Breaking the prejudice habit: Mechanisms, timecourse, and longevity

Multiple marginalized identities: A qualitative exploration of intersectional perinatal experiences of birthing people of color with substance use disorder in Massachusetts

INTRODUCTION

Racial and ethnic inequities persist in receipt of prenatal care, mental health services, and addiction treatment for pregnant and postpartum individuals with substance use disorder (SUD). Further qualitative work is needed to understand the intersectionality of racial and ethnic discrimination, stigma related to substance use, and gender bias on perinatal SUD care from the perspectives of affected individuals.

METHODS

Peer interviewers conducted semi-structured qualitative interviews with recently pregnant people of color with SUD in Massachusetts to explore the impact of internalized, interpersonal, and structural racism on prenatal, birthing, and postpartum experiences. The study used a thematic analysis to generate the codebook and double coded transcripts, with an overall kappa coefficient of 0.89. Preliminary themes were triangulated with five participants to inform final theme development.

RESULTS

The study includes 23 participants of diverse racial/ethnic backgrounds: 39% mixed race/ethnicity (including 9% with Native American ancestry), 30% Hispanic or Latinx, 26% Black/African American, 4% Asian. While participants frequently names racial and ethnic discrimination, both interpersonal and structural, as barriers to care, some participants attributed poor experiences to other marginalized identities and experiences, such as having a SUD. Three unique themes emerged from the participants' experiences: 1) Participants of color faced increased scrutiny and mistrust from clinicians and treatment programs; 2) Greater self-advocacy was required from individuals of color to counteract stereotypes and stigma; 3) Experiences related to SUD history and pregnancy status intersected with racism and gender bias to create distinct forms of discrimination.

CONCLUSION

Pregnant and postpartum people of color affected by perinatal SUD faced pervasive mistrust and unequal standards of care from mostly white healthcare staff and treatment spaces, which negatively impacted their treatment access, addiction medication receipt, postpartum pain management, and ability to retain custody of their children. Key clinical interventions and policy changes identified by participants for antiracist action include personalizing anesthetic plans for adequate peripartum pain control, minimizing reproductive injustices in contraceptive counseling, and addressing misuse of toxicology testing to mitigate inequitable Child Protective Services (CPS) involvement and custody loss.

Just-in-Time Strategies to Reduce the Effect of Interviewer Bias During Trainee Recruitment

Bias impacts all aspects of medical trainee applications, from grades to narrative reviews. Interviews provide an avenue to become acquainted with applicants beyond their written application, but even the most egalitarian interviewers are subject to implicit biases, including those who hold marginalized identities themselves. Simply building awareness around implicit bias is inadequate to reduce the effect. Here, 5 evidence-informed strategies are presented that can be implemented by faculty on-the-spot to mitigate the impact of implicit bias during the short interview interaction: individuation, mindfulness, perspective taking, stereotype replacement, and counter-stereotypic imaging. These strategies can be used by individual interviewers as one component of a comprehensive plan including institutional changes to promote more equitable recruitment processes.

Compassionate Curiosity: Mitigating the Effects of Bias Through Motivational Interviewing

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient's point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Awareness and Calibration: The Role of Descriptive Norms and Social Desirability in Accurate IAT Score Predictions of Food Items vs. Social Groups

Extending research that people are able to predict the patterns of their social group biases on Implicit Association Tests (IATs), we let participants predict and complete IATs toward five different food item pairs and compared the results with the social-groups domain. Participants predicted the patterns of their IAT scores with similar accuracy in both domains, suggesting similar internal awareness (evidenced by comparable within-subjects correlations), even though food evaluations followed less descriptively-normative patterns. At the same time, participants were better-calibrated in communicating their evaluations in the domain of food than social groups (evidenced by higher between-subjects correlations). This discrepancy may partly stem from participants' tendency to refrain from using harsh labels when predicting social group biases, despite their demonstrated awareness of them: IAT scores predicted as "moderate" or "strong" for food preferences tended to be labeled "mild" for social groups. Discussion centers on the importance of distinguishing between awareness and calibration.

Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training

BACKGROUND

Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits.

METHOD

Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment.

RESULTS

Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians.

CONCLUSIONS

Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed.

TRIAL REGISTRATION

Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.

Reducing Facial Stereotype Bias in Consequential Social Judgments: Intervention Success With White Male Faces

Initial impressions of others based on facial appearances are often inaccurate yet can lead to dire outcomes. Across four studies, adult participants underwent a counterstereotype training to reduce their reliance on facial appearance in consequential social judgments of White male faces. In Studies 1 and 2, trustworthiness and sentencing judgments among control participants predicted whether real-world inmates were sentenced to death versus life in prison, but these relationships were diminished among trained participants. In Study 3, a sequential priming paradigm demonstrated that the training was able to abolish the relationship between even automatically and implicitly perceived trustworthiness and the inmates' life-or-death sentences. Study 4 extended these results to realistic decision-making, showing that training reduced the impact of facial trustworthiness on sentencing decisions even in the presence of decision-relevant information. Overall, our findings suggest that a counterstereotype intervention can mitigate the potentially harmful effects of relying on facial appearance in consequential social judgments.

Advancing Diversity in Behavior Genetics: Strategies for Incorporating Undergraduates into Student-Driven Research

Undergraduate research experiences are crucial for fostering the next generation of behavior genetics researchers. However, incorporating undergraduates into research can be challenging for faculty mentors. In this article, we provide strategies for successfully integrating undergraduates into behavior genetics research based on our experiences mentoring undergraduates in our lab. These strategies include: (1) Practicing reflexivity, specifically an ongoing self-examination and critical self-awareness of personal biases, beliefs, and practices; (2) Implementing an Inclusion, Diversity, Equity, and Access (IDEA) centered approach; (3) empowering students through clear expectations; (4) Providing focused training and mentorship; (5) Aligning research projects with student interests; (6) Assigning meaningful tasks; and (7) Facilitating professional development opportunities. By following these strategies, faculty mentors can cultivate a supportive and inclusive research environment that empowers undergraduates for successful careers in behavior genetics research.

A scoping review to identify and organize literature trends of bias research within medical student and resident education

BACKGROUND

Physician bias refers to the unconscious negative perceptions that physicians have of patients or their conditions. Medical schools and residency programs often incorporate training to reduce biases among their trainees. In order to assess trends and organize available literature, we conducted a scoping review with a goal to categorize different biases that are studied within medical student (MS), resident (Res) and mixed populations (MS and Res). We also characterized these studies based on their research goal as either documenting evidence of bias (EOB), bias intervention (BI) or both. These findings will provide data which can be used to identify gaps and inform future work across these criteria.

METHODS

Online databases (PubMed, PsycINFO, WebofScience) were searched for articles published between 1980 and 2021. All references were imported into Covidence for independent screening against inclusion criteria. Conflicts were resolved by deliberation. Studies were sorted by goal: 'evidence of bias' and/or 'bias intervention', and by population (MS or Res or mixed) andinto descriptive categories of bias.

RESULTS

Of the initial 806 unique papers identified, a total of 139 articles fit the inclusion criteria for data extraction. The included studies were sorted into 11 categories of bias and showed that bias against race/ethnicity, specific diseases/conditions, and weight were the most researched topics. Of the studies included, there was a higher ratio of EOB:BI studies at the MS level. While at the Res level, a lower ratio of EOB:BI was found.

CONCLUSIONS

This study will be of interest to institutions, program directors and medical educators who wish to specifically address a category of bias and identify where there is a dearth of research. This study also underscores the need to introduce bias interventions at the MS level.

Reciprocal relations between past behavior, implicit beliefs, and habits: A cross-lagged panel design

The current study assessed cross-lagged relationships between binge drinking, implicit beliefs, and habit in undergraduate university students (N = 105). Students completed self-report survey and implicit measures in lab visits 3 months apart. A structural equation model revealed cross-lagged relations between habit and behavior, and some evidence for a reciprocal relationship between implicit beliefs and habit. Implicit beliefs were related to alcohol behavior across time, but no cross-lagged relationship was observed. Findings provide preliminary support for recent advances in habit theory, suggesting that implicit beliefs and habit may develop in tandem or even share common knowledge structures and schemas.

The Urgency of Now: Rethinking and Improving Assessment Practices in Medical Education Programs

Assessment is essential to professional development. Assessment provides the information needed to give feedback, support coaching and the creation of individualized learning plans, inform progress decisions, determine appropriate supervision levels, and, most importantly, help ensure patients and families receive high-quality, safe care in the training environment. While the introduction of competency-based medical education has catalyzed advances in assessment, much work remains to be done. First, becoming a physician (or other health professional) is primarily a developmental process, and assessment programs must be designed using a developmental and growth mindset. Second, medical education programs must have integrated programs of assessment that address the interconnected domains of implicit, explicit and structural bias. Third, improving programs of assessment will require a systems-thinking approach. In this paper, the authors first address these overarching issues as key principles that must be embraced so that training programs may optimize assessment to ensure all learners achieve desired medical education outcomes. The authors then explore specific needs in assessment and provide suggestions to improve assessment practices. This paper is by no means inclusive of all medical education assessment challenges or possible solutions. However, there is a wealth of current assessment research and practice that medical education programs can use to improve educational outcomes and help reduce the harmful effects of bias. The authors' goal is to help improve and guide innovation in assessment by catalyzing further conversations.

A 3D framework of implicit attitude change

According to early theories, implicit (automatic) social attitudes are difficult if not impossible to change. Although this view has recently been challenged by research relying on experimental, developmental, and cultural approaches, relevant work remains siloed across research communities. As such, the time is ripe to systematize and integrate disparate (and seemingly contradictory) findings and to identify gaps in existing knowledge. To this end, we introduce a 3D framework classifying research on implicit attitude change by levels of analysis (individual vs. collective), sources of change (experimental, ontogenetic, and cultural), and timescales (short term vs. long term). This 3D framework highlights where evidence for implicit attitude change is more versus less well established and pinpoints directions for future research, including at the intersection of fields.

Estimating the Reliability and Stability of Cognitive Processes Contributing to Responses on the Implicit Association Test

Implicit measures were initially assumed to assess stable individual differences, but other perspectives posit that they reflect context-dependent processes. This pre-registered research investigates whether the processes contributing to responses on the race Implicit Association Test are temporally stable and reliably measured using multinomial processing tree modeling. We applied two models-the Quad model and the Process Dissociation Procedure-to six datasets (N = 2,036), each collected over two occasions, examined the within-measurement reliability and between-measurement stability of model parameters, and meta-analyzed the results. Parameters reflecting accuracy-oriented processes demonstrate adequate stability and reliability, which suggests these processes are relatively stable within individuals. Parameters reflecting evaluative associations demonstrate poor stability but modest reliability, which suggests that associations are either context-dependent or stable but noisily measured. These findings suggest that processes contributing to racial bias on implicit measures differ in temporal stability, which has practical implications for predicting behavior using the Implicit Association Test.

Developing scientifically validated bias and diversity trainings that work: empowering agents of change to reduce bias, create inclusion, and promote equity

Purpose –

Research consistently shows that non-scientific bias, equity, and diversity trainings do not work, and often make bias and diversity problems worse. Despite these widespread failures, there is considerable reason for hope that effective, meaningful DEI efforts can be developed. One approach in particular, the bias habit-breaking training, has 15 years of experimental evidence demonstrating its widespread effectiveness and efficacy.

Design/methodology/approach –

This article discusses bias, diversity, equity, and inclusion (DEI) efforts from the author's perspective as a scientist-practitioner - the author draws primarily on the scientific literature, but also integrates insights from practical experiences working in DEI. The author provides a roadmap for adapting effective, evidence-based approaches from other disciplines (e.g. cognitive-behavioral therapy) into the DEI context and reviews evidence related to the bias habit-breaking training as one prominent demonstration of a scientifically-validated approach that effects lasting, meaningful improvements on DEI issues within both individuals and institutions.

Findings –

DEI trainings fail due to widespread adoption of the information deficit model, which is well-known as a highly ineffective approach. Empowerment-based approaches, in contrast, are highly promising for making meaningful, lasting changes in the DEI realm. Evidence indicates that the bias habit-breaking training is effective at empowering individuals as agents of change to reduce bias, create inclusion, and promote equity, both within themselves and the social contexts they inhabit.

Originality/value –

In contrast to the considerable despair and pessimism around DEI efforts, the present analysis provides hope and optimism, and an empirically-validated path forward, to develop and test DEI approaches that empower individuals as agents of change.

Misplaced Intuitions in Interventions to Reduce Attractiveness-Based Discrimination

Individuals and organizations are increasing efforts to address discrimination. Nonexperts may lack awareness of, or are resistant to, scientifically informed strategies for reducing discrimination, instead relying on intuition. Five studies investigated the accuracy of nonexperts' intuitions about reducing discrimination concerning physical attractiveness. In Studies 1a to 1c (N = 902), participants predicted the effectiveness of six interventions to reduce attractiveness-based favoritism on a judgment task. Studies 2a and 2b (N = 6,292) investigated the effectiveness of these interventions. Although two interventions reduced discrimination, intuitions were poorly aligned with actual results; fewer than 1% of participants identified the combination of interventions that did, versus did not, impact judgment, and responses were more likely to be below than above chance when predicting each intervention's effectiveness. Although follow-up work should investigate the accuracy of intuition in other forms of discrimination, these results further stress the need for greater development and adoption of evidence-based strategies for combating discrimination.

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana

BACKGROUND

Person-centered maternity care (PCMC) has become a priority in the global health discourse on quality of care due to the high prevalence of disrespectful and lack of responsive care during facility-based childbirth. Although PCMC is generally sub-optimal, there are significant disparities. On average, women of low socioeconomic status (SES) tend to receive poorer PCMC than women of higher SES. Yet few studies have explored factors underlying these inequities. In this study, we examined provider implicit and explicit biases that could lead to inequitable PCMC based on SES.

METHODS

Data are from a cross-sectional survey with 150 providers recruited from 19 health facilities in the Upper East region of Ghana from October 2020 to January 2021. Explicit SES bias was assessed using situationally-specific vignettes (low SES and high SES characteristics) on providers' perceptions of women's expectations, attitudes, and behaviors. Implicit SES bias was assessed using an Implicit Association Test (IAT) that measures associations between women's SES characteristics and providers' perceptions of women as 'difficult' or 'good'. Analysis included descriptive statistics, mixed-model ANOVA, and bivariate and multivariate linear regression.

RESULTS

The average explicit bias score was 18.1 out of 28 (SD = 3.60) for the low SES woman vignette and 16.9 out of 28 (SD = 3.15) for the high SES woman vignette (p < 0.001), suggesting stronger negative explicit bias towards the lower SES woman. These biases manifested in higher agreement to statements such as the low SES woman in the vignette is not likely to expect providers to introduce themselves and is not likely to understand explanations. The average IAT score was 0.71 (SD = 0.43), indicating a significant bias in associating positive characteristics with high SES women and negative characteristics with low SES women. Providers with higher education had significantly lower explicit bias scores on the low SES vignette than those with less education. Providers in private facilities had higher IAT scores than those in government hospitals.

CONCLUSIONS

The findings provide evidence of both implicit and explicit SES bias among maternity providers. These biases need to be addressed in interventions to achieve equity in PCMC and to improve PCMC for all women.

The Impact of Implicit-Bias-Oriented Diversity Training on Police Officers' Beliefs, Motivations, and Actions

U.S. police departments have attempted to address racial inequities in policing with diversity training. However, little research has evaluated whether these trainings are effective at changing officers' beliefs, motivations, and actions. To examine their efficacy, we tested a day-long implicit-bias-oriented diversity training designed to increase U.S. police officers' knowledge of biases, concerns about bias, and use of evidence-based strategies to mitigate bias (total N = 3,764). The training was immediately effective at increasing knowledge about bias, concerns about bias, and intentions to address bias, relative to baseline. However, the effects were fleeting. Although the training was linked to higher knowledge for at least 1 month, it was ineffective at durably increasing concerns or strategy use. These findings suggest that diversity trainings as they are currently practiced are unlikely to change police behavior. We conclude with theorizing about what organizations and training programs could do for greater impact.

Social Movements as Parsimonious Explanations for Implicit and Explicit Attitude Change

Recently, interest in aggregate and population-level implicit and explicit attitudes has opened inquiry into how attitudes relate to sociopolitical phenomenon. This creates an opportunity to examine social movements as dynamic forces with the potential to generate widespread, lasting attitude change. Although collective action remains underexplored as a means of reducing bias, we advance historical and theoretical justifications for doing so. We review recent studies of aggregate attitudes through the lens of social movement theory, proposing movements as a parsimonious explanation for observed patterns. We outline a model for conceptualizing causal pathways between social movements and implicit and explicit attitudes among participants, supporters, bystanders, and opponents. We identify six categories of mechanisms through which movements may transform attitudes: changing society; media representations; intergroup contact and affiliation; empathy, perspective-taking, and reduced intergroup anxiety; social recategorization; and social identification and self-efficacy processes. Generative questions, testable hypotheses, and promising methods for future work are discussed.

A mixed-methods evaluation of unconscious racial bias training for NHS senior practitioners to improve the experiences of racially minoritised students

OBJECTIVE

The degree awarding gap indicates that racially minoritised higher education students receive lower degree classifications relative to their white peers. While the reasons for this are complex, research suggests that educator and practitioner attitudes and behaviour towards racially minoritised students are a significant contributing factor. This preregistered study evaluates the effectiveness of unconscious racial bias training (URBT) to enhance National Health Service senior practitioner's recognition of how racial inequalities negatively impact racially minoritised students.

DESIGN

A mixed-methods study with a pretest and post-test design was conducted in the higher education and healthcare practice environment.

METHODS

Forty-nine NHS senior practitioners completed a 4-hour URBT workshop with activities focusing on activating stereotypes, exploring differences between unconscious and implicit bias, discussing the development of bias, and reflecting on student experiences of prejudice, harassment and discrimination. They completed pre- and post- quantitative measures that assessed the effectiveness of URBT and changes in racial competency, awareness and perceptions of unconscious racial bias. Qualitative measures explored the usefulness and perceived applications of URBT, and a 1-month follow-up assessed further how it had been applied within practice.

RESULTS

Participants reported positive evaluations of URBT, higher perceived racial competency, awareness and perceptions of racial bias (ps<0.001, dz>0.35). After 1 month, key themes from qualitative responses suggested that participants had increased self-awareness and were exploring how to set up mentoring and working groups, change recruitment and progression processes, and diversify the taught curriculum.

CONCLUSIONS

URBT may be one effective strategy to enhance awareness and encourage reflections of racial bias. We discuss how reducing racial inequalities requires a multifaceted approach that affords upfront conversations about systemic racism, implements effective initiatives, policies and procedures, and engages in continuous evaluation.

Engaging White parents to address their White children's racial biases in the Black-White context

Multiple studies (n = 1065 parents, 625 females, 437 males, 3 nonbinary, 99.06% White; n = 80, 5 to 7-year-old children, 35 girls, 45 boys, 87.50% White; data collection September 2017-January 2021) investigated White U.S. parents' thinking about White children's Black-White racial biases. In Studies 1-3, parents reported that their own and other children would not express racial biases. When predicting children's social preferences for Black and White children (Study 2), parents underestimated their own and other children's racial biases. Reading an article about the nature, prevalence, and consequences of White children's racial biases (Study 3) increased parents' awareness of, concern about, and motivation to address children's biases (relative to a control condition). The findings have implications for engaging White parents to address their children's racial biases.

Effects of intergroup contact on explicit and implicit outgroup attitudes: A longitudinal field study with majority and minority group members

A longitudinal field study tested the long-term effects (three years) of intergroup contact on both explicit and implicit outgroup attitudes. Participants were majority (Italian) and minority (immigrant) high-school students, who were tested at four waves from the beginning of their first year in high-school to the end of the third school year. Results revealed, first, a longitudinal association of quantity (but not quality) of contact with lower intergroup anxiety and more positive explicit attitudes, as well as bidirectional effects over time between explicit attitudes and intergroup anxiety, on the one hand, and quantity and quality of contact, on the other. Second, reduced intergroup anxiety mediated the association between quantity of contact and improved explicit attitudes over time. Third, the product of quantity and quality of contact longitudinally predicted more positive implicit outgroup attitudes over school years. We discuss the theoretical and practical implications of findings.

Equity and diversity in the nephrology workforce in Australia and New Zealand

BACKGROUND

Despite diversity initiatives, inequities persist in medicine with negative implications for the workforce and patients. Little is known about workplace inequity in nephrology.

AIM

To describe perceptions and experiences of bias by health professionals in the Australian and New Zealand Society of Nephrology (ANZSN), focussing on gender and race.

METHODS

A web-based survey of ANZSN members recorded degree of perceived inequity on a Likert scale, ranging from 1 (none) to 5 (complete). Groups were compared using Mann-Whitney U-test and logistic regression. Comments were synthesised using qualitative methods to explore themes of inequity and pathways to an inclusive future.

RESULTS

Of the 620 members of the ANZSN, there were 134 (22%) respondents, of whom 57% were women and 67% were White. The majority (88%) perceived inequities in the workforce. Perceived drivers of inequity were gender (84/113; 75%), carer responsibilities (74/113; 65%) and race (64/113; 56%). Half (74/131) had personally experienced inequity, based on gender in 70% (52/74) and race in 39% (29/75) with perceived discrimination coming from doctors, patients, academics and health administrators. White males were least likely (odds ratio 0.39; 95% confidence interval 0.18-0.90) to experience inequity. Dominant themes from qualitative analysis indicated that the major impacts of inequity were limited opportunities for advancement and lack of formal assistance for those experiencing inequities. Proposed solutions to reduce inequity included normalising the discourse on inequity at an organisational level, with policy changes to ensure diverse representation on committees and in executive leadership positions.

CONCLUSIONS

Inequity, particularly driven by gender and race, is common for nephrology health professionals in Australia and New Zealand and impacts career progression.

Generalization Bias in Science

Many scientists routinely generalize from study samples to larger populations. It is commonly assumed that this cognitive process of scientific induction is a voluntary inference in which researchers assess the generalizability of their data and then draw conclusions accordingly. We challenge this view and argue for a novel account. The account describes scientific induction as involving by default a generalization bias that operates automatically and frequently leads researchers to unintentionally generalize their findings without sufficient evidence. The result is unwarranted, overgeneralized conclusions. We support this account of scientific induction by integrating a range of disparate findings from across the cognitive sciences that have until now not been connected to research on the nature of scientific induction. The view that scientific induction involves by default a generalization bias calls for a revision of the current thinking about scientific induction and highlights an overlooked cause of the replication crisis in the sciences. Commonly proposed interventions to tackle scientific overgeneralizations that may feed into this crisis need to be supplemented with cognitive debiasing strategies against generalization bias to most effectively improve science.

Social risk, health inequity, and patient safety

Social factors that affect health are called social determinants. Social determinants may also carry risk, known as social risk. Management and patient safety professionals understand health care and enterprise risk. Social risk may add a new dimension for some. Social risks are probably amenable to the strategies patient safety and risk management professionals already employ, such as enterprise risk management, a culture of safety, and just culture. A large body of evidence suggests that social risks, particularly literacy and discrimination, strongly affect patient safety and well-being. This paper examines the relationship between social determinants of health and social risks and considers how health care organizations might address literacy and discrimination from the perspective of patient safety and risk management.

Online interventions for reducing hate speech and cyberhate: A systematic review

BACKGROUND

The unique feature of the Internet is that individual negative attitudes toward minoritized and racialized groups and more extreme, hateful ideologies can find their way onto specific platforms and instantly connect people sharing similar prejudices. The enormous frequency of hate speech/cyberhate within online environments creates a sense of normalcy about hatred and the potential for acts of intergroup violence or political radicalization. While there is some evidence of effective interventions to counter hate speech through television, radio, youth conferences, and text messaging campaigns, interventions for online hate speech have only recently emerged.

OBJECTIVES

This review aimed to assess the effects of online interventions to reduce online hate speech/cyberhate.

SEARCH METHODS

We systematically searched 2 database aggregators, 36 individual databases, 6 individual journals, and 34 websites, as well as bibliographies of published reviews of related literature, and scrutiny of annotated bibliographies of related literature.

INCLUSION CRITERIA

We included randomized and rigorous quasi-experimental studies of online hate speech/cyberhate interventions that measured the creation and/or consumption of hateful content online and included a control group. Eligible populations included youth (10-17 years) and adult (18+ years) participants of any racial/ethnic background, religious affiliation, gender identity, sexual orientation, nationality, or citizenship status.

DATA COLLECTION AND ANALYSIS

The systematic search covered January 1, 1990 to December 31, 2020, with searches conducted between August 19, 2020 and December 31, 2020, and supplementary searches undertaken between March 17 and 24, 2022. We coded characteristics of the intervention, sample, outcomes, and research methods. We extracted quantitative findings in the form of a standardized mean difference effect size. We computed a meta-analysis on two independent effect sizes.

MAIN RESULTS

Two studies were included in the meta-analysis, one of which had three treatment arms. For the purposes of the meta-analysis we chose the treatment arm from the Álvarez-Benjumea and Winter (2018) study that most closely aligned with the treatment condition in the Bodine-Baron et al. (2020) study. However, we also present additional single effect sizes for the other treatment arms from the Álvarez-Benjumea and Winter (2018) study. Both studies evaluated the effectiveness of an online intervention for reducing online hate speech/cyberhate. The Bodine-Baron et al. (2020) study had a sample size of 1570 subjects, while the Álvarez-Benjumea and Winter (2018) study had a sample size of 1469 tweets (nested in 180 subjects). The mean effect was small (g = -0.134, 95% confidence interval [-0.321, -0.054]). Each study was assessed for risk of bias on the following domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported results. Both studies were rated as "low risk" on the randomization process, deviations from intended interventions, and measurement of the outcome domains. We assessed the Bodine-Baron et al. (2020) study as "some" risk of bias regarding missing outcome data and "high risk" for selective outcome reporting bias. The Álvarez-Benjumea and Winter (2018) study was rated as "some concern" for the selective outcome reporting bias domain.

AUTHORS' CONCLUSIONS

The evidence is insufficient to determine the effectiveness of online hate speech/cyberhate interventions for reducing the creation and/or consumption of hateful content online. Gaps in the evaluation literature include the lack of experimental (random assignment) and quasi-experimental evaluations of online hate speech/cyberhate interventions, addressing the creation and/or consumption of hate speech as opposed to the accuracy of detection/classification software, and assessing heterogeneity among subjects by including both extremist and non-extremist individuals in future intervention studies. We provide suggestions for how future research on online hate speech/cyberhate interventions can fill these gaps moving forward.

Changing Employers’ Implicit Attitudes About the Competence of People Who Are Blind

Introduction: Long-held societal beliefs about the incompetence and dependence of people who are blind are thought to contribute to their low employment rates. This experimental study examined the impact of a meeting between a vocational rehabilitation (VR) professional and a hiring manager on these beliefs, or implicit attitudes, about the competence of people who are blind. Method: Participants were 57 hiring managers working for a financial services company in the southern United States who participated in a one-hour meeting with a VR professional. Two VR professionals, one sighted and one blind, conducted the meetings, utilizing one of two approaches, resulting in a 4 (group) × 3 (time) experimental design. Implicit attitudes were measured with the Implicit Association Test-Blind & Visually Impaired (IAT-BVI) at pre-test, post-test, and a 4-month follow-up and data were analyzed using repeated-measures ANOVA. Results: IAT-BVI scores decreased significantly following the meeting, though the size of the change was small. Type of approach and the interaction between approach and the VR professional’s vision status were not significantly associated with IAT-BVI change. Although vision status was not significantly associated with IAT-BVI change, follow-up analyses documented that participants who met with the blind VR professional had a significant decrease in IAT-BVI scores. Discussion: Hiring managers’ implicit attitudes significantly improved following a meeting with a VR professional, providing evidence that a brief interaction can decrease employers’ implicit bias regarding the competence of blind people. In addition, hiring managers who met with the blind VR professional showed significant improvement in their implicit attitudes after the meeting, with a medium-to-large effect. Implications for Practice: VR professionals should communicate with employers as much as possible about the work capabilities of individuals who are blind to help improve their implicit attitudes, and be aware that incorporating exposure to a competent blind person may result in a greater impact.

Implicit-Bias Remedies: Treating Discriminatory Bias as a Public-Health Problem

Accumulated findings from studies in which implicit-bias measures correlate with discriminatory judgment and behavior have led many social scientists to conclude that implicit biases play a causal role in racial and other discrimination. In turn, that belief has promoted and sustained two lines of work to develop remedies: (a) individual treatment interventions expected to weaken or eradicate implicit biases and (b) group-administered training programs to overcome biases generally, including implicit biases. Our review of research on these two types of sought remedies finds that they lack established methods that durably diminish implicit biases and have not reproducibly reduced discriminatory consequences of implicit (or other) biases. That disappointing conclusion prompted our turn to strategies based on methods that have been successful in the domain of public health. Preventive measures are designed to disable the path from implicit biases to discriminatory outcomes. Disparity-finding methods aim to discover disparities that sometimes have obvious fixes, or that at least suggest where responsibility should reside for developing a fix. Disparity-finding methods have the advantage of being useful in remediation not only for implicit biases but also systemic biases. For both of these categories of bias, causes of discriminatory outcomes are understood as residing in large part outside the conscious awareness of individual actors. We conclude with recommendations to guide organizations that wish to deal with biases for which they have not yet found solutions.

A discussion of White fragility to facilitate cultural competence development in a foundations of pharmaceutical care class

INTRODUCTION

The objective of this study was to explore pharmacy students' emotional reaction to the concept of White fragility and garner ideas about improving pharmacy curriculum to initiate constructive patient engagement across racial divides.

METHODS

An online questionnaire was distributed to 160 first-year pharmacy students after reading the article "White Fragility" for a Foundations of Pharmaceutical Care Course. Class prep questions included (1) How can the college and you improve the capacity and stamina of Whites, so they are prepared to teach and initiate constructive patient engagement across racial divides? and (2) Recognizing that emotions play a critical role in learning, how does the information in the "White Fragility" article make you feel? Responses were analyzed using a constant comparative method by all three authors; discrepancies were resolved by consensus.

RESULTS

Of the 160 students across two campuses, 157 submitted responses. Four major categories of college culture, curriculum, educational topics, and educational suggestions or enhancements emerged "to improve the capacity and stamina of Whites." With regard to the observed feelings after reading "White Fragility," seven categories of feelings (frequency) emerged, including awareness (49%), discomfort (38.2%), empathy (19.7%), defensiveness (16.6%), frustration (15.9%), empowerment (11.5%), and curiosity (8.3%).

CONCLUSIONS

This student cohort is at the beginning of their intercultural journey in pharmacy. Many indicated that more emphasis on and discussion about issues like White fragility and racism would benefit their ability to care for people from a wide variety of cultures to optimize patient outcomes.

An Interactive Game with Virtual Reality Immersion to Improve Cultural Sensitivity in Health Care

Purpose

Biased perceptions of individuals who are not part of one's in-groups tend to be negative and habitual. Because health care professionals are no less susceptible to biases than are others, the adverse impact of biases on marginalized populations in health care warrants continued attention and amelioration.

Method

Two characters, a Syrian refugee with limited English proficiency and a black pregnant woman with a history of opioid use disorder, were developed for an online training simulation that includes an interactive life course experience focused on social determinants of health, and a clinical encounter in a community health center utilizing virtual reality immersion. Pre- and post-survey data were obtained from 158 health professionals who completed the simulation.

Results

Post-simulation data indicated increased feelings of compassion toward the patient and decreased expectations about how difficult future encounters with the patient would be. With respect to attribution, after the simulation participants were less inclined to view the patient as primarily responsible for their situation, suggesting less impact of the fundamental attribution error.

Conclusion

This training simulation aimed to utilize components of evidence-based prejudice habit breaking interventions, such as learning more about an individual's life experience to help minimize filling in gaps with stereotyped assumptions. Although training simulations cannot fully replicate or replace the advantages that come with real-world experience, they can heighten awareness in the increase of increasing the cultural sensitivity of clinicians in health care professions for improving health equity.

Lifting the Bar: A Relationship-Orienting Intervention Reduces Recidivism Among Children Reentering School From Juvenile Detention

When children return to school from juvenile detention, they face a severe stigma. We developed a procedure to orient educators and students toward each other as positive relationship partners during this period. In Study 1, through a structured exercise, students reentering school powerfully articulated to an educator of their choosing their prosocial hopes for school as well as challenges they faced. In a preliminary field trial (N = 47), presenting this self-introduction to this educator in a one-page letter via a third-party requesting the educator's help reduced recidivism to juvenile detention through the next semester from 69% to 29%. In Study 2 (preregistered), the letter led experienced teachers (N = 349) to express greater commitment to, anticipate more success for, and feel more love and respect for a student beginning their reentry into school, potentially initiating a better trajectory. The results suggest how relationship-orienting procedures may sideline bias and make school more supportive for students facing stigma.

Cultural Differences in Susceptibility to Stereotype Threat: France versus India

OBJECTIVES

Negative aging stereotypes make older adults perform below their true potential in a number of cognitive domains. This phenomenon, known as Age-Based Stereotype Threat, is currently viewed as a powerful factor contributing to an overestimation of cognitive decline in normal aging. However, age-based stereotype threat has been investigated almost exclusively in Western countries. Whether this phenomenon is universal or culture-specific is unknown.

METHOD

Here, we first ran a pilot study (N = 106) in which we assessed French and Indian participants' attitudes towards aging. Then, we assessed stereotype threat effects on arithmetic problem-solving performance and strategies in French and Indian older adults (N = 104).

RESULTS

We found that French older adults have more negative implicit attitudes towards aging than Indian older adults. We also found that culture modulates age-based stereotype threat effects. Whereas French older adults experienced stereotype threat on both selection and execution of strategies on all arithmetic problems, Indian older adults experienced this threat only in their strategy selection on harder problems. Most interestingly, cultural differences emerged on arithmetic problems under stereotype threat condition, where otherwise no cultural differences were found in the control condition.

DISCUSSION

Our findings have important implications for understanding how cultural contexts change aging effects on human cognition and age-related difference in cognitive performance.

Anomalies in implicit attitudes research

In this review, I provide a pessimistic assessment of the indirect measurement of attitudes by highlighting the persisting anomalies in the science of implicit attitudes, focusing on their validity, reliability, predictive power, and causal efficiency, and I draw some conclusions concerning the validity of the implicit bias construct. This article is categorized under: Psychology > Reasoning and Decision Making.

Minimizing Unconscious Bias in Nursing School Admission

BACKGROUND

The potential exists for unconscious bias to influence decisions throughout the admission process to nursing school and derail holistic admission review processes. Although little is known about unconscious bias in nursing school admissions, unconscious bias has been demonstrated in nurse educators at levels similar to the general population.

METHOD

This article examines concepts of unconscious bias, factors that may interfere with accurate and fair assessment of applicants to nursing school, and ways to mitigate unconscious bias in the application and admission decision processes.

RESULTS

Interventions that have shown success in reducing unconscious bias center on increased awareness of the presence of unconscious bias and cognitive strategies that include motivation and effort to counter the unconscious bias.

CONCLUSION

Creating structures in the admission process that promote fairness and reduce the risk of relying on automatic judgments can minimize the influence of unconscious bias on admission decisions. [J Nurs Educ. 2021;60(6):317-323.].

Wise reasoning, intergroup positivity, and attitude polarization across contexts

We hypothesized that a wisdom-based reasoning process comprised of epistemic humility, accounting for context, and integrating different perspectives and interests, would be helpful in overcoming intergroup bias and attitude polarization in societal conflicts. Here we test the hypothesis using both the Situated Wise Reasoning Scale and experimental induction. In each study, we recruited participants who self-identified as members of a group implicated in an ongoing intergroup situation. In five correlational studies (Studies 1-5) we examined the relations between measured wise reasoning and intergroup positivity and attitude polarization. In two experiments, we tested the effects of a brief online wise-reasoning thought exercise on intergroup positivity and polarization (Studies 6-7), and charitable behaviors to an outgroup (Study 6). We found that wise reasoning relates to more positivity toward outgroups and less attitude polarization across different groups and conflicts. The results have implications for theory and may also have implications for future research on interventions to improve intergroup relations.

Launching the Reduction of Peripartum Racial/Ethnic Disparities Bundle: A Quality Improvement Project

INTRODUCTION

Health care organizations have a responsibility to reduce racial and ethnic perinatal health disparities. In the United States, Black women experience the worst perinatal outcomes. The process for successfully addressing this problem in clinical practice remains unclear.

PROCESS

A community hospital implemented components of the Alliance for Innovation on Maternal Health Reduction of Peripartum Racial/Ethnic Disparities Patient Safety Bundle. The purpose was to collect and share perinatal disparities data, increase staff awareness of perinatal racial and ethnic disparities, and engage staff to address these disparities at the project site. Perinatal care data were reviewed by race and ethnicity and results were shared with staff. Staff were engaged through a series of activities including a Health Equity Party, implicit bias workshop, Snack and Learn sessions, online modules, 2 grand rounds, and the establishment of a Health Equity Committee.

OUTCOMES

Racial and/or ethnic disparities were identified for perinatal outcomes and experience of care indicators including rates of cesarean birth, newborn mortality, and 30-day readmission. Of the staff 137 (65.9%) participated in project activities. The majority of participants were registered nurses (n = 82). Certified nurse-midwives (n = 10) were the profession with the highest rate of attendance (83.3%). Staff developed 26 new recommendations to address racial and ethnic disparities in care. After project implementation, mean scores of High Provider Attribution, an indicator of readiness to address health disparities, increased from preimplementation scores (P = .01). There was also a significant increase in the number of staff who reported engaging in activities to address the health care needs of racial and ethnic minority patients (P < .001).

DISCUSSION

This quality improvement project demonstrated that interventions at the health care organization level can be effective in influencing health care providers and staff to address racial and ethnic perinatal disparities.

Microaggression in Academia: Consequences and Considerations

Microaggression as a concept has received significant attention in the popular media as well as in literature. The concept has yet to be addressed, however, in the context of health care education or academia. In this article, current thoughts on racial microaggressions are reviewed with a focus on implications for nursing faculty and academia. The role of implicit bias and microaggressions on faculty diversity and promotion is discussed, and recommendations for next steps are reviewed.