Bias and Stereotyping in Health Care

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

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

3. 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

4. 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

5. 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?

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

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14. 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

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16. Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Black:White IAT Percentage of Sample Neutral Preference for Whites Preference for African Americans Blair et al. (2013). Am J Public Health.

17. Implicit Ethnic/Racial Attitudes of Primary Care Providers Providers Community Latino:White IAT Percentage of Sample Neutral Preference for Latinos Preference for Whites Blair et al. (2013). Am J Public Health.

18. 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

19. 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