P3D263: “humility, Concern, and Respect”: A Qualitative Study Exploring a Pediatrician’s Role in Addressing Racial Identity and Discrimination in Clinical Practice

Background: The American Academy of Pediatrics’ (AAP) 2019 policy statement, “The Impact Of Racism on Child and Adolescent Health,” implores pediatricians to address negative health effects due to racism. Despite a clear link between experiences with racial discrimination and negative health outcomes, there is a paucity of literature exploring how pediatricians should address these topics in clinical practice. Moreover, the voices and preferences of youth and their families, including military beneficiaries, have not been elucidated. The purpose of this study is to explore the perceptions of ethnic and racially minoritized families regarding discussions of racial identity and racism within clinical settings.

Methods: In this IRB-approved qualitative study, semi-structured interviews were conducted with self-identified racially minoritized families within the Defense Health Agency (DHA) with children ages 5-18 years. Interviews consisted of open-ended questions encouraging discussion of experiences with racial identity formation and discrimination. We also explored if and how each family would prefer their pediatrician address these topics in relation to their health. Children were included in interviews at the discretion of their parents. Interview transcripts were coded by multiple team members from diverse backgrounds with progression to thematic analysis. This study is supported, in part, by an AAP Community Access to Child Health (CATCH) grant.

Results: Preliminary data from four initial participant groups in this ongoing study have illuminated common themes amongst DHA beneficiary families. Parents shared that they encourage positive cultural practices to allow their children to embrace their racial identities, but also feel an overwhelming responsibility to shield their children from negative associations or situations based in systemic racism. Parents agreed that it could be helpful if their pediatrician would address issues of racial identity and discrimination, but that it should be approached in a manner that is specific to their situation. Participants uniformly voiced that their pediatrician should not treat these discussions as a checklist and expressed that race may not be relevant to every clinic visit. Participants voiced that unnecessarily or inappropriately addressing race may cause tension in therapeutic relationships with clinicians. However, participants felt that permission could be granted for these discussions by answering a brief pre-clinic question, such as, 'Is this visit related to concerns about racial identity, racism, or discrimination?' Families highlighted the importance of humility, trust, and respect from their pediatricians when addressing racism and discrimination.

Conclusion: This ongoing qualitative study suggests that military-connected pediatricians may approach discussions of race and discrimination with minoritized families by applying concepts of cultural humility, including self-reflection, empathy, active listening, and flexible negotiation (Figure 1). Using this framework, pediatricians can take personal responsibility to assist in optimizing the health and well-being of minoritized youth and their families by creating an environment of cultural safety.