May 2019 Copyright 2019, Yopina G. Pertiwi This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author. An Abstract of The Role of Physician Social Identities in Patient-Physician Intergroup Relations by Yopina G. Pertiwi Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Doctor of Philosophy Degree in Experimental Psychology The University of Toledo May 2019 This study examined the role of the physician combined race/ethnic and gender identities on patient perceptions, emotions, attitudes, and behavioral tendencies toward the physicians. An integrative approach was utilized in examining this phenomenon with three prominent theories in intergroup relations and stereotyping and prejudice, i.e., Social Identity Approach, Stereotype Content Model, and Role Congruity Theory. Based on the Social Identity Approach, it was hypothesized that patient emotions, attitudes, and behavioral tendencies toward the physicians depended on the patient and physician’s social identity similarities. The Stereotype Content Model predicted that patient emotions and behavioral tendencies depended on patient perceptions of physician warmth and competence. Finally, the Role Congruity Theory suggested that patient evaluation and behavioral tendencies depended on the congruency between their expectations and the physician actual roles. MTurk workers completed a set of questionnaires measuring their perceptions, emotions, and attitude toward the physician, after seeing a White, Asian, or Black physician profile. Subsequently, they imagined a slightly unpleasant visit experience to the physician office and predicted their behavioral tendencies. MIMIC iii models were developed and tested based on the three theories. The findings showed a minimal effect of the physician social identities on patient perceptions, emotions, attitude, and behavioral tendencies across the three statistical models. Physicians were perceived similarly regardless of their social groups. Findings from each of the models’ analysis also showed the uniqueness of each theory in predicting patient-physician intergroup relations. The study has both theoretical and practical implications that are discussed in this document. Keywords: patient-physician, intergroup relations, social perceptions, social identity, stereotypes, social role iv To Ahmed: the perfect partner to defy the odds, and to Issa and Aisha: the best motivational trainers anyone could ever asked for. This work is for you. v Acknowledgments Almost six year ago, I started the graduate school marathon to accomplish an ultimate personal goal. Today, I would have not reached the end of the race without an excellent team work. I am extremely grateful to Dr. Andrew Geers, for ‘adopting’ me into his lab and has become the best mentor I could ever asked for in graduate school. His expertise in the academic and professional work along with his faith and understanding that he has to his students have transformed me into a much better researcher, student, and, importantly, a person than I was when I first started this journey. I am thankful for Dr. Rose, Dr. Elhai, Dr. Kumar, and Dr. Tull who served as committee members for this dissertation. Their feedback and suggestions have improved the quality of the study and made this a full-of-learning experience to me. Accomplishing graduate school and dissertation work would have been too difficult to bear if not because of the friendship I’ve made along the way with Michelle, Ashley, Fawn, Jacclynn, and many others who have definitely made significant contribution into where I am at right now. I am blessed with a supportive husband, Ahmed, who has not only showered me with love but provided me with the means I needed during the most stressful period in my life. For my two children, I am truly blessed to have the opportunity to still be able to fight for an important accomplishment in my personal life, but at the same time to learn to be a loving mother. I hope, someday, both of you will look back to these days with a sense of pride and inspiration. For my family in Indonesia, I am thankful for their patience and support while their daughter and sister strive to achieve her dream. Finally, a special thanks to Brooke who has spent her valuable time reading this lengthy draft and provided me with constructive feedback. vi Table of Contents Abstract iii Acknowledgments vi Table of Contents vii List of Tables xii List of Figures xiii List of Abbreviations xv I. Patient-Physician Relationship based on Three Theoretical Perspectives 1 on Intergroup Relations and the Stereotyping and Prejudice A. A Social Identity Approach to the Patient-Physician Intergroup 5 Relationship a. Crossed Categorization Theory of Social Identity 7 b. Intergroup Emotions Theory of Social Identity 10 B. Stereotype Content Model and Patient-Physician Intergroup 14 Relationship C. Role Congruity Theory and Patient-Physician Intergroup 21 Relationship D. Summary 26 II. Preliminary Findings 28 A. Pilot Study 1: Exploring Patient-Physician Intergroup 28 Relationship a. Perceptions of the Physicians, Behavioral Tendencies, 29 Participants Gender and Physician Race/Ethnicity vii b. Perceptions of the Physicians, Behavioral Tendencies, 30 Participant Gender, and Race-Concordance c. Perceptions of the Physicians, Behavioral Tendencies, 31 Participant Gender, and Black vs. non-Black Physicians d. Conclusion 32 B. Pilot Study 2: Investigating Relevant Emotions and Behavioral 33 Tendencies in Patient-Physician Interactions a. Patient Emotions 34 b. Patient Behavioral Tendencies 35 c. Conclusion 37 III. Hypotheses and Proposed Models 38 A. Hypotheses and the Proposed Model of the Social Identity 38 Approach’s Prediction B. Hypotheses and the Proposed Model of the Stereotype Content 40 Model’s Prediction C. Hypotheses and the Proposed Model of the Role Congruity 42 Theory’s Prediction IV. Method 44 A. Overview 44 B. Participants 46 a. Exploratory Factor Analysis 46 b. Main Study 46 C. Procedure 49 viii D. Experimental Stimuli: Physician Profiles 52 E. Measures 53 a. Stereotypic Beliefs on Various Types of Occupation 53 b. Perceptions of the Physician 54 c. Emotions toward the Physician 55 d. Evaluation of the Physician (Outgroup Feeling 55 Thermometer) e. Evaluation of the Physician (Semantic-Differential 56 Measure of Attitudes) f. Facilitative Behavioral Tendency toward the Physician 56 g. Harmful Behavioral Tendency toward the Physician 57 F. Data Analytical Strategy 57 V. Results 62 A. Exploratory Factor Analysis 62 a. Facilitative Behavioral Tendency 63 b. Harmful Behavioral Tendency 63 B. Confirmatory Factor Analysis 64 a. Facilitative Behavioral Tendency 64 b. Harmful Behavioral Tendency 65 C. Social Identity Approach 66 a. Evaluating Group Differences on Dependent Variables 66 b. Correlations between Focal Variables 70 c. Test of the MIMIC Model 71 ix D. Stereotype Content Model 76 a. Evaluating Group Differences on Dependent Variables 76 b. Correlations between Focal Variables 80 c. Test of the MIMIC Model 82 E. Role Congruity Theory 84 a. Evaluating Group Differences on Dependent Variables 85 b. Correlations between Focal Variables 88 c. Test of the MIMIC Model 89 VI. Discussion 92 A. Social Identity Approach 92 a. Hypothesis 1 93 b. Hypothesis 2 95 c. Hypothesis 3 95 d. Hypothesis 4 96 e. Summary 96 B. Stereotype Content Model 97 a. Hypothesis 1 98 b. Hypothesis 2 98 c. Hypothesis 3 99 d. Hypothesis 4 99 e. Summary 100 C. Role Congruity Theory 100 a. Hypothesis 1 101 x b. Hypothesis 2 101 c. Hypotheses 3 and 4 102 d. Summary 102 D. The Lack of Race Effect in the Present Study Findings 103 a. Context Matters 103 b. The Absence of Threat 105 c. The Lack of Choice 106 E. Implications 107 a. Integrating the Three Theoretical Views 107 b. Practical Implications 110 F. Limitations 110 References 113 Appendices A. Pilot Study 1 Materials 142 B. Pilot Study 2 Materials 146 C. Main Study Materials 149 D. Consent Forms 176 xi List of Tables Table 1. Description of patient and physician crossed categories.…………………..9 Table 2. Participant demographics based on race/ethnicity………………………...49 Table 3. Standardized factor loadings of the facilitative behavioral tendency scale..65 Table 4. Standardized factor loadings of the harmful behavioral tendency scale…..65 Table 5. Correlations between all focal variables in Social Identity Approach model………………………………………………………………………69 Table 6. Correlations between all focal variables in Stereotype Content Model…...79 Table 7. Correlations between all focal variables in Role Congruity Theory………87 xii List of Figures Figure 1. Patient and physician crossed categories…………………………………..9 Figure 2. Illustration of patient-physician
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