A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test

• Published in: Social science & medicine (1982) Vol. 199; pp. 219 - 229
• Main Authors: Maina, Ivy W., Belton, Tanisha D., Ginzberg, Sara, Singh, Ajit, Johnson, Tiffani J.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2018; Pergamon Press Inc
• Subjects: African Americans; American Indians; Association; Attitude of Health Personnel; Bias; Clinical outcomes; Communication; Concepts; Empathy; Ethnic groups; Ethnicity; Health care; Health disparities; Health Personnel - psychology; Health services; Health Services Research; Healthcare Disparities; Healthcare outcomes; Healthcare providers; Hispanic Americans; Humans; IAT; Implicit association test; Implicit beliefs; Implicit bias; Intervention; Measurement; Medical ethics; Medical personnel; Minority groups; Pain; Patient communication; Patients; Physician-Patient Relations; Psychological Tests; Quality of care; Racial bias; Racial differences; Racial discrimination; Racial/ethnic bias; Racism; Standardized patients; Systematic review; Tests; Training; Treatment outcomes; Vignettes; United States > US; Racial/ethnic bias; Healthcare outcomes; Implicit bias; Healthcare providers; IAT; Implicit association test; Health disparities
• ISSN: 0277-9536; 1873-5347; 1873-5347
• DOI: 10.1016/j.socscimed.2017.05.009

Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes. •Synthesizes the current literature on the use of the IAT in healthcare providers.•37 studies demonstrate mixed results for the role of implicit bias in disparities.•Increased provider bias consistently correlates with poorer patient-provider interactions.•Identifies future directions for continued research using the IAT.