Transcript Blair 2013
Bias and Stereotyping in Health Care Irene V. Blair, PhD Department of Psychology and Neuroscience University of Colorado Boulder [email protected] Stereotypes & Prejudice Work Family Politics Society Environment School Community Insurance Recreation Neighborhood Travel Police Commerce Religion Entertainment A Simple Model of Clinical Interactions Provider Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Verbal & Nonverbal Communication Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior A Simple Model of Clinical Interactions Provider Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior Verbal & Nonverbal Communication Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior 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 negative positive gift sunshine vacation pollute love rotten ugly friend vomit lucky garbage filth Doctors or negative Lawyers or positive gift love sunshine rotten filth ugly vacation friend pollute vomit garbage lucky negative positive gift sunshine vacation pollute love rotten ugly friend vomit lucky garbage filth Doctors or positive Lawyers or negative gift love sunshine rotten filth ugly vacation friend pollute vomit garbage lucky 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 gift love sunshine rotten filth ugly vacation friend pollute vomit Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Black:White IAT 30% Percentage of Sample 25% 20% 15% 10% 5% 0% Strong Moderate Mild Preference for African Americans Blair et al. (2013). Am J Public Health. Neutral Neutral Mild Moderate Strong Preference for Whites Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Latino:White IAT 30% Percentage of Sample 25% 20% 15% 10% 5% 0% Strong Moderate Mild Preference for Latinos Blair et al. (2013). Am J Public Health. Neutral Neutral Mild Moderate Strong Preference for Whites 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 Verbal & Nonverbal Communication Treatment Decisions Patient Adherence Follow-up Primary & Secondary Health Outcomes Patient Background Experiences, Attitudes, Beliefs, Judgments, Decisions, & Behavior