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Online Program

329061
A Systematic Review to Understand What we Know about Implicit Racial/Ethnic Bias and Healthcare Outcomes


Monday, November 2, 2015

William Hall, PhD, MSW, School of Social Work, The Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC
Mimi Chapman, Ph.D., School of Social Work, The Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC
Robert Colby, Ph.D., Institute for the Arts and Humanities, The Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC
Tamera Coyne-Beasley, MD, Pediatrics, University of North Carolina, Chapel Hill, NC
Steve Day, MCP, School of Social Work, The Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC
Eugenia Eng, MPH, DrPH, Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
Kent Lee, MA, Department of Social Psychology, The Universtiy of North Carolina at Chapel Hill, Chapel Hill, NC
Alexandra Lightfoot, EdD, Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
John McGowan, Ph.D., English, The Universtiy of North Carolina at Chapel Hill
Yesenia Merino, MPH, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Keith Payne, PhD, Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Florence Simán, MPH, Health Programs, El Pueblo, Inc., Raleigh, NC
Kari Thatcher, MPH, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Tainayah Thomas, MPH, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
Background: Health disparities persist for patients of color in access to healthcare, quality of care, and health outcomes.  Attitudes and behaviors of healthcare providers are considered malleable targets to promote equal and equitable healthcare.  Attitudes that exist on the margins of conscious awareness, often referred to as “implicit biases” may shape providers’ behaviors and impact care for patients of color.  Determining the prevalence of biased attitudes among healthcare providers and testing whether and how implicit bias contributes to problems in patient-provider relationships, care experiences, and health outcomes lays the groundwork for intervention development. 

Methods: A systematic review conducted consistent with PRISMA standards was conducted to ascertain what was known and unknown in the implicit bias and health care provision literature. Ten bibliographic databases were searched yielding 105 records.  Following duplicate removal and screening, 15 studies were included for review. 

Results: Almost all studies used cross-sectional designs, convenience sampling, U.S. participants, and the Implicit Association Test to assess implicit racial/ethnic bias.  Most studies examined Black vs. White bias. Few studies examined Latino/a vs. White bias.  Approximately 80% of providers displayed implicit bias against Black and/or Latino/a Americans vs. White Americans.  Findings on providers’ implicit racial/ethnic bias and healthcare outcomes were mixed.  More significant associations were found for outcomes related to patient-provider relationships as opposed to outcomes related to treatment processes or patient health outcomes. 

Conclusions: Most healthcare providers have pro-White implicit bias.  Future studies need to employ more rigorous methods to examine associations between implicit bias and healthcare outcomes.

Learning Areas:

Diversity and culture
Provision of health care to the public
Social and behavioral sciences

Learning Objectives:
Explain how implicit racial/ethnic bias may contribute to disparities in healthcare. Describe the methodological limitations of studies that have examined implicit racial/ethnic bias among healthcare professionals. Discuss the substantive findings of studies examining the prevalence of implicit bias among healthcare providers and associations between implicit bias and healthcare outcomes, including patient-provider relationships and interactions, treatment processes, and patient health outcomes.

Keyword(s): Health Disparities/Inequities, Minority Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked on multiple foundation and NIH funded grants. I have 10 years of research experience in the area of minority health, health disparities, and health equity.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3209.0: Poster session: Disparities in patient care