2020 US Census race category

The Race Box: Let’s Unpack Survey Demographics

When filling out forms, I have always dreaded the infamous “race box.”

You know, the one that gives you a standard list of choices to pick from? This guy? ↓↓↓

red check box icon

Please select your race:

☐  White
☐  Black or African American
☐  American Indian or Alaska Native
☐  Asian
☐  Native Hawaiian or Other Pacific Islander

Source: The United States Census Bureau

For some people, this box is just another field they fill out on forms. But for others, it can represent something of an identity crisis.

As a biracial woman, I never know what to put in that box. My mother is white, and my dad is Vietnamese. A million thoughts run through my head when I’m asked to fill out that box — especially on medical forms.

“Do I just put white? Do I just check Asian? Do I check both? Can I check both? What if there’s a really specific disease specific to one of those races, but I put the other one and they don’t test for it?”

(I tend to overthink in general, if you couldn’t tell).

It took me a long time to realize that these are valid questions — and they may be ones your patients ask themselves as well. But as healthcare marketers and professionals, a better question might be: Does it have to be this way? And, can we be doing something better?

We Unpacked The Race Box: What Happened

In the fall of 2021, CareContent partnered with a client who, like us, was pushing back on the idea of the race box. They were interested in attracting a diverse audience to their residency program. Like, a genuinely diverse audience, not just one that looked diverse on paper.

In order to accomplish this, our partnership included many different points of growth and development. It included strategies like revamping their website, putting their commitment to diversity front and center, showcasing their already diverse graduate students, and focusing on SEO so the right candidates could find them.

Another element of this focus on inclusion was to reconsider the race and ethnicity questions on one of their interest forms. Potential applicants would have the opportunity to chat with a current resident in the program, and they wanted to know a little bit about the individuals who were interested.

Rather than just do what’s always been done, both their team and ours saw this as an opportunity to rethink some of those questions we take for granted — including the questions about race and ethnicity.

What We Did

To get a better sense of who was considering applying — and to communicate to them that the program was committed to accepting those residents’ whole identities — we decided to rewrite the race data-collecting question entirely.

When we went about crafting this question, our first goal was to remove the burden of the options. In making this question open-ended with a text entry box — instead of a checkbox — applicants could feel empowered to provide an answer that felt more accurate and authentic.

We also considered potential results of making the question encompass race, ethnicity, and cultural identity — instead of making these separate questions. In doing so, the question recognizes that our identities are not made up of disparate variables, but rather that we sit at the intersection of multiple identities that are all pushing and pulling on our sense of self.

Lastly, we wanted to communicate our intentions for making the choice we did. When collecting demographic data, there can be a lack of transparency. “What do you need my race for? Are you immediately going to sell my email to the highest bidder?” In deviating from the expected, this form chose to explain why.

What We Found Out

By asking this question in this way, we opened ourselves up to the wide range of responses we might get. Over 100 potential applicants filled out the “Chat With a Residency Leader” form — and of those, nearly 75% answered the question on race, ethnicity, and cultural identity.

Open-Ended Identity Question Findings

10% indicated their status as first, second, or third-generation immigrants or college graduates.
6% shared the ways religion impacts their identity.
65% responded with two or more identity markers.

Others spoke of the places they were born or the places they call home now. Many spoke about their parents, the languages they speak, and how their identity drives their desire to pursue medicine. Some even expressed their gratitude about being asked this question in this particular way.

The results blew us away — we could not have expected the breadth of responses, and we couldn’t replicate them again if we tried. Each individual response encapsulated a specific person at a specific time, reflecting on their identity in a specific way.

Where Do We Go From Here?

Ultimately, what we sought to do was to remove the burden of a different box — the “other” box — where maybe you’re not 100% sure what to select, so you choose the write-in option under “other.” By reframing this as an open-ended prompt, we were able to address this “othering” of the other box.

As we continue to grapple individually and societally with questions of race and identity, there are many things we might come up against that could use some reimagining. How we ask people about their identity is just one of them.

The case shared here is just one potential approach — and it might not be the best one for every single situation. For example, if you want to know how many people receive a blood pressure screening at your hospital this quarter — and how many belong to a certain racial or ethnic minority — it may not be the best data-collecting option to ask people to identify in this open-ended way.

But if you’re running a grief support group — and you want to bring in experts with fitting cultural expertise — then maybe it does make more sense to ask group participants to answer an open-ended prompt instead.

Very rarely is there one “right answer.” More often, there are simply many potential approaches that offer different insights depending on the information we’re actually looking for.

When it comes to demographic data collection, the way you ask this question might be impacted by anything from geography to what data you’re trying to collect. But while there may not be one right way to ask this demographic question, how we ask it is worth questioning.

Are you looking to attract more diverse residents, physicians, or patients? CareContent can help you get there.