Bias and Stereotyping in Health Care Irene V. Blair, PhD Department of Psychology and Neuroscience University of Colorado Boulder [email protected].

Bias and Stereotyping in Health Care

Irene V. Blair, PhD

Department of Psychology and Neuroscience

University of Colorado Boulder

[email protected]

Stereotypes & Prejudice

Politics

Society

Community

Work

School

Commerce

Entertainment

Family

Recreation

Neighborhood

Insurance Travel

Police

Environment

Religion

You are Here

ProviderBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

A Simple Model of Clinical Interactions

PatientBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

Verbal &Nonverbal

Communication

Treatment DecisionsPatient Adherence

Follow-up

Primary & SecondaryHealth Outcomes

ProviderBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

A Simple Model of Clinical Interactions

PatientBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

Verbal &Nonverbal

Communication

Treatment DecisionsPatient Adherence

Follow-up

Primary & SecondaryHealth 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

gift

sunshine

vacation

pollute

love

rotten

ugly

friend

vomit

lucky

garbage

filth

negative positive

Doctorsor

negative

Lawyersor

positivelove

rotten

ugly

friend

vomit

lucky

gift

sunshine

filth

vacation

pollute

garbage

gift

sunshine

vacation

pollute

love

rotten

ugly

friend

vomit

lucky

garbage

filth

positive negative

Doctorsor

positive

Lawyersor

negativelove

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

Blackor

positive

Whiteor

negativelove

rotten

ugly

friend

vomit

gift

sunshine

filth

vacation

pollute

Implicit Ethnic/Racial Attitudes of Primary Care Providers

Preference for African Americans Preference for Whites

Black:White IAT

Neutral

Providers Community

Blair et al. (2013). Am J Public Health.

Implicit Ethnic/Racial Attitudes of Primary Care Providers

Preference for Latinos Preference for Whites

Latino:White IAT

Neutral

Providers Community

Blair et al. (2013). Am J Public Health.

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

Effects of Implicit Bias Are Increased When...

ProviderBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

How might implicit bias affect health care?

PatientBackground Experiences,

Attitudes, Beliefs, Judgments, Decisions, &

Behavior

Verbal &Nonverbal

Communication

Treatment DecisionsPatient Adherence

Follow-up

Primary & SecondaryHealth Outcomes