“And All These Prejudices That Exist, I Think I Also Fall For That” Healthcare Providers’ Perceptions of Interacting With Patients in a Low Socioeconomic Position

An Interview Study

Abstract

Communication between healthcare providers (HCPs) and patients in a low socioeconomic position (SEP) is challenging, partly because an adequate communication style requires HCPs to recognise patients’ skills and needs, perceptions that can be subject to biases. To better understand the impact of patient SEP on HCPs’ communication approaches, we explored HCPs’ perceptions of low-SEP patients, and patients’ communication and their engagement in shared decision-making (RQ1) and HCP perceptions of their own communication and engagement in shared decision-making with low-SEP patients (RQ2). Sixteen HCPs (M = 40.7; SD = 11.8) from varied practice settings participated in semi-structured interviews. Thematic analysis revealed five themes for RQ1, with key themes indicating that HCPs often struggle to recognise low-SEP patients and perceive them as more passive communicators. For RQ2, four themes emerged, showing that HCPs report using simpler language and involving low-SEP patients less in shared decision-making. These findings contribute to a better understanding of the complexities of medical interactions with low-SEP patients. We suggest that HCPs could benefit from more guidance in the form of trainings to better identify SEP, as this may complement existing communication interventions. Additionally, we encourage HCPs to explicitly ask patients about their preferences and understanding.