JMIR Publications

ABSTRACT

Background:

Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position (SSP), particularly race/ethnicity, gender, and sexual orientation. To advance from identifying to intervening upon such intersectional health disparities, studies that examine underlying mechanisms are required. While much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination; these attribution-free measures ask about experiences of mistreatment “because of who you are.” These measures show promise for intersectional health disparities research, but require further validation across intersectional groups and languages. Additionally, the proposal to remove attributions is controversial and no direct comparison has ever been conducted.

Objective:

This study aims to (1) cognitively and (2) psychometrically evaluate the Intersectional Discrimination Index (InDI) in English and Spanish and (3) determine whether attributions should be included.

Methods:

Study aims will draw on one preliminary validation dataset and three original sequentially collected sources of data: (a) qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting SSP (gender, sexual orientation, race/ethnicity, socio-economic status, age, nativity); (b) a Spanish quantitative survey (n=500; 50% sexual and gender minorities [SGM]); and (c) an English quantitative survey (n=3000), with quota sampling by race/ethnicity (Black, Latino/a/x, White), SGM status, and gender.

Results:

The study was funded by the National Institute on Minority Health and Health Disparities in May 2021 and data collection will begin in July 2021.

Conclusions:

The study’s key deliverable will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods.