Danya K. Krueger, MSW, MBA, PhD Student and Graduate Research Assistant, University of North Carolina at Chapel Hill, Chapel Hill, NC
Michael C. Lambert, PhD, Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC
Tracy Truong, MS, Principal Biostatistician, Duke University, Durham, NC
Keisha Bentley-Edwards, PhD, Associate Professor in Medicine, Duke University, Durham, NC
Evan R. Myers, MD, Walter L. Thomas Distinguished Professor of Obstetrics and Gynecology in the School of Medicine, Duke University, Durham, NC
Maria I. Rodriguez, MD, Professor of Obstetrics and Gynecology, School of Medicine; Medical Director Oregon's Reproductive Health Program; Director, Center for Women's Health; Director, Center for Reproductive Health Equity, Oregon Health Sciences University, OR, OR
Geeta K. Swamy, MD, Haywood Brown, MD Distinguished Professor of Women's Health, Duke University, Durham, NC
Jonas J. Swartz, MD, Associate Professor of Obstetrics and Gynecology, Duke University, Durham, NC
Background and Purpose: Perceived racial and ethnic discrimination is associated with poor maternal health outcomes, disproportionately affecting Black, Indigenous, and People of Color (BIPOC) and those from historically marginalized communities. Yet, validation of psychometric tools measuring such discrimination in postpartum care remains largely unexplored. The 7-item Discrimination in Medical Settings (DMS) scale is a patient-centered tool for assessing discrimination attributed to race or ethnicity during patient-clinician interaction. While it has been deployed with diverse patient populations and healthcare settings, including HIV, hypertension, and breast cancer treatments, the DMS has not been evaluated in a postpartum setting. Moreover, its psychometric properties have not been assessed for over a decade, with previous evidence noting the scale has demonstrated both one- and two-factor solutions across different samples. To address the research gap, this study deployed and evaluated the DMS Scale with a postpartum patient sample within an academic hospital setting.
Methods: Participants were recruited during their postpartum inpatient stay between June 2021 and January 2023 at a single tertiary care hospital in the South. A total of 491 participants completed the DMS scale. The sample’s mean age was 31, with 43% identifying as White, 36% identifying as Black or African American, 8% identifying as Asian, 6% identifying as two or more races, and 5% identifying as other. Additional races represented 1% or less of the sample, while 10% reported Hispanic/Latino ethnicity (90%, n=441). A confirmatory factor analysis (CFA) was conducted to evaluate the factorial structure of the DMS scale. Model fit was evaluated using the chi-square test of model fit (X²), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Standardized Root Mean Square Residual (SRMR).
Results: The DMS scale retained a unidimensional structure with high internal consistency reliability (7 items; Cronbach’s α = 0.92). CFA yielded excellent model fit: RMSEA = 0.08, [90% CI: 0.06, 0.10], CFI = 1.00, TLI = 1.00, and SRMR = 0.025. All standardized factor loadings exceeded .70 (p ≤ .001), suggesting that the seven items were robust indicators of perceived racial/ethnic discrimination among the sample.
Conclusions and Implications: Findings contribute to further substantiation that the DMS scale is a valid and reliable tool for measuring patient-reported experiences of racial/ethnic discrimination in postpartum settings. Utilization of the scale allows clinicians and policymakers to center the experiences of BIPOC and marginalized postpartum patients. Results can be used to design tailored interventions that build awareness of and train clinical staff on anti-racist, patient-centered care.
![[ Visit Client Website ]](images/banner.gif)