Cover: Understanding Negative Feedback from South Asian Patients

Understanding Negative Feedback from South Asian Patients

An Experimental Vignette Study

Published in: BMJ Open, v. 6, no. 9, e011256, 2016

Posted on Sep 15, 2016

by Jenni A. Burt, Gary A. Abel, Natasha L. Elmore, Cathy Lloyd, John Benson, Lara Sarson, Anna Carluccio, John Campbell, Marc N. Elliott, Martin Roland

Research Question

  1. To what extent do differences in reported patient experiences between South Asian and other patients in England reflect differences in quality of care?


In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care.


Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16.


Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling.


564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach.

Main Outcome Measure

Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression.


Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor.


Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.

Key Findings

  • When shown video vignettes of patient-doctor interactions, British Pakistani patients gave substantially higher ratings of the communication shown than their White counterparts.
  • Ratings did not vary by gender, socioeconomic status, or the ethnicity of the doctor pair shown in the vignette.
  • Greater ethnic differences in ratings were seen among older patients and with vignettes scripted to show poor communication.
  • The high ratings of the vignette interactions among British South Asian patients in the study suggests that the low ratings from South Asians observed in the English GP Patient Survey reflect their experiencing poorer communication from their doctors in real-life care.

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