Perceived Discrimination in Healthcare Settings is Associated with Medication Side Effects and Adherence: A Cross-Sectional Survey Representing the Four Largest Ethnic Groups in the UK

Many medication side effects are the result of negative patient expectations rather than the pharmacological action of the drugs, thus triggering a "nocebo effect." Negative expectations can be generated by contextual factors that contribute to the perceived quality of care. Research shows that perceived discrimination in healthcare settings among Black, Asian, and other Minority Ethnic (BAME) groups is associated with lower perceived quality of care. Yet, no work has considered whether perceived discrimination contributes to experiences of nocebo effects among BAME groups, leading to potentially poorer medication adherence and health outcomes. We conducted an online cross-sectional survey of 801 participants representing the four largest UK racial/ethnic groups (Asian, Black, Mixed, and White) who had been prescribed a new medication in a general practitioner (GP) consultation in the previous 6 months. Participants' perceived discrimination during their GP consultation was significantly and positively associated with their side-effect experience, and significantly and negatively associated with their adherence to the prescribed medication, with side-effect expectations significantly mediating these relationships. There was a significant interaction between ethnicity and perceived discrimination: participants who identified as mixed race were less likely to report side effects than White participants who experienced the same level of discrimination. Future longitudinal studies are needed to confirm the identified causal relationships and to explore the types of perceived discrimination BAME individuals are experiencing in health care to help develop interventions to reduce nocebo effects.