Bias and Stereotyping in Health Care

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Presentation transcript:

Bias and Stereotyping in Health Care Irene V. Blair, PhD Department of Psychology and Neuroscience University of Colorado Boulder Irene.blair@colorado.edu

Stereotypes & Prejudice Work You are Here Family Politics Health Society Environment School Insurance Travel Community Recreation Police Neighborhood Commerce Religion Entertainment

A Simple Model of Clinical Interactions Provider Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Verbal & Nonverbal Communication Perception, Memory, Judgment Perception, Memory, Judgment Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes

A Simple Model of Clinical Interactions Provider Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Verbal & Nonverbal Communication Perception, Memory, Judgment Perception, Memory, Judgment Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes

Group Bias: Attitudes that favor or disfavor a group; typically one favors one’s own groups. Explicit Bias: known and intentionally used to guide judgment and behavior; measured directly. “My African American patients are uncooperative.” “My Latina patients complain endlessly.” “Thankfully I have a white patient now!” Implicit Bias: May not be consciously accepted, but may still influence judgment and behavior; measured indirectly. What?

Perception = Experience + Expectations + Cues It happens automatically. No one is perfect. It makes little sense to just tell yourself to stop it!

Doctors Lawyers Just showed perceptual unconscious bias, now look at social unconscious bias

negative positive gift sunshine vacation pollute love rotten ugly friend vomit lucky garbage filth

Doctors or negative Lawyers or positive love rotten ugly friend vomit lucky gift sunshine filth vacation pollute garbage

positive negative gift sunshine vacation pollute love rotten ugly friend vomit lucky garbage filth

Doctors or positive Lawyers or negative love rotten ugly friend vomit lucky gift sunshine filth vacation pollute garbage

Implicit Association Test (IAT) Associations are estimated from speed of operation, instead of verbal statements. The IAT is the most well known and used measure of implicit associations (bias). It has the best demonstrated reliability & validity of currently available implicit measures. Can be used to measure many different types of bias and other associations: https://implicit.harvard.edu

Black or positive White or negative love rotten ugly friend vomit gift sunshine filth vacation pollute

Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Black:White IAT Percentage of Sample Implicit race attitudes measured with an evaluative Black:White IAT N = 210, Experienced Internal and Family Medicine Adult Care Providers Mostly White (84%) Male and Female (53%) ***Range of responses, but shifted significantly to the pro-White side of the scale. ***No differences from a community sample Neutral Preference for African Americans Preference for Whites Blair et al. (2013). Am J Public Health.

Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Latino:White IAT Percentage of Sample Same providers and very similar results, but with an evaluative Latino:White IAT Neutral Preference for Latinos Preference for Whites Blair et al. (2013). Am J Public Health.

Effects of Implicit Bias Are Increased When... Behavior is less controllable Cognitive resources are low Time pressure or competing demands Low working-memory capacity Alcohol or similar substances Uncertainty and indecision Ambiguity of diagnostic information Lack of expertise Preference for intuition (affect) over cognition Match between bias and target characteristics Biased explicit attitudes or a lack of motivation to counter bias

How might implicit bias affect health care? Provider Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Verbal & Nonverbal Communication Perception, Memory, Judgment Perception, Memory, Judgment Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes