Medical technology innovativeness differed between white and black veterans in an urban, primary care setting. Innovativeness was correlated with a greater likelihood that patients were favorably oriented to new medical devices and prescription drugs. Blacks, who had generally lower medical technology innovativeness, were correspondingly more likely to be hesitant about adopting particular new technologies. We found that both blacks and whites with low innovativeness were hesitant to embrace a new medical device, but that whites with low innovativeness were more likely to adopt a new prescription drug than blacks with low innovativeness. Conversely, both blacks and whites with higher innovativeness were more favorably oriented to a hypothetical new implantable medical device. Yet, although innovative black patients were more favorably oriented toward a new prescription drug, innovative whites did not view the new drug more favorably.
This racial difference in reactions to different technologies may have occurred because many whites did not generally view new prescription drugs as “innovative”—thus, there would have been no greater propensity to use this technology among whites who were generally more enthusiastic about new technology compared with whites who were not. Blacks, however, may have viewed the new prescription drug in a manner similar to a new implantable device, i.e., as new and risky, and thus less innovative blacks may have shunned the technology. This difference may also reflect greater comfort with prescription drugs across the spectrum of patient innovativeness among whites, greater distrust of new prescription drugs by some blacks (particularly among those who are hesitant to adopt new concepts), or both.
Our multivariate analyses adjusted for many potential confounders of the relationship between race and innovativeness, including lower income and education, limited prior health care experiences, and risk aversion. In particular, blacks were less likely to have had prior medical procedures and were more risk-averse than whites. Nevertheless, racial differences in innovativeness persisted despite adjustment for these differences. Among the unmeasured factors that may have contributed to racial differences in innovativeness include varying sources of medical information, differences in the size and diversity of peer networks, differences in social mobility, and varying degrees of optimism about future prospects, all of which have been identified as contributors to innovativeness. 11
Other vital mediators of medical technology innovativeness may include health information accessibility, doctor-patient communication quality, and trust. In particular, racial differences in trust in health care providers were suggested by selected items in our survey, suggesting that this may be a key factor.
This study confirms prior findings that innovativeness influences patient behavior. Armstrong et al. 9
determined that women with higher innovativeness were more likely to pursue genetic testing for breast cancer. Sedlis et al. 7
found that refusal of cardiac procedures by black veterans may partially explain racial differences in receipt of new technology in the VA health care system. Heidenreich et al. 20
determined that black Medicare beneficiaries refused coronary angiography after myocardial infarction more frequently than white beneficiaries. In contrast, Kressin et al. 21
found few differences in medical technology attitudes among black and white veterans with a recent, positive cardiac nuclear imaging study, although the authors' study design may have preferentially enrolled patients who were more willing to undergo procedures.
Persons of any race with lower levels of innovativeness are likely to require more information and/or the endorsement of trusted sources before adopting a new technology. 22, 23
For health care innovations, it is possible that health care providers and systems could enhance patients' decision making regarding medical technology, particularly for those patients whose interpersonal networks, education, health literacy, or income constraints limit the quantity and quality of information available to them. Peer counseling, culturally sensitive multimedia resources, expanded Internet access for minority patients, and minority community outreach are all potential remediators of the “innovativeness gap.” Each of these represents a testable intervention by which providers and health care systems could address low innovativeness among patients of all races.
We used a convenience sample of veterans that may have produced a biased sample, particularly if innovativeness was correlated with the likelihood of enrolling in a health care research survey. However, the age, sex, and race distribution of our respondents closely matched the distribution of all primary care patients at the Philadelphia VA Medical Center. As age and race were correlated with innovativeness, we would have expected our population to be disproportionately younger and have a higher percentage of white patients if patients with low innovativeness were opting out. As we did not observe this, we do not believe that biased study entry produced the observed racial differences in innovativeness. A second shortcoming of the study was that we could not assess whether differences in innovativeness influenced actual health care choices, but instead we measured patients' responses to hypothetical situations. It is possible that patients' actual behavior when confronted with real treatment decisions would have differed from their reported responses to hypothetical treatments. It is also possible that differences between reported responses and actual behavior might be more pronounced in 1 racial group, thus presenting the appearance of a racial difference when none actually exists.
There are measurably different attitudes toward medical technology innovations among otherwise similar black and white VA primary care patients. These differences in innovativeness are associated with significant racial differences in response to particular health care technologies. Blacks with lower levels of innovativeness are less likely than comparable whites to have favorable attitudes toward new prescription drugs. Both blacks and whites with low innovativeness are less favorably oriented to new implantable medical devices. These findings suggest potentially remediable causes for persistent differences in the uptake and utilization of innovative prescription drugs, devices, and procedures among blacks and whites.