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