The influence of sex, race, and age on pain assessment and treatment decisions using virtual human technology: a cross-national comparison

Calia A Torres,¹ Emily J Bartley,¹ Laura D Wandner,¹ Ashraf F Alqudah,² Adam T Hirsh,³ Michael E Robinson<sup>1

1</sup>Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA; ²Department of Psychology, The University of Jordan, Amman, Jordan; ³Department of Psychology, Indiana University–Purdue University, Indianapolis, IN, USA

Purpose: Studies in the United States have found that patients' sex, race, and age influence the pain assessment and treatment decisions of laypeople and medical professionals. However, there is limited research as to whether people of other nationalities make pain management decisions differently based on demographic characteristics. Therefore, the purpose of the following study was to compare pain assessment and treatment decisions of undergraduate students in Jordan and the United States as a preliminary examination of nationality as a potential proxy for cultural differences in pain decisions.
Methods: Virtual human (VH) technology was used to examine the influences of patients' sex (male or female), race (light-skinned or dark-skinned), and age (younger or older) on students' pain management decisions. Seventy-five American and 104 Jordanian undergraduate students participated in this web-based study.
Results: American and Jordanian students rated pain intensity higher in females and older adults and were more likely to recommend medical help to these groups, relative to males and younger adults. Furthermore, Jordanian participants rated pain intensity higher and were more likely to recommend medical help for all patient demographic groups (ie, sex, race, age) than American participants.
Conclusion: This is the first cross-national study that compares pain decisions between undergraduate students. The results suggest that sex, race, and age cues are used in pain assessment and treatment by both Americans and Jordanians, with Jordanians more likely to rate pain higher and recommend medical help to patients. Additional research is needed to determine the cultural determinants of these differences.

Keywords: pain management, pain disparities, nationality, stereotypes, biases