Initial race preference. For their initial video doctor selection, 53% of participants chose a European American, 29% chose a Latino, and 18% chose an African American. This pattern of preference was significantly different from the 33.3% for each race that would be expected in the absence of a racial preference (P<.001; Table 2).
Video doctor racial preferences differed significantly by race of the participant (P<.0001), with a preference for the same race. A substantial number of participants, however, chose a different-race video doctor. Racial preferences were similar across male and female participants (P=.98).
TABLE 1
Initial and final video doctor selections by sex
| Initial selection | Final selection | |||
|---|---|---|---|---|
| Participants | Female video doctor | Male doctor video | Female video doctor | Male video doctor |
| Female (n=240) | 85% | 15% | 88% | 12% |
| Male (n=155) | 63% | 37% | 71% | 29% |
| Overall (n=395) | 76% | 24% | 82% | 18% |
TABLE 2
Initial and final video doctor selections by race
| Initial selection | Final selection | |||||
|---|---|---|---|---|---|---|
| Participants | African American | Latino | European American | African American | Latino | European American |
| African American (n=30) | 50% | 17% | 33% | 52% | 19% | 29% |
| Latino (n=101) | 12% | 51% | 37% | 20% | 44% | 36% |
| European American (n=113) | 15% | 19% | 66% | 23% | 21% | 56% |
| Asian American or “other” (n=145) | 18% | 25% | 57% | 20% | 37% | 43% |
| Overall (n=389) | 18% | 29% | 53% | 23% | 32% | 44% |
Final preferences for video doctors
Final sex preference. The preference for a female video doctor increased across female and male participants (P<.001; Table 1). The net shift among males from male to female video doctor was significant (P=.014). More female participants shifted from male to female (9%) than from female to male (4%), although the difference was not statistically significant (P=.10).
Final race preference. Forty-eight percent of African American participants, 56% of Latino participants, and 44% of European Americans chose a different-race video doctor. Among Asian and other-race participants, a sizable shift occurred so that only 43% selected a European American video doctor (Table 2).
Between the initial and final selections, 3% of African American participants shifted to a video doctor of a different race, whereas 7% shifted to an African American video doctor. Eleven percent of Latino participants shifted to a different-race video doctor, whereas 6% shifted to a Latino video doctor. Among European American participants, 22% shifted to a different-race video doctor, whereas 12% shifted to a European American video doctor. With the exception of African American participants, there was a significant net shift from same- to different-race choice (P=.036). Many Asian and other-race participants shifted from a European American video doctor to a non–European American video doctor (14% net).
Assessment scores
The 3 female video doctors, who were chosen by more participants than were the 3 male video doctors at the initial and final selections, also received higher mean assessment scores (Table 3). On particular items, the highest score was 6.001 (of a possible 7), received by the European American female for the question: “How professional is this doctor?” The lowest score was 3.590 received by the European American male for the question: “If this person were your doctor, how comfortable might you be in talking with this person about personal health matters?”
TABLE 3
Selection of video doctor by sex and race
| Video doctor’s name* (ethnicity/sex) | Initial selection of video doctor | Mean assessment score | Final selection of video doctor† |
|---|---|---|---|
| Dr. Ann Johnson (European American/female) | 43% | 5.49 | 38% |
| Dr. Renee Garcia (Latina/female) | 22% | 5.32 | 26% |
| Dr. Terry Williams (African American/female) | 12% | 5.13 | 17% |
| Dr. Mark Benson (European American/male) | 10% | 4.31 | 6% |
| Dr. Glen Martinez (Latino/male) | 7% | 4.33 | 6% |
| Dr. Calvin Butler (African American/male) | 6% | 4.84 | 6% |
| *Fictitious names were assigned by the researchers. | |||
| †Figures do not add to 100% due to rounding. | |||
Association of preferences and ratings. Analysis of the mean assessment scores showed a substantial rating tendency among participants, by which they tended to give all 6 video doctors relatively high or low scores. Our analysis indicated that 34.9% (95% confidence interval [CI], 30.4–39.5) of the variance in assessment scores is explained by rating tendency.
We also found that participants tended to increase their scores as they proceeded through the sequence of doctors. Compared with the first video doctor, the second through the sixth video doctors received increases in mean scores of 0.15 (P=.016), 0.16 (P=.011), 0.29 (P<.001), 0.43 (P<.001), and 0.60 (P<.001), respectively. These results showed the importance of using multiple presentation orders to balance the order effect.
After adjusting for the order effect and the respondent rating tendency, the mean assessment scores given to video doctors selected at the initial stage were an average of 0.7 points higher than scores given to the other video doctors (P<.001, 95% CI, 0.56–0.81). At the final selection, the chosen video doctor scored on average 1.04 units higher on the assessment scores than did the other video doctors (P<.001, 95% CI, 0.94–1.1). Thus, the selection made based on the video doctors’ images and brief introductions alone was significantly associated with the subsequent assessment, and the final selection of video doctor was even more strongly associated with the assessment.
Discussion
More participants preferred same-race physicians at the initial selection (66% of European Americans, 51% of Latinos, and 50% of African Americans). This effect was not as large as one might expect, however, because a substantial minority of subjects in each racial category selected a different-race video doctor at the initial selection and a majority of Latinos selected a different-race video doctor at the final selection.