Abstract
BackgroundIt is well established that racism is a fundamental contributor to poor health and inequities. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools. We aim to validate instruments developed to measure interpersonal discrimination.MethodsInstruments were discussed at five focus groups and with experts, and field tested in developing Mayi Kuwayu: The National Study of Aboriginal and Torres Strait Islander Wellbeing. Data from 7501 baseline survey participants were analysed. Acceptability was assessed according to extent of missingness, construct validity using exploratory and confirmatory factor analysis, and reliability using Cronbach’s alpha. Associations between each instrument and outcomes conceptually understood to be closely (community-level racism) or less closely (family wellbeing) related were quantified to test convergent and discriminant validity.ResultsAn 8-item instrument captures experiences of discrimination in everyday life and a 4-item instrument experiences in healthcare, each followed by a global attribution item. Item missingness was 2.2–3.7%. Half (55.4%) of participants reported experiencing any everyday discrimination, with 65.7% attributing the discrimination to Indigeneity; healthcare discrimination figures were 34.1% and 51.1%. Items were consistent with two distinct instruments, differentiating respondents with varying experiences of discrimination. Scales demonstrated very good reliability and convergent and divergent validity.ConclusionThese brief instruments demonstrate face validity and robust psychometric properties in measuring Aboriginal and Torres Strait Islander adults’ experiences of interpersonal discrimination in everyday life and in healthcare. They can be used to quantify population-level experiences of discrimination, and associated wellbeing consequences, and monitor change.
Highlights
Racism is a fundamental cause of ill health and health inequities globally [1]
Discrimination can occur on the basis of ethnicity, race, Indigeneity, or other characteristics; it is difficult to identify the basis for discrimination, but regardless of the perceived reason for the discrimination, evidence indicates that there are negative outcomes associated with exposure [3, 5,6,7,8]
Face validity The initial racism instrument tested through the Mayi Kuwayu Study was adapted from the first question of the Measuring Indigenous Racism Experiences (MIRE) (Table S1)
Summary
Racism is a fundamental cause of ill health and health inequities globally [1]. Racism is a system of oppression based on the social ranking of groups of people into categories of race, with those lower in the social strata considered inferior and denied access to rights, resources, and opportunities—processes that have clear health consequences [2]. Aboriginal and Torres Strait Islander (Indigenous Australian) stakeholders have identified as a high priority research on the experiences of discrimination, overall and within healthcare [9, 10]. Regardless of the measure used, there is consistent evidence of high exposure to discrimination in this pouplation [11,12,13,14,15,16,17] This is a consequence of ongoing colonisation, which has contributed to the systematic oppression, disempowerment and exclusion of Aboriginal and Torres Strait Islander peoples. There is consistent evidence of high exposure to discrimination among Aboriginal and Torres Strait Islander (Indigenous Australian) peoples, but impacts have not been fully quantified, in part due to limited measurement tools.
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