Cultur Divers Ethnic Minor Psychol. 2026 Sep 10. doi: 10.1037/cdp0000826. Online ahead of print.
ABSTRACT
OBJECTIVES: Racial microaggressions in health care are an underexamined mechanism through which structural racism shapes health behavior change among Black Americans. Drawing on microaggression and ecological systems theory, this research examines how essentialist health messages and clinical microaggressions relate to self-efficacy and readiness for cardiovascular health behaviors.
METHOD: Across two experimental mixed methods studies, a nationally representative sample of Black American adults viewed health messages varying in racial essentialism, from absent to ambiguous to explicit microaggression intensity. Study 1 (N = 374) tested message effects on self-efficacy and decisional balance alongside microaggressions in medical practice. Study 2 (N = 589) tested whether the jointly held beliefs about race as biological/genetic and social/political related to these outcomes. A subset across both studies (n = 57) provided short narratives analyzed with reflexive thematic analysis.
RESULTS: Health messages affected neither outcome in either study. Racial microaggressions negatively predicted decisional balance in both studies (partial η² = .069, .036) and self-efficacy in Study 1 (.084), but not self-efficacy in Study 2. Biological/genetic race endorsement related to higher self-efficacy and decisional balance only when paired with stronger social/political endorsement and to neither when social endorsement was low. Five qualitative themes described how clinical interactions naturalized racial disease risk and shaped health-behavior motivation.
CONCLUSIONS: Clinical racial microaggressions undermine behavioral readiness among Black Americans, as do beliefs about the meaning of race. Decentering biological essentialism, paired with acknowledgment of race as a social and political construction, may strengthen health behaviors and reduce cardiovascular disparities. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
PMID:42721314 | DOI:10.1037/cdp0000826