MERH Congress 18 May 2018, Edinburgh Amsterdam Public Health, Global Health Program - Health professionals’ perception of implicit bias towards minority patients in health care in the Netherlands and Hungary AMC – VUmc – UniPécs Katja Lanting, Maartje Ridder, Erika Marek, Zsofia Feiszt, Petra Verdonk, Jeanine Suurmond MERH Congress 18 May 2018, Edinburgh APHdkc mklk 1 1 1 1

Background Implicit bias (IB) - unconscious, uncontrollable processes Most health care providers (HCP) have IB towards people of color (Hall, 2015) IB may negatively impact clinical decisions (see e.g. Green, 2007), lower QoC Research on IB in US, but little in Europe Aim of study: Explore perceptions of IB of HCP in Europe The Netherlands and Hungary Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, difficult to consciously acknowledge and control. Hall 2015 Systematic review Green 2007 : implicit race bias measured by vignettes and IAT Patients with acute coronary syndromes. - 220 Physicians were less likely to recommend thrombolysis for Blacks. - IAT revealed 1, preference for White and 2. stereotype of Black as less cooperative Health care system in US often different than many other health systems in Europe, such as the role of the GP and the way patients are insured. 2 2

Methods 20 interviews with health care providers Convenience sample of 14 MD’s, 3 nurses, 2 dentists, 1 helpdesk coordinator April-June 2017 Focus: Roma (Pécs, HU), Undocumented migrants (VUmc), chronically ill patients with migration background (AMC) Audio-taped and transcribed Results compared and integrated 3 3

Results IB may be based on reading patient files or on physical appearance IB towards specific groups: Roma: ‘behavioral change is impossible’ UDM: ‘burden for the health care system’ Chronically ill: ‘Islamic patients are eager to get maximum treatment’ IB may lead to a priori different behavior of HCP “With child patients, whose parents have a migration background and may have a language problem - and the child patient may totally not [have a language problem] only in 40% a small joke was made.” Roma: ‘they cannot change their behaviours’ UDM: ‘they are a burden to the health care system’ Chronicall ill: ‘Islamic patients medicalize everything’ Bij Quote: to ease the child when a physical examination 4 4

Results Reported IB effects on health care provision: Later referral to specialist Not offering health services e.g. home care HCP more directive, less involved However: Positive effects: helpful in e.g. diagnostics “How we look, is being patient centered: if I see a black man with frizzy hair, he is an Eritrean, until the opposite has been proven, and if he has a headache, he has malaria until opposite proven.” 5 5

Discussion IB recognized by all HCP HCP could be trained to recognise and reflect on one’s own assumptions More research is needed to explore further effects of IB on health care provision . Misschien toevoegen: IB is a quick information processing tool which also leads to problems?? 6 6

Thank you k.n.lanting@amc.uva.nl 7 7