Cultivating Inclusivity in Medicine: The Impact of Offering Bandage Options of Various Skin Shades on Patient Experience

THE INNOVATION

The lack of skin tone representation is a major disparity in our current health care system.^1,2 We believe that offering bandage options in various skin tones recognizes the diversity of our patient population and is one step toward cultivating a more patient-centered medical system. We designed a project to evaluate if offering bandages in different skin shades impacts the patient experience in the outpatient setting.

WHO & WHERE

The research team at our institution designed an anonymous self-administered survey to measure patient experience, which was adapted from 2 research-validated patient satisfaction questionnaires^3-5 (Supplemental Figure 1). Patients at a single COVID-19 vaccination site were offered 4 bandages in various skin shades and voluntarily filled out the survey after their visit. Our institutional review board deemed this project as not human subject research. Ethical approval was not necessary as this was considered a quality improvement project.

HOW

Patients at a COVID-19 vaccination site were provided with 4 bandage options: 1 conventional bandage and 3 darker-toned bandage options (Supplemental Figure 2). The patient experience survey was given to patients who verbally agreed to complete it after receiving the bandage. Surveys were collected on weekends in the clinic over approximately 2 months, with approximately 60 patients asked. Patients were not told that it was related to the bandage options provided, and they could fill out either an electronic (via a quick response [QR] code) or paper version of the survey. We also collected general demographic information. At the end of the survey, patients had the option to leave comments. In total, 44 participants participated in this project.

THE LEARNING

The survey collected our participants’ reported race and gender demographics (Supplemental Figures 3 and 4). The gender demographics collected in the survey did not fully reflect the clinic’s gender demographics. We were unable to compare the survey race demographics to that of the clinic’s, as the clinic does not collect data on self-reported race.

Overall, participants responded positively to being offered the 4 bandage options (Supplemental Figure 1). Of participants, 27 (63%) responded that they chose a bandage option that best matched their skin tone. Of the participants who preferred being offered bandage options over being given a conventional bandage, almost one-third of the non-White participants stated that they strongly preferred the options compared with 0 of the White participants.

We also found that offering bandage options influenced patient perception of both the clinic and health care worker. Of all participants, 21 (47.7%) and 15 (34.1%) either agreed or strongly agreed that the bandage options positively impacted their view of the clinic and health care worker, respectively. Of patients who strongly agreed that provision of bandage options positively affected their perceptions of the clinic and health care workers, a greater percentage of non-White individuals strongly agreed compared with White individuals.

The provision of bandage options impacted patients differently based on reported gender. The majority of women stated they agreed or strongly agreed that their perception of the clinic was positively impacted, compared with <20% of the men (Supplemental Figure 2)

Two common themes emerged based on survey comments: inclusivity and patient experience. One participant stated: “Glad this study is being conducted. Inclusive culture helps all.” Other participants used the comment option to raise questions on the purpose of the project in the long-term improvement of health care, with one asking, “Why does bandage color determine my quality of care?”

This project provides insight on the positive impacts of offering skin-colored bandages on patience experience. Provision of bandages in various skin shades is a low-cost initiative that is meaningful to patients, particularly patients of color and women. We found it unsurprising that the groups most impacted by these bandage options were those historically underrepresented in medicine. Provision of bandage options may be a starting point toward disrupting the structural norm that White skin is the default and is one tangible way toward a more inclusive medical system that actively works toward practicing cultural humility.