A systematic review of implicit bias in health care: A call for intersectionality

Background and objectives: Health disparities are a growing concern in health care. Research provides ample evidence of bias in patient care and mistrust between patient and providers in ways that could perpetuate health care disparities. This study aimed to review existing literature on implicit bias (or unconscious bias) in healthcare settings and determine studies that have considered adverse effects of bias of more than one domain of social identity (e.g., race and gender bias) in health care. Methods: This is a systematic review of articles using databases such as EBSCO, Embase, CINAHL, COCHRANE, Google Scholar, PsychINFO, Pub Med, and Web of Science. Search terms included implicit bias, unconscious bias, healthcare, and public health. The inclusion criteria included studies that assessed implicit bias in a healthcare setting, written in English, and published from 1997-2018. Results: Thirty-five articles met the selection criteria – 15 of which examined race implicit bias, ten examined weight bias, four assessed race and social class, two examined sexual orientation, two focused on mental illness, one measured race and sexual orientation, and another investigated age bias. Conclusions: Studies that measured more than one domain of social identity of an individual did so separately without investigating how the domains overlapped. Implicit Association Test (IAT) is a widely used psychological test which is used to determine existence of an implicit bias in an individual. However, this study did not find any use of an instrument that could assess implicit bias toward multiple domains of social identities. Because of possible multiplicative effects of several biases affecting a single entity, this study suggests the importance of developing a tool in measuring intersectionality of biases. IMC J Med Sci 2019; 13(1): 005

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Risk Factors for Childhood Obesity among Asian Americans: A Systematic Review of Literature and Recommendations for Health Care Research

Journal of Health Care for the Poor and Underserved ◽

10.1353/hpu.2015.0056 ◽

2015 ◽

Vol 26 (2A) ◽

pp. 171-190 ◽

Cited By ~ 8

Author(s):

Wenhua Lu ◽

Cassandra S. Diep ◽

E. Lisako J. McKyer

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Health Care ◽

Childhood Obesity ◽

Asian Americans ◽

Health Care Research ◽

Review Of Literature ◽

Care Research

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The Efficacy of an Antioppression Curriculum for Health Professionals

Family Medicine ◽

10.22454/fammed.2018.227415 ◽

2019 ◽

Vol 51 (1) ◽

pp. 22-30 ◽

Cited By ~ 5

Author(s):

Diana Wu ◽

Lamercie Saint-Hilaire ◽

Andrew Pineda ◽

Danielle Hessler ◽

George W. Saba ◽

...

Keyword(s):

Health Care ◽

Teaching Methods ◽

Health Professionals ◽

Health Care Professionals ◽

Health Care Disparities ◽

Unconscious Bias ◽

Survey Response Rate ◽

The Mean ◽

Skill Building

Background and Objectives: Health professionals increasingly recognize the role that social determinants play in health disparities. However, little focus is placed on how health care professionals themselves contribute to disparities through biased care. We have developed a curriculum based on an antioppression framework which encourages health professionals to evaluate their biases and combat health care disparities through an active process of allyship. Methods: Teaching methods emphasize skill building and include lectures, guided reflections, and facilitated discussions. Pre- and postsurveys were administered to assess participants’ confidence level to recognize unconscious bias and to be an ally to colleagues, patients, and staff. In total, we conducted 20 workshops with a total of 468 participants across multiple disciplines. Results: The survey response rate was 80%. Using a paired t-test, the mean difference in the pre- and postsurveys revealed a statistically significant improvement across all measures. Participants showed the greatest improvements (large effect size d>0.8) in their understanding of the process of allyship, their ability to describe strategies to address, assess, and recognize unconscious bias, and their knowledge of managing situations in which prejudice, power, and privilege are involved. Conclusions: Results show that an antioppression curriculum can enhance health professionals’ confidence in addressing bias in health care through allyship. For those who value social justice and equity, moving from the role of bystander to a place of awareness and solidarity allows for one’s behaviors to mirror these values. Allyship is an accessible tool that all health professionals can use in order to facilitate this process.

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Eliminating disparities and implicit bias in health care delivery by utilizing a hub-and-spoke model

Research Ideas and Outcomes ◽

10.3897/rio.4.e26370 ◽

2018 ◽

Vol 4 ◽

pp. e26370

Author(s):

Pradeep Joseph

Keyword(s):

Health Care ◽

Health Care Disparities ◽

Clinical Decision Making ◽

Care Delivery ◽

Implicit Bias ◽

Complex Form ◽

Community Outreach ◽

The United States ◽

Great Success ◽

Nurse Navigator

The state of health disparities in the United States has remained relatively stable over a number of years. Although overall outcomes for all patients have improved, a difference persists in how different racial, ethnic, and gender groups have fared in our health care system. Many programs that have sought to combat this problem have been predicated on the belief that only a small number of providers in the medical community are aware of their own biases. Accordingly, it was believed that bias awareness is the direct conduit for this particular change in the health system. However, the results of such programs have been unsatisfactory. The reason for such ineffectiveness is that many programs have not taken into account the presence of implicit bias within the patient-provider relationship. This complex form of bias operates in specific ways, and must be dealt with appropriately. The use of digital checklists to aid in clinical decision making has proved to be both a way that patients can receive equitable care, and a way to improve overall patient outcomes. Secondly, in order to reach the most at-risk populations, health care must expand beyond the hospital walls, and out into the community. Nurse navigator programs have been shown to accomplish this with great success. Together, checklists and nurse navigators are the necessary next-step in the battle against health care disparities. What’s more, this two-pronged approach is relatively simple to implement. By making use of current electronic medical records, digital checklists can be quickly installed. Likewise, nurse navigator programs, a comparatively inexpensive option, can be rolled out quickly because of their simple design. A focus on the patient-provider relationship and community outreach is critical for progress in eliminating health care disparities.

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Health-care disparities stemming from sexual orientation of Italian patients with Multiple Sclerosis: A cross-sectional web-based study

Multiple Sclerosis and Related Disorders ◽

10.1016/j.msard.2017.02.001 ◽

2017 ◽

Vol 13 ◽

pp. 28-32 ◽

Cited By ~ 4

Author(s):

Luigi Lavorgna ◽

Marcello Moccia ◽

Antonio Russo ◽

Raffaele Palladino ◽

Lucia Riccio ◽

...

Keyword(s):

Multiple Sclerosis ◽

Health Care ◽

Sexual Orientation ◽

Health Care Disparities ◽

Cross Sectional ◽

Web Based

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The conduct of Australian Indigenous primary health care research focusing on social and emotional wellbeing: a systematic review

Public Health Research & Practice ◽

10.17061/phrp27451704 ◽

2018 ◽

Vol 28 (2) ◽

Author(s):

Sara Farnbach ◽

Anne-Maree Eades ◽

Josephine Gwynn ◽

Nick Glozier ◽

Maree Hackett

Keyword(s):

Systematic Review ◽

Health Care ◽

Primary Health Care ◽

Health Care Research ◽

Emotional Wellbeing ◽

Care Research ◽

Social And Emotional ◽

Primary Health ◽

Social And Emotional Wellbeing

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Systematic Review of Integrative Health Care Research: Randomized Control Trials, Clinical Controlled Trials, and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2011/636134 ◽

2011 ◽

Vol 2011 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Raheleh Khorsan ◽

Ian D. Coulter ◽

Cindy Crawford ◽

An-Fu Hsiao

Keyword(s):

Systematic Review ◽

Health Care ◽

Methodological Quality ◽

Health Care Research ◽

Cochrane Library ◽

Inclusion Criteria ◽

Care Research ◽

Integrative Health ◽

Integrative Health Care

A systematic review was conducted to assess the level of evidence for integrative health care research. We searched PubMed, Allied and Complementary Medicine (AMED), BIOSIS Previews, EMBASE, the entire Cochrane Library, MANTIS, Social SciSearch, SciSearch Cited Ref Sci, PsychInfo, CINAHL, and NCCAM grantee publications listings, from database inception to May 2009, as well as searches of the “gray literature.” Available studies published in English language were included. Three independent reviewers rated each article and assessed the methodological quality of studies using the Scottish Intercollegiate Guidelines Network (SIGN 50). Our search yielded 11,891 total citations but 6 clinical studies, including 4 randomized, met our inclusion criteria. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. The methodological quality of the included studies was assessed independently using quality checklists of the SIGN 50. Only a small number of RCTs and CCTs with a limited number of patients and lack of adequate control groups assessing integrative health care research are available. These studies provide limited evidence of effective integrative health care on some modalities. However, integrative health care regimen appears to be generally safe.

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Systematic review: methodological flaws in racial/ethnic reporting for gastroesophageal reflux disease

Diseases of the Esophagus ◽

10.1093/dote/dox154 ◽

2018 ◽

Vol 31 (3) ◽

Cited By ~ 1

Author(s):

M R Craven ◽

L Kia ◽

L C O’Dwyer ◽

E Stern ◽

T H Taft ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Health Care Disparities ◽

Related Factors ◽

Majority Population ◽

Race Ethnicity ◽

Racial Ethnic

SUMMARY Health care disparities affecting the care of multiple disease groups are of growing concern internationally. Research guidelines, governmental institutions, and scientific journals have attempted to minimize disparities through policies regarding the collection and reporting of racial/ethnic data. One area where shortcomings remain is in gastroesophageal reflux disease (GERD). This systematic review, which adheres to the PRISMA statement, focuses on characterizing existing methodological weaknesses in research focusing on studies regarding the assessment, prevalence, treatment, and outcomes of GERD patients. Search terms included GERD and typical symptoms of GERD in ethnic groups or minorities. We reviewed 62 articles. The majority of studies did not report the race/ethnicity of all participants, and among those who did, very few followed accepted guidelines. While there were diverse participants, there was also diversity in the manner in which groups were labeled, making comparisons difficult. There appeared to be a disparity with respect to countries reporting race/ethnicity, with certain countries more likely to report this variable. Samples overwhelmingly consisted of the study country's majority population. The majority of studies justified the use of race/ethnicity as a study variable and investigated conceptually related factors such as socioeconomic status and environment. Yet, many studies wrote as if race/ethnicity reflected biological differences. Despite recommendations, it appears that GERD researchers around the world struggle with the appropriate and standard way to include, collect, report, and discuss race/ethnicity. Recommendations on ways to address these issues are included with the goal of preventing and identifying health care disparities.

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