Video study of physician selection: Preferences in the face of diversity

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Original Research

Video study of physician selection: Preferences in the face of diversity

J Fam Pract. 2003 July;52(7):552-559

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References

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To balance the video doctors with respect to any possible order effect, we created 18 video presentations showing the video doctors in different orders. We obtained the sequences by creating 6 x 6 Latin squares containing all 720 possible orders and then randomly selecting 3 Latin squares and using the 18 orders contained therein. By delivering 1 of the 18 orders to each group of 22 to 24 participants, we obtained nearly perfect balance in the ordering of the video doctors.

Participants

Individuals at a shopping mall in the San Francisco Bay Area aged >18 years and able to read and write English were invited to watch a short video and rate doctors for a healthcare research project. Four hundred people participated; 395 completed questionnaires. Participants were told that their responses were anonymous, and each questionnaire was marked only with the group number. Study procedures were approved by the Committee on Human Research at the University of California at San Francisco.

FIGURE
Video doctors

Study design and procedures

After viewing brief introductions of each video doctor (Figure), participants were asked: “If you were to choose 1 of these doctors to be your doctor, which would you pick?” They were then instructed to write the number of their choice on the questionnaire.

Participants then viewed the message from each video doctor about eating 5 fruits and vegetables a day. After each presentation, participants rated the video doctor by circling a number on 7-point scales, where a response of 7 indicated the following qualities: very professional, very knowledgeable, excellent communication skills, respectfulness, genuine/authentic, warm/friendly, and pleasant facial expressions.^14,15 Participants also rated each video doctor on a 7-point scale for how likely they would be to increase their fruit and vegetable consumption, how interested they might be in choosing this person as their doctor, and how comfortable they might be in talking with this person about personal health matters such as sexual, alcohol, and drug-using behaviors.

After viewing and rating all 6 video doctors, participants again viewed the 6 head shots together and answered the following question: “Now that you’ve heard each video doctor, which one would you pick to be your doctor?” To conclude, participants answered demographic questions, turned in their booklets, and received a $20 gift certificate.

Statistical analysis

Differences in the initial preferences for the sex and race of the video doctors by the sex and race of the participants were studied by using standard 2-way tables, with Fisher exact tests for 2 × 2 tables and χ² tests for larger tables. Multivariable analysis of sex preferences for the video doctor was done with logistic regression to test the effect of participants’ demographic variables. Matched pair analysis, with an exact version of the McNemar test, was used to assess whether participants’ tendency to choose a same-sex or a same-race video doctor changed from their initial to their final selection.

From each participant’s ratings of the video doctors, an assessment score was generated by averaging the 10 scaled ratings. The clustered assessment scores were analyzed with a normal linear mixed model analysis with a random effect to represent participant scoring tendency and fixed effects to account for the differential mean score for the preferred vs nonpreferred video doctors and differences in mean score depending on the order in which the video doctor was scored. All analyses were performed in Stata 6.0. (More detailed on the methods is found in Appendix A at www.jfponline.com.)

Results

Demographics

Participants were diverse in sex (61% female, 39% male), ethnicity (30% Asian American, 29% European American, 26% Latino, 8% African American, and 7% other), age (11% were 18 to 19 years old, 24% were 20 to 29, 18% were 30 to 39, 17% were 40 to 49, 13% were 50 to 59, 8% were 60 to 69, and 9% were 70 to 87), and education (9% had less than a high school education, 34% had a high school diploma or graduation equivalency diploma, 26% had some college, 22% were college graduates, and 9% had graduate degrees).

Initial preferences for video doctors

Initial sex preference. The strong preference for a female video doctor was significantly different from the 50% preference for each sex that would be expected in the absence of any sex preference (P<.0001). Most females (85%) and males (63%) selected a female video doctor (difference between males and females significant at P<.001; Table 1). The percentages of sex preference by race were not significantly different from one another (P=.36).

Multivariable logistic regression confirmed the relation between participants’ sex and the sex preference of the video doctor but showed no convincing evidence of differences in sex preference related to race (P=.73), age (P=.15), schooling (P=.23), marital status (P=.13), or employment status (P=.19).