From Discrimination to Unmet Healthcare Needs and Care (Dis)Satisfaction among Urban-Dwelling Indigenous Taiwanese Adults: A Path Analysis

Despite universal healthcare coverage in Taiwan, urban-dwelling Indigenous Taiwanese (UDIT) individuals continue to experience significant health disparities. While everyday discrimination's influence on healthcare outcomes has been documented, few studies have empirically tested the mechanisms linking discrimination to unmet healthcare needs and care dissatisfaction. This study examines how everyday discrimination affects healthcare outcomes among UDIT adults through psychosocial pathways, including patient activation, relationships with healthcare providers (HCPs), and perceived barriers to care. A cross-sectional survey of 443 self-identified UDIT adults was conducted across Taiwan using a community-based participatory research approach. Measures included validated scales of everyday discrimination, patient activation, relationships with HCPs, barriers to care, unmet healthcare needs, and care satisfaction. Structural equation modeling with weighted least squares mean and variance adjusted estimation was used to test hypothesized pathways, controlling for sociodemographic covariates. Standardized estimates and bootstrapped standard errors were reported. Discrimination was significantly associated with lower patient activation, weaker relationships with HCPs, and more perceived barriers to care. Perceived barrier was linked to higher unmet healthcare needs, while patient activation and relationships with HCPs were strongly associated with greater care satisfaction. The effect of discrimination on unmet needs was fully mediated by perceived barriers. Similarly, discrimination's effect on care satisfaction was fully mediated by lower activation and poorer provider relationships. Everyday discrimination adversely shapes UDIT adults' healthcare outcomes through diminished activation, strained provider relationships, and heightened perceived barriers. Addressing these pathways through culturally responsive and relationally attuned interventions may reduce healthcare disparities that have persisted.