1. Ideal Affect Mediates Age-Related Cultural Differences in Physician Preference
Tamara L. Sims, MA1, Jeanne L. Tsai, PhD1 and Mary K. Goldstein, MD, MS1, 2
1. Stanford University 2. VA Palo Alto Health Care System
BACKGROUND
METHODS
RESULTS
Asian Americans report lower satisfaction with their physicians than Caucasians regardless of language and ethnic match.
Ethnic disparities in patient physician communication are commonly attributed to unidentified cultural factors.
We predict that cultural differences in the affective states that people value may explain some disparities in patient satisfaction with physicians.
Affect is an important factor in:
Evaluations of others (Ambady & Rosenthal, 1993)
Patient physician communication (Roter et al., 2006)
Affect Valuation Theory (Tsai, 2007)
Cultural differences in the emotions we want to feel (ideal affect)
Western cultures value excitement and other high arousal positive (HAP) states more than East Asian cultures.
East Asian cultures value calm and other low arousal positive (LAP) states more than Western cultures.
Ideal affect predicts what we do to feel good (e.g., leisure activities, consumer product preferences)
Ideal Affect across the Life Span
Chinese American older adults value HAP states less than younger adults.
European American older adults value HAP states to the same extent as younger adults.
Cultural variation in age trajectories reflective of Chinese ideal to accept one’s age vs. American ideal to stay youthful.
Such variation in ideal affect may be one cultural factor that helps explain ethnic disparities in patient physician communication.
2. For CAs, younger rate HAP physician higher than older
For EAs, no age difference in HAP physician rating
PARTICIPANT CHARACTERISTICS
San Francisco Bay Area Community Sample
1. For CAs, younger value HAP more than older For EAs, no age difference in ideal HAP
N=140
Younger (21-35 yrs.)
Older (65-83 yrs.)
Chinese American (CA) 31 35
European American (EA) 39
PROCEDURE
At Time 1, participants reported how often they actually feel and would ideally like to feel emotion states based on a typical week using a scale ranging from 1(never) to 5 (all the time). :
1) High arousal positive (HAP) affect: enthusiastic, excited, elated
2) Low arousal positive (LAP) affect: calm, relaxed, serene
(Affect Valuation Index; Tsai, Knutson & Fung, 2006)
At Time 2 (~1 year later), participants read descriptions of two physicians based on photos (matched to participant by ethnicity) and descriptions framed in terms of “their “excitement” (HAP) states or “calm” (LAP) states.
Each physician was rated along the following indicators:
Likelihood of selecting this physician
Perceived knowledge
Likelihood of compliance
Trust
Comfort
Overall positive to negative rating
α = .92 for HAP physician; α = .91 for LAP physician
Ideal HAP Frequency
#Controlling for Actual HAP
3. Variation in HAP physician ratings partially mediated by variation in Ideal HAP
CONCLUSIONS
We found no relationship between ideal LAP and preferences for the LAP Physician.
As predicted, age-related cultural differences in ideal affect can shape physician preference.
Consistent with their ideal affect, younger Chinese Americans prefer the physician who promotes excitement more than older Chinese Americans.
Also consistent with their ideal affect, younger European Americans prefer the physician who promotes excitement to the same extent as the older European Americans.
Ideal HAP
Culture x
Age
HAP
Physician
.35*
.30**
.30† (.22)
“My goal as a physician is to ensure that my patients have peace of mind when it comes to their health by promoting a stress-free lifestyle.”
Hobbies:
Golfing, meditation, gardening, fishing
“My primary objective is to enhance patient well-being by increasing their activity levels and overall vitality so my patients can lead healthy, dynamic lifestyles.”
Rock-climbing, waterskiing, snowboarding, football
Example of LAP Physicians
Example of HAP Physicians
Photo for EA Participants
Photo for CA Participants
Photo for EA Participants
Photo for CA Participants
Sobel = 1.81†
**p<.01, *p<.05, † p=.06
#Controlling for Actual HAP
IMPLICATIONS & FUTURE DIRECTIONS
Our findings suggest that ideal affect may be one source of cultural disparity in patient preferences for physicians who emphasize certain affective states. By considering the patient’s ideal affect when making recommendations, physicians may be able to enhance communication and increase patient satisfaction and compliance.
Currently, we are examining the role of ideal affect in cultural disparities for other types of health care decisions (e.g., medication adherence, engagement in exercise, long term care use).
Using experimental designs, we plan to assess both the causal direction of this effect and whether the influence of ideal affect on physician preference translates beyond intention to actual compliance behaviors in future studies.
HYPOTHESIS
We predict that the age-related decrease in ideal HAP among Chinese Americans compared to European Americans will account for variation in preferences for a physician that promotes HAP states.
The authors wish to thank the Stanford Psychology Department Culture and Emotion Lab, the Stanford Culture Collaboratory, and the Stanford Center on Advancing Decision Making in Aging. The research reported on this poster was supported by the National Institutes of Health: National Institute on Aging, P30 AG024957