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Medical and health sciences
- Mental healthcare services
Along with the tremendous increase in ethnic diversity in European societies, equity of care for people with a migration background has become a major policy goal. However, recent figures reveal that there is still a long way to go in this respect. One worrying finding is that people with a migration background are underrepresented or even absent from ambulant and residential mental healthcare services, despite the higher prevalence of depression in minority populations as compared to non-minorities. In this study, we aim to shed light on this paradox by examining whether there might exist unintentional discrimination in general practitioners’ (GPs) attitudes and recommendations regarding treatment and referral. GPs generally are the first contact for patients with mental health problems. As gatekeepers, they decide whether or not patients are referred to specialized mental healthcare services based on their assessment of the severity and impact of the observed symptoms. However, recent studies from the United States indicate that these recommendations may be biased by unconscious reactions. GPs may unintentionally apply stereotypes when assessing patients, which carries the potential to influence their behavior and decision-making. Hence, if negative stereotypes about people with a migration background lurk in the unconscious of GPs, discrimination is likely to play a role during medical encounters. To date, only a few studies have investigated possible discrimination in the healthcare sector in the European context and all have focused on patients with functional limitations or have used research methods that leave room for discussion. The current study aims to expand this research stream by addressing possible discrimination in GPs’ recommendations to minority patients with mental health problems in the Belgian context, employing research instruments that offer great potential for the identification of discrimination. Belgium represent an excellent case to study this topic for two reasons. First, relevant differences between Flanders, Wallonia and Brussels (e.g. the share of minority residents, the organization of the mental healthcare system) allow to investigate the context-dependency of unintentional discrimination. Second, federal initiatives designed to increase accessibility of care (such as intercultural mediation) might reduce possible regional differences and allow to scrutinize the potential of such tools in diminishing unintentional discriminatory practices among GPs. We will conduct a mixed-method study in which both quantitative and qualitative approaches will be used for triangulation purposes. The quantitative data collection will consist of online survey questionnaires that comprise a scripted video vignette. Three different video vignettes will be used in which every factor (e.g. gender, age, physical characteristics) will be similar, except for ethnicity and migration status. The qualitative data collection will entail a combination of in-depth semi-structured interviews and focus groups with GPs who agreed to partake in a follow-up study. In sum, we aim to identify and interpret attitudes and behaviors of GPs and to translate them into a constructive knowledge and a training tool that will help preventing unconscious stereotyping and possible unintentional discrimination. In doing so, we hope to ultimately reduce disparities in mental healthcare access between patients with and without a migration background