Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review

被引:1349
|
作者
Hall, William J. [1 ]
Chapman, Mimi V. [1 ]
Lee, Kent M. [2 ]
Merino, Yesenia M. [3 ]
Thomas, Tainayah W. [3 ]
Payne, B. Keith [2 ]
Eng, Eugenia [3 ]
Day, Steven H. [1 ]
Coyne-Beasley, Tamera [4 ]
机构
[1] Univ N Carolina, Sch Social Work, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Dept Psychol, Chapel Hill, NC 27599 USA
[3] Univ N Carolina, Gillings Sch Global Publ Hlth, Chapel Hill, NC 27599 USA
[4] Univ N Carolina, Sch Med, Chapel Hill, NC 27599 USA
基金
美国国家卫生研究院;
关键词
ASSOCIATION-TEST; EXTRAPERSONAL ASSOCIATIONS; AFFECT MISATTRIBUTION; RACIAL PREJUDICE; ATTITUDES; RACE; PHYSICIANS; DISPARITIES; QUALITY; BLACK;
D O I
10.2105/AJPH.2015.302903
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background. In the United States, people of color face disparities in access to health care, the quality of care received, and health outcomes. The attitudes and behaviors of health care providers have been identified as one of many factors that contribute to health disparities. Implicit attitudes are thoughts and feelings that often exist outside of conscious awareness, and thus are difficult to consciously acknowledge and control. These attitudes are often automatically activated and can influence human behavior without conscious volition. Objectives. We investigated the extent to which implicit racial/ethnic bias exists among health care professionals and examined the relationships between health care professionals' implicit attitudes about racial/ethnic groups and health care outcomes. Search Methods. To identify relevant studies, we searched 10 computerized bibliographic databases and used a reference harvesting technique. Selection Criteria. We assessed eligibility using double independent screening based on a priori inclusion criteria. We included studies if they sampled existing health care providers or those in training to become health care providers, measured and reported results on implicit racial/ethnic bias, and were written in English. Data Collection and Analysis. We included a total of 15 studies for review and then subjected them to double independent data extraction. Information extracted included the citation, purpose of the study, use of theory, study design, study site and location, sampling strategy, response rate, sample size and characteristics, measurement of relevant variables, analyses performed, and results and findings. We summarized study design characteristics, and categorized and then synthesized substantive findings. Main Results. Almost all studies used cross-sectional designs, convenience sampling, US participants, and the Implicit Association Test to assess implicit bias. Low to moderate levels of implicit racial/ethnic bias were found among health care professionals in all but 1 study. These implicit bias scores are similar to those in the general population. Levels of implicitbias against Black, Hispanic/Latino/Latina, and dark-skinned people were relatively similar across these groups. Although some associations between implicit bias and health care outcomes were nonsignificant, results also showed that implicit bias was significantly related to patient-provider interactions, treatment decisions, treatment adherence, and patient health outcomes. Implicit attitudes were more often significantly related to patient provider interactions and health outcomes than treatment processes. Conclusions. Most health care providers appear to have implicit bias in terms of positive attitudes to ward Whites and negative attitudes toward people of color. Future studies need to employ more rigorous methods to examine the relationships between implicit bias and health care outcomes. Interventions targeting implicit attitudes among health care professionals are needed because implicitbias may contribute to health disparities for people of color.
引用
收藏
页码:E60 / E76
页数:17
相关论文
共 50 条
  • [41] The Influence of Wearables on Health Care Outcomes in Chronic Disease: Systematic Review
    Mattison, Graeme
    Canfell, Oliver
    Forrester, Doug
    Dobbins, Chelsea
    Smith, Daniel
    Toyras, Juha
    Sullivan, Clair
    [J]. JOURNAL OF MEDICAL INTERNET RESEARCH, 2022, 24 (07)
  • [42] Racial and ethnic disparities in access and outcomes in children's health care
    Purcell, Laura N.
    Hayes-Jordan, Andrea
    [J]. SURGERY, 2021, 169 (06) : 1288 - 1289
  • [43] The Use of Racial and Ethnic Health care Disparities in Simulation-Based Experiences: A Systematic Review
    Diaz, Desiree A.
    Murillo, Crystal L.
    Bryant, Kellie
    Todd, Andrew
    Uzosike, Amarachi
    Foronda, Cynthia L.
    [J]. CLINICAL SIMULATION IN NURSING, 2023, 83
  • [44] Awareness of Racial and Ethnic Bias and Potential Solutions to Address Bias With Use of Health Care Algorithms
    Jain, Anjali
    Brooks, Jasmin R.
    Alford, Cleothia C.
    Chang, Christine S.
    Mueller, Nora M.
    Umscheid, Craig A.
    Bierman, Arlene S.
    [J]. JAMA HEALTH FORUM, 2023, 4 (06): : E231197
  • [45] Implicit Bias and Machine Learning in Health Care
    Zaidi, Danish
    Miller, Taylor
    [J]. SOUTHERN MEDICAL JOURNAL, 2023, 116 (01) : 62 - 64
  • [46] Racial/ethnic differences in vaccine hesitancy among health care workers
    不详
    [J]. AORN JOURNAL, 2021, 114 (06) : P2 - P2
  • [47] Explaining racial and ethnic disparities in health care
    Kirby, JB
    Taliaferro, G
    Zuvekas, SH
    [J]. MEDICAL CARE, 2006, 44 (05) : 64 - 72
  • [48] Racial and Ethnic Disparities in the Quality of Health Care
    Fiscella, Kevin
    Sanders, Mechelle R.
    [J]. ANNUAL REVIEW OF PUBLIC HEALTH, VOL 37, 2016, 37 : 375 - 394
  • [49] Reducing Racial and Ethnic Disparities in Health Care
    Steinbrook, Robert
    [J]. JAMA INTERNAL MEDICINE, 2021, 181 (09) : 1216 - 1216
  • [50] Racial and ethnic disparities in health care - In response
    Francis, CK
    [J]. ANNALS OF INTERNAL MEDICINE, 2005, 142 (02) : 153 - 154