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Table 3 Items tested and summary of categories identified in cognitive interviews

From: Development and testing of study tools and methods to examine ethnic bias and clinical decision-making among medical students in New Zealand: The Bias and Decision-Making in Medicine (BDMM) study

Items tested

Source

Categories identified in cognitive interviews*

1. Are you:

 ▪ Male

 ▪ Female

 ▪ Other: ____

Statistics New Zealand Population Census 2013 question (adapted)

Understanding

Response formatting

Emotion

2a. How would you best describe your socioeconomic background growing up?

 ▪ Lower socioeconomic level

 ▪ Lower middle socioeconomic level/working class

 ▪ Middle socioeconomic level

 ▪ Upper-middle socioeconomic level

 ▪ Upper socioeconomic level

[39]

Understanding

Task performance

Response formatting

2b. Would you describe your family income as: (mark one)

 ▪ Low income

 ▪ Middle income

 ▪ Upper-Middle income

 ▪ High income

[65]

Understanding

Task performance

Response formatting

3. Listed below are a few statements about your relationships with others. How much is each statement TRUE or FALSE for you?

 1. I am always courteous even to people who are disagreeable.

 2. There have been occasions when I took advantage of someone.

 3. I sometimes try to get even rather than forgive and forget.

 4. I sometimes feel resentful when I don’t get my way.

 5. No matter who I’m talking to, I’m always a good listener.

RAND 5-item Social Desirability Response [66]

Understanding

Task performance

Response formatting

Emotion

 5 response options (1. Definitely True; 2. Mostly True; 3. Don’t Know; 4. Mostly False; 5. Definitely False)

 

4. Which of the following best describes you in general?

 ▪ I strongly prefer NZ Europeans to Māori

 ▪ I moderately prefer NZ Europeans to Māori

 ▪ I slightly prefer NZ Europeans to Māori

 ▪ I like NZ Europeans and Māori equally

 ▪ I slightly prefer Māori to NZ Europeans

 ▪ I moderately prefer Māori to NZ Europeans

 ▪ I strongly prefer Māori to NZ Europeans

[39] (adapted)

Understanding

Response formatting

Emotion

5. Please rate your feelings of WARMTH toward the following groups using the “feeling thermometer scale” for each group.

 7-pt scale from LEAST WARM to MOST warm for each group separately (i.e. NZ Europeans, Māori)

[67] (adapted)

Understanding

Task performance

Response formatting

Emotion

6. Please answer the following questions by selecting your response on the scale below.

 a. In general, how competent do you think Māori/NZ European patients are?

 b. In general, how intelligent do you think Māori/NZ European patients are?

 c. In general, how confident do you think Māori/NZ European patients are?

[64] (adapted)

Understanding

Task performance

Response formatting

Emotion

 Asked for each ethnic group separately; 7-pt scale from 1. Not at all [adjective] to 7. Extremely [adjective]

  

7. Please answer the following questions by selecting your response on the scale below.

 a. In general, how compliant do you think Māori/NZ European patients are?

 b. In general, how reliable do you think Māori/NZ European patients are?

 c. In general, how motivated do you think Māori/NZ European patients are?

Developed by authors drawing on [64] and [68]

Understanding

Response formatting

Emotion

 Asked each ethnic group separately; 7-pt scale from 1. Not at all [adjective] to 7. Extremely [adjective]

  

8. Major inequalities in health exist between Māori and NZ European in New Zealand. Please indicate how much you AGREE or DISAGREE with the following statements about Māori health and ethnic inequalities.

 a) Māori have a higher prevalence of chronic disease because they are genetically predisposed.

 b) Māori have worse health than NZ Europeans because of individual behavioural risk factors such as smoking and diet.

 c) Māori have worse health than NZ Europeans because of lower socioeconomic position.

 d) Māori have worse health than NZ Europeans because of racism in New Zealand.

 e) Māori have worse health than NZ Europeans because they present later for care.

 f) Health provider biases about patients based on their ethnicity contribute to poorer quality of care for Māori.

 g) If Māori patients receive less care than NZ European patients it is most likely due to their own preferences.

Developed by authors

Understanding

Response formatting

Emotion

 Likert scale from 1. Strongly disagree to 7. Strongly agree

  
  1. Note: *Category was identified by at least one participant in the cognitive interviews, Underlined and capitalised words are how they appear in the cognitive interview format