Perceived Discrimination and Racism

Although discrimination is a potential determinant of health disparities among older adults, existing measures may have limitations. We provide two resources:

  1.  A paper reviewing the appropriateness of measures of discrimination for theory-based research on discrimination and health in older African Americans
  2. A modified Perceived Racism Scale (PRS) to be appropriate for a study of older African American patients with diabetes.

Review of Appropriateness of Existing Measures of Discrimination

We review three theoretical frameworks relevant to the study of perceived discrimination and health – stress-process, lifecourse, and Critical Race Theory. These frameworks incorporate complementary and sometimes parallel concepts when describing the biopsychosocial factors that help explain racial/ethnic disparities in health. We discuss how discrimination should be measured to conduct research within each framework. We review four well-known measures of perceived discrimination (Everyday Discrimination Scale, Experiences of Discrimination Scale, Schedule of Racist Events, and the Index of Race-Related Stress) in terms of their applicability. We assess the extent to which each measure addresses key aspects of the theoretical frameworks and suggest potential areas of modification.

Citation: Thrasher AD, Clay OJ, Ford CL, and Stewart AL. Theory-guided selection of discrimination measures for racial/ethnic health disparities research among older adults. Journal of Aging and Health, 2012;24(6):1018-43. PMCID: PMC3693449.

Modified Perceived Racism Scale

The perceived racism scale (PRS) is a structured self-administered questionnaire assessing the experience of white racism against African Americans in multiple domains including employment and public domains. It has been validated in several studies and has demonstrated good reliability.

Citation: McNeilly MD, Anderson NB, Armstead CA, Clark R, Corbett M, Robinson EL, Pieper CF, Lepisto EV. The perceived racism scale: a multidimensional assessment of the experience of white racism among African Americans. Ethnicity and Disease, 1996;6:154-66. PMID: 8882844

We adapted the scale to be appropriate for use in a cohort of older African American patients with diabetes. The adapted scale is provided with permission from Dr. Maya D. McNeilly, Duke University Departments of Psychiatry and Psychology, North Carolina ([email protected]). The adaptations and psychometric results are presented in the following publication:

Citation: Moody-Ayers SY, Stewart AL, Covinsky KE, Inouye SK. Prevalence and correlates of perceived societal racism among older African-American adults with type 2 diabetes mellitus. Journal of the American Geriatric Society, 2005;53:2202-2208. PMID: 16398910

This study identified several issues in assessing discrimination in older adults. Many specific experiences of discrimination were not captured by the “lists” provided in this measure. When patients were queried about stresses in their lives, many recalled experiences of discrimination that they had not reported on the structured measure. In addition, measurement studies suggested a 2-factor structure to the coping items: active responses (e.g., speaking up) and passive responses (e.g., avoiding it) which usually are scored as a single scale.

The adapted version included three modifications: 1) excluded questions in the “academic” and “response to racist statements” domains, leaving two original domains: racist incidents in the employment and public, 2) changed questions from first person to second person to enable face-to-face administration, and 3) added one open-ended question to obtain qualitative data: please describe a racist incident that made you feel angry, frustrated, powerless, or sad.