March 23, 2022

Study indicates shift in health care provider preferences of Middle Eastern- and North African-descent women

In an analysis of 97 patient surveys, Department of Family Medicine researchers found that patient-provider race/ethnicity/cultural concordance was of decreasing importance to women of Middle Eastern and North African (MENA) backgrounds – and was cited as a barrier to routine preventative and women’s health exams.

Many women of Middle Eastern and North African (MENA) descent no longer necessarily prefer having a physician of the same sex, religion or culture, according to a new community survey analysis from 2019. In fact, concordant clinician-patient characteristics were significant drivers of the avoidance of routine preventative and women’s health care checkups, including pelvic exams to detect cancer.

The findings were generated by researchers from the Department of Family Medicine and the Rogel Cancer Center, as well as Ken Resnicow, Ph.D., of the Center for Health Communications Research, all from the University of Michigan. Their study was recently published online in Lancet Regional Health – Americas. The article is titled, “Concordant physician-patient characteristics lose importance for Arab American women and their healthcare- cross-sectional study.”

“In the past, concordance of religion/culture of her physician with the MENA women was a positive facilitator for any health exam,” the researchers write. “We are now reporting that this concordance has become a barrier to receiving routine and women’s health exams.”

Diane Harper MD MPH MS
Diane Harper, MD, MPH, MS

“These women are saying, ‘When I have a physician who believes more in their religion than the evidence of medicine, I really don’t like that,’” said Diane Harper, MD, MPH, MS, professor of Family Medicine and Obstetrics and Gynecology at U-M. Harper led the research team.

To explore the interplay of religiosity and cultural identity on the health-seeking behaviors of MENA women, the research team surveyed 97 MENA women between the ages of 30 and 65 in southeast Michigan, which has one of the fastest-growing populations of MENA women in the United States. Surveys were provided in both Arabic and English.

The researchers found that some MENA women who were surveyed avoided routine health exams and women’s health exams if their physician was of the same religion, sex or culture. The research team also learned that the more education a MENA woman had, the more she avoided routine health exams due to perceived conflicts of the physicians’ religion and culture with herself.

ALSO READ: U-M researchers examine predictors of cervical, colorectal cancer screenings in women 50-65 (which includes screening rates for MENA women)

However, the impact of these patient preferences varied by appointment purpose, with Dr. Harper noting that: “For a routine health exam, MENA women are more concerned about their doctors and concordant sex, culture and religiosity” than for a women’s health exam (i.e. a pelvic exam).

Further analysis of the data indicated that many MENA women, particularly those who have lived in the United States for 10 or more years and have a higher education level, prefer their doctor to not ‘proselytize’ about their own religious or cultural ideas when choosing what sexual health information they share with her or the health services and tests they provide.

These findings echo earlier research that found that MENA women often feel dismissed and negatively judged by their same-religion primary care physicians, who sometimes allow their own cultural and religious beliefs to take precedence over women’s healthcare needs of MENA women.  

“When someone’s religious and cultural values supersede the expectation of community and public and personal health, it becomes an issue,” Harper said. “Those personal values create barriers.”

Harper hopes that the paper’s findings serve as a reminder that doctors of all faiths and cultures should be mindful about how their personal beliefs and cultural backgrounds impact the care they provide to patients. 

“Physicians must always continue to educate themselves on what their patients’ needs are,” Harper said. “What this study has shown is that the trusting relationship between the patient and doctor is most important.”

Citation: Harper, D. M., Sen, A., Tariq, M., El Khoury, C., Haro, E. K., Alman, E., Patel, M. R., & Resnicow, K. (2022). Concordant physician-patient characteristics lose importance for Arab American women and their healthcare- cross-sectional study. The Lancet Regional Health - Americas, 10, 100225.