Patient Perception, Preference and Participation Kenyan patients’ attitudes regarding doctor ethnicity and doctor–patient ethnic discordance Ann Neville Miller a, *, Jesica Kinya b , Nancy Booker b , Mary Kizito b , Kyalo wa Ngula c a University of Central Florida, USA b Daystar University, Kenya c Africa Nazarene University, Kenya When patients and doctors hail from different cultural or ethnic backgrounds, effective communication can be difficult [13– 15,38,45]. In North American and European settings studies indicate that in comparison with intra-cultural medical interviews, intercultural interviews are characterized by more misunder- standing, less satisfaction, lower patient compliance (for a recent review see [1]), and a range of negative patient outcomes of care [2–5]. Street [6] has identified four major communication-related issues that might contribute to about these negative outcomes. Ethnically discordant patients and providers may: (a) speak different languages or dialects, or use different metaphors and idioms with the same language; (b) have different preferred styles of communicating in medical encounters; and (c) operate out of different explanatory models of health and illness. Finally, (d) providers may hold racist or perceptual biases. These issues may affect patient outcomes not only directly, but also indirectly as they influence the level of trust that patients have in their providers [7]. Relatively little research, however, has addressed the role of ethnicity in the medical interview outside of Northern Europe and North America [10]. Even in the African AIDS epidemic, which has generated hundreds of studies regarding specific cultural values and behaviors that impact prevention and care efforts (See for example Miller et al. [40], Muturi [41], and Rugalema [43] for such discussions specific to Kenya), virtually no attention has been paid to ethnicity as it impacts the patient–provider interaction itself. This is despite the fact that ethnic identity in Africa is a critical component of the modern African situation [8], as ethnically based conflicts in Uganda, Rwanda, Burundi, Sudan, and more recently Kenya, make all too clear. What studies have been published on the topic in the African context have primarily been situated in South Africa. Scholars there have noted language barriers between English and Afrikaans- speaking doctors and patients who speak African vernacular languages [9,35,50], patient embarrassment with medical personnel whom they perceive to be highly educated and authoritative [10,11], and differences between patient magico-religious understanding of health and the biomedical approach of white physicians [12]. These observations parallel the first three mechanisms identified by Street. South Africa is unique on the continent, however, and findings in that context are not necessarily relevant to the rest of sub- Saharan Africa. In other African nations, including Kenya where the Patient Education and Counseling 82 (2011) 201–206 ARTICLE INFO Article history: Received 29 August 2009 Received in revised form 3 March 2010 Accepted 22 April 2010 Keywords: Patient–provider communication Patient–provider ethnic discordance Kenya Africa ABSTRACT Objective: This study explored Kenyan patients’ perspectives on the role of ethnicity in the doctor– patient relationship. Methods: 221 participants completed questionnaires on ethnicity in doctor–patient relationships; eight focus groups were held with low- and middle-income urban and rural women. Results: About half of participants expressed no preference for doctor ethnicity. Participants rated demographic factors as less important than factors related to the doctor’s qualifications, communication skills, and cost of service. Those who did indicate a preference were more likely to prefer Indian doctors for eye problems and Europeans for major surgery, cancer, and heart problems. With less severe medical issues participants were more likely to prefer a doctor who was ethnically concordant with them. Reasons for this centered around communication issues. In contrast, several focus group participants did not want to be treated by doctors from their own ethnic group because of concerns about confidentiality. Conclusion: Additional research is needed on negative implications of patient–provider concordance. Practice implications: Medical service providers must be aware of concerns about ethnic concordance. Alternatively medical centers that deal with sensitive medical information need to consider hiring staff who are not of the majority ethnic group in their region. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Corresponding author at: University of Central Florida, Nicholson School of Communication, P.O. Box 161344, Orlando, FL 32816-1344, USA. Tel.: +1 407 617 2651. Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2010.04.037