Large-Scale Online stimulus Norming and Surveys about Perceptions in Healthcare

National Center For Complementary & Integrative Health

Investigators

Linked publications & trials

Abstract

Pain can be modulated by interpersonal processes that support the patient-provider relationship, and contextual factors related to the treatment environment. For example, placebo effects reflect the positive influence of social contexts on pain relief, whereas health disparities in pain are subject to stereotypes and inequities in pain assessment and its treatment. In this project, we investigate large-scale norms and beliefs about healthcare in America, and how perceptions of people and other visual cues in the treatment environment influence expectations about pain during treatment and about the pain other people feel. This project uses online survey methodologies to measure large scale normed beliefs and expectations from a geographically, ethnically, and socioeconomically diverse population of Americans. The purpose of this project is to investigate healthcare beliefs that may enhance or diminish pain in the clinic, which can be used to design studies in the laboratory to test if manipulating these beliefs can be advantageous for pain outcomes. In the past year, we published one article from this project in the journal Affective Science (Dildine, Amir, Parsons, Atlas, 2023). Prior research suggests White individuals need stronger expressions before labeling a face as in pain when viewing the face of a Black actor relative to a White actor. However, these faces differed in identity, were actors, and were all male. We therefore ran a study in which we manipulated the same facial muscle movements (with action units determined based on the pain expression literature) but superimposed these on different identities. Therefore the expressions were identical, it was just the face they were imposed on that differed. We also decided to not only measure potential differences in pain judgments by race, but also by sex, since female patients and research participants have lower pain tolerance and are less likely to be treated for pain than male patients, similar to the disparities between Black and White individuals regardless of sex. We completed three studies over the course of 2019-2020, including a period of racial unrest that led to increased awareness of racial disparities in the US. Following initial manuscript submission, we completed two additional studies suggested by reviewers that compared pain with basic emotions and tested whether findings from our computer generated stimuli generalized across individuals. We did not observe consistent gender or racial biases in pain assessment across studies based on meta-analysis. However, our fifth study demonstrated that pain was less accurately assessed than other basic emotions, and that regardless of emotion, individuals attributed lower intensity to Black, relative to White, individuals, and had lower confidence for female faces, even though faces displayed the same expressions regardless of race or gender. The fact that we did not observe consistent findings in pain assessment across the studies may reflect the changing context and awareness of racial disparities in the middle of 2020, but also highlights that pain assessment may be more subject to context than assessment of basic emotion. In addition, we also completed collaborative work with Dr. Joyce Chung (OD, formerly NIMH) that measures the impact of the covid-19 pandemic on mental and physical health. We have used natural language processing to evaluate the association between mental health and language use in a free response item and published our work in the Journal of Medical Internet Research - Mental Health (Weger et al., 2022). We also submitted one paper on the association between expectations and worries and reported symptoms (Akintola et al., Submitted) and are preparing three additional manuscripts for submission. Several additional collaborative papers on the mental health during the pandemic have been submitted and are currently under review.