1. 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 May 2018, Edinburgh
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2. 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 Systematic review Green 2007 : implicit race bias measured by vignettes and IAT Patients with acute coronary syndromes 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

3. 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

4. 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

5. 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

6. 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

7. Thank you 7 7