TABLE 3—

Emergent Medical Discrimination Themes From Interviews and Focus Groups with Breast Cancer Survivors: Greater San Francisco Bay Area, CA, July 21, 2008–March 13, 2009

Type of Discrimination	Theme
Institutionalized	Economic inequities: Income is positively associated with quality of care.
	Language barriers: English language proficiency influenced patient-provider communication and subsequently quality of care.
Personally mediated	Provider prejudice: Providers may make assumptions about patients based on their personal prejudice regarding race/ethnicity, education, and immigrant status.
	Patients believe that providers withheld information from them based on their assumptions about the patient’s limited ability to comprehend all the information.
	Immigrant participants believed they were treated with less respect by providers because of their immigrant status.
Internalized	Self-blame: Patients may attribute poorer quality of care or problems with their providers to their own inadequacies (e.g., language proficiency or educational level).
Other	Personal and group discrimination discrepancy: Patients tend to report less on discrimination directed at the individual level yet more on discrimination directed toward their own racial/ethnic group.
	Active coping behavior: African American and Asian patients apply active coping mechanisms in which they believe they must work harder to receive optimal health care. This behavior includes impression management strategies to present positive images of themselves to receive better care.