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Arveklev SH, Tengelin E. Learning to teach at a norm-critical clinical learning centre: A Phenomenographic study. NURSE EDUCATION TODAY 2024; 139:106250. [PMID: 38759338 DOI: 10.1016/j.nedt.2024.106250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Campus-based clinical learning centres are used for practice and learning in nursing students' education and can be arenas in which to enhance students' awareness and competence in social justice issues. Norm-critical approaches can be used as pedagogical tools in these centres to prepare students for hands-on caring situations in which social norms can bias the outcome. OBJECTIVES To describe nursing teachers' conceptions of learning norm-critical approaches and implementing them in a clinical training centre. SETTING AND PARTICIPANTS The study is based on interviews with 10 teachers at a Swedish university college. METHODS The data was analysed using a phenomenographic approach. RESULTS Five categories of description emerged in the analysis that described conceptions related to norm-critical approaches. These categories were: personally developing and meaningful; easily integrated with established nursing concepts; highlighting surrounding power; something to lean on when letting students take the first steps in norm-critical initiatives; and helping implementation in teaching and education. CONCLUSIONS Teachers who are facing the task of providing norm-critical, practical education to nursing students in campus-based clinical learning environments are ambivalent towards the core principles of norm criticism, which they conceive as natural and provoking, at the same time. We therefore need to un-dramatise norm criticism and better prepare teachers in how to use it. Teachers would benefit from follow-up activities and formal collaborations regarding norm-critical teaching, so that they are given context to discuss, reflect, and learn from each other.
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Affiliation(s)
- Susanna H Arveklev
- Department of Health Sciences, University West, SE-461 86 Trollhattan, Sweden.
| | - Ellinor Tengelin
- Department of Health Sciences, Rehabilitation Science, Mid Sweden University, SE-831 25 Ostersund, Sweden
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Nassal T, Tezcan-Güntekin H. Critical Self-reflection on Racism by Hospital Physicians in Large German Cities. A Qualitative Reconstructive Study Using Episodic Interviews. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02073-2. [PMID: 38969924 DOI: 10.1007/s40615-024-02073-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 07/07/2024]
Abstract
Racism permeates healthcare institutions and interpersonal interactions, impacting both staff and patients. The role of doctors, given their influential position in the healthcare system, is particularly crucial in this context. Despite this, there is a scarcity of evidence regarding the manifestation of racism among healthcare professionals in Germany. Critical whiteness studies emphasize the importance of white* individuals engaging in critical self-reflection to mitigate racism. This study aimed to explore the attitudes of white* physicians in hospitals in major German cities towards racism and their critical reflection on personal attitudes and actions concerning racism in interactions with staff members and patients. Data was collected through six episodic interviews with physicians, analyzed using the reconstructive qualitative procedure of the documentary method, leading to a sense-genetic typology. The sense-genetic typology revealed three distinct attitudes towards racism: acknowledging, individualistic, and ignoring. Four types emerged concerning the self-reflection of white doctors: self-critical, socially critical, worried, and defensive. The most promising potential for interventions to reduce racism lies within the self-critical and socially critical types, both demonstrating an acknowledging attitude. Conversely, the worrying and defensive types may present challenges in deconstruction. This suggests that interventions aimed at reducing racism should be tailored and implemented with a nuanced approach.
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Affiliation(s)
- Tonia Nassal
- Department Public Health, Berlin School of Public Health: Charité - Universitätsmedizin Berlin, Alice Salomon Hochschule, Technische Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Hürrem Tezcan-Güntekin
- Department of Public Health, Berlin School of Public Health: Charité - Universitätsmedizin Berlin, Alice Salomon Hochschule, Technische Universität Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Department Public Health, Alice Salomon Hochschule Berlin, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Coalson GA, Castello S, Johnson KN, Oetting JB, Haebig E. Acceptability of Racial Microaggressions From the Perspective of Speech-Language Pathology Students. Lang Speech Hear Serv Sch 2024; 55:767-780. [PMID: 38701432 DOI: 10.1044/2024_lshss-23-00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
PURPOSE Implicit racial and ethnic biases have been documented across a variety of allied health professions; however, minimal research on this topic has been conducted within the field of speech-language pathology. The purpose of this study was to understand implicit racial and ethnic bias in speech-language pathology students by examining their perceptions and attitudes about the acceptability of racial and ethnic microaggressions. We also examined whether the student ratings varied by their racial and ethnic identity (White vs. people of color [POC]). METHOD Fifty-nine students (72% White, 28% POC) currently enrolled in a speech-language pathology program voluntarily completed the Acceptability of Racial Microaggressions Scale via an online Qualtrics survey. RESULTS Although 70% of the student ratings classified the microaggressive statements as unacceptable, 30% of their ratings classified the statements as either (a) acceptable or (b) neither acceptable nor unacceptable. Although both groups of students rated the majority of statements as unacceptable, students who self-identified as White rated more statements as acceptable than students who self-identified as POC. CONCLUSIONS Findings indicating relatively high rejection of microaggressive statements by speech-language pathology students are promising. However, responses were not uniform, and a nontrivial proportion of responses provided by speech-language pathology students reflected passivity toward or active endorsement of microaggressive statements.
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Affiliation(s)
- Geoffrey A Coalson
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Skyller Castello
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - Kia N Johnson
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Janna B Oetting
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - Eileen Haebig
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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Brand G, Bonnamy J, Dix S, Morphet J, Molloy R, Davis J, Challis H, Watts A, Daniel M, D'Astoli P, Wise S, Sevenhuysen S. 'You don't see what I see': Co-designing simulation to uncover and address cognitive bias in healthcare. MEDICAL TEACHER 2024; 46:885-888. [PMID: 38350453 DOI: 10.1080/0142159x.2024.2313581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
EDUCATIONAL CHALLENGE Each year, adverse events are reported in healthcare, of which many relate to healthcare workforce cognitive bias. The active involvement of workforce and consumers in the review and co-design of effective training for the healthcare workforce to recognise, monitor, and manage unconscious bias is required. PROPOSED SOLUTION We used participatory action research to co-design an innovative, interprofessional simulation based on 'real world' clinical incidents and lived experiences to improve the delivery of safe, high quality, consumer-focused healthcare. Following ethics approval, content analysis of serious adverse patient safety events involving cognitive bias was conducted. These data informed audio-recorded interviews with the healthcare workforce and consumers to explore their experiences of cognitive bias. Following thematic analysis, key themes of communication, stigma, diagnostic overshadowing, and fragmented systems were uncovered. Guided by consumers, these themes were interwoven into a simulation scenario that included real places, stories, and verbatim quotes delivered through mixed media artefacts. This heightened the immersive and experiential learning that aimed to uncover unconscious bias and help learners recognise its impact on clinical decisions and practice. POTENTIAL BENEFITS AND NEXT STEPS To our knowledge, this is the first interprofessional, co-designed simulation to specifically address cognitive bias in current and future healthcare workforce. Plans to translate this research into a practical framework on how to work with key stakeholders (including consumers) to identify 'real-world' health service risks and co-design targeted simulations to address these gaps are described, including lessons learned.
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Affiliation(s)
- Gabrielle Brand
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - James Bonnamy
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Samantha Dix
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Julia Morphet
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Renee Molloy
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
| | - Joy Davis
- Peninsula Health, Frankston, Australia
| | - Holly Challis
- Peninsula Health, Frankston, Australia
- Safer Care Victoria, Melbourne, Australia
| | | | | | | | - Steve Wise
- 27Creative Photography Design, Perth, Australia
| | - Samantha Sevenhuysen
- School of Nursing and Midwifery, Sub-Faculty of Health Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Australia
- Peninsula Health, Frankston, Australia
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Lee A, Hastie M. Recognising and managing bias and prejudice in healthcare. BJA Educ 2024; 24:245-253. [PMID: 38899317 PMCID: PMC11184476 DOI: 10.1016/j.bjae.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
- A. Lee
- University of Pennsylvania, Philadelphia, PA, USA
| | - M. Hastie
- Columbia University Irving Medical Center, New York, NY, USA
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Monteiro S, Acai A, Kahlke R, Chan TM, Sukhera J. Shifting paradigms: A collective and structural strategy for addressing healthcare inequity. J Eval Clin Pract 2024. [PMID: 38853452 DOI: 10.1111/jep.14013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/04/2024] [Accepted: 04/28/2024] [Indexed: 06/11/2024]
Abstract
Healthcare inequity is a persistent systemic problem, yet many solutions have historically focused on "debiasing" individuals. Individualistic strategies fit within a competency-based medical education and assessment paradigm, whereby professional values of social accountability, patient safety, and healthcare equity are linked to an individual clinician's competence. Unfortunately, efforts to realise the conceptual linkages between medical education curricula and goals to improve healthcare equity fail to address the institutional values, policies, and practices that enable structural racism. In this article, we explore alternative approaches that target collective and structural causes of health inequity. We first describe the structural basis of healthcare inequity by identifying the ways in which institutional culture, power and privilege erode patient-centred care and contribute to epistemic injustice. We then outline some reasons that stereotypes, which are a culturally supported foundation for discrimination, bias and racism in healthcare, cannot be modified effectively through individualistic strategies or education curricula. Finally, we propose a model that centres shared values for leadership by individuals and institutions with consistency in goal setting, knowledge translation, and talent development. Figure 1 summarises the key recommendations. We have provided cases to supplement this work and facilitate discussion about the model's application to practice.
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Affiliation(s)
- Sandra Monteiro
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Ontario, Hamilton, Canada
- St. Joseph's Education Research Centre (SERC), St. Joseph's Healthcare Hamilton, Ontario, Hamilton, Canada
| | - Renate Kahlke
- Division of Education and Innovation, Department of Medicine, McMaster Education Research, Innovation and Theory (MERIT) Program, McMaster University, Hamilton, Ontario, Canada
| | - Teresa M Chan
- Division of Emergency/Division of Education & Innovation, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Health Sciences, Office of Continuing Professional Development, McMaster University, Ontario, Hamilton, Canada
| | - Javeed Sukhera
- Hartford Hospital/Institute of Living, Hartford, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, Connecticut, New Haven, USA
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Lowe C, Beach MC, Erby LH, Biesecker BB, Joseph G, Roter DL. Effects of Implicit Racial Bias and Standardized Patient Race on Genetic Counseling Students' Patient-Centered Communication. HEALTH COMMUNICATION 2024:1-12. [PMID: 38847325 DOI: 10.1080/10410236.2024.2361583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
Clinician racial bias has been associated with less patient-centered communication, but little is known about how it affects trainees' communication. We investigated genetic counseling students' communication during sessions with Black or White standardized patients (SPs) and the extent to which communication was associated with SP race or student scores on the Race Implicit Association Test (IAT). Sixty students conducted a baseline SP session and up to two follow-up sessions. Students were randomly assigned to a different White or Black SP and one of three clinical scenarios for each session. Fifty-six students completed the IAT. Session recordings were coded using the Roter Interaction Analysis System. Linear regression models assessed the effects of IAT score and SP race on a variety of patient-centered communication indicators. Random intercept models assessed the within-student effects of SP race on communication outcomes during the baseline session and in follow-up sessions (n = 138). Students were predominantly White (71%). Forty students (71%) had IAT scores indicating some degree of pro-White implicit preference. Baseline sessions with White relative to Black SPs had higher patient-centeredness scores. Within-participant analyses indicate that students used a higher proportion of back-channels (a facilitative behavior that cues interest and encouragement) and conducted longer sessions with White relative to Black SPs. Students' stronger pro-White IAT scores were associated with using fewer other facilitative statements during sessions with White relative to Black SPs. Different patterns of communication associated with SP race and student IAT scores were found for students than those found in prior studies with experienced clinicians.
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Affiliation(s)
- Chenery Lowe
- Center for Biomedical Ethics, Stanford University
- Department of Health, Behavior and Society, Johns Hopkins University
| | | | - Lori H Erby
- Center for Precision Health Research, National Human Genome Research Institute
| | | | - Galen Joseph
- Department of Humanities and Social Sciences, University of California San Francisco
| | - Debra L Roter
- Department of Health, Behavior and Society, Johns Hopkins University
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Svetkey LP, Bennett GG, Reese B, Corsino L, Pinheiro SO, Fischer JE, Seidenstein J, Olsen MK, Brown T, Ezem N, Liu E, Majors A, Steinhauser KE, Sullivan BH, van Ryn M, Wilson SM, Yang H, Johnson KS. Design and pilot test of an implicit bias mitigation curriculum for clinicians. Front Med (Lausanne) 2024; 11:1316475. [PMID: 38903809 PMCID: PMC11187258 DOI: 10.3389/fmed.2024.1316475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity." Methods To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys. Results Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum. Conclusions Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.
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Affiliation(s)
- Laura P. Svetkey
- Department of Medicine, Duke University Medical School, Durham, NC, United States
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University Medical School, Durham, NC, United States
| | - Benjamin Reese
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, United States
| | - Leonor Corsino
- Departments of Medicine and Population Health Sciences, Duke University Medical School, Durham, NC, United States
| | - Sandro O. Pinheiro
- Department of Medicine, Duke University Medical School, Durham, NC, United States
| | - Jonathan E. Fischer
- Department of Family Medicine and Community Health, Duke University Medical School, Durham, NC, United States
| | - Judy Seidenstein
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
| | - Maren K. Olsen
- Department of Biostatistics & Bioinformatics, Duke University Medical School, Durham, NC, United States
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Veterans Affairs Health Care System, Durham, NC, United States
| | - Tyson Brown
- Department of Sociology, Duke University, Durham, NC, United States
| | - Natalie Ezem
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
- Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Evan Liu
- Duke School of Medicine, Duke University Medical School, Durham, NC, United States
- Tufts University School of Medicine, Somerville, MA, Untied States
| | - Alesha Majors
- Duke Clinical Research Institute, Durham, NC, United States
| | - Karen E. Steinhauser
- Department of Medicine, Duke University Medical School, Durham, NC, United States
- Departments of Medicine and Population Health Sciences, Duke University Medical School, Durham, NC, United States
| | - Brandy H. Sullivan
- Department of Anatomy and Physiology at Forsyth Technical Community College, Winston-Salem, NC, United States
| | | | - Sarah M. Wilson
- Department of Psychiatry and Behavioral Sciences, Duke University Medical School, Durham, NC, United States
| | - Hongqiu Yang
- Duke Clinical Research Institute, Durham, NC, United States
| | - Kimberly S. Johnson
- Department of Medicine, Duke University Medical School, Durham, NC, United States
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Gonzalez CM, Greene RE, Cooper LA, Lypson ML. Recommendations for Faculty Development in Addressing Implicit Bias in Clinical Encounters and Clinical Learning Environments. J Gen Intern Med 2024:10.1007/s11606-024-08832-5. [PMID: 38831249 DOI: 10.1007/s11606-024-08832-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
| | - Richard E Greene
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
- Office of Diversity Affairs, NYU Grossman School of Medicine, New York, NY, USA
| | - Lisa A Cooper
- Department of Medicine, Johns Hopkins University School of Medicine and Johns Hopkins Center for Health Equity, Baltimore, MD, USA
| | - Monica L Lypson
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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Bilotta I, Tonidandel S, Liaw WR, King E, Carvajal DN, Taylor A, Thamby J, Xiang Y, Tao C, Hansen M. Examining Linguistic Differences in Electronic Health Records for Diverse Patients With Diabetes: Natural Language Processing Analysis. JMIR Med Inform 2024; 12:e50428. [PMID: 38787295 PMCID: PMC11137426 DOI: 10.2196/50428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Background Individuals from minoritized racial and ethnic backgrounds experience pernicious and pervasive health disparities that have emerged, in part, from clinician bias. Objective We used a natural language processing approach to examine whether linguistic markers in electronic health record (EHR) notes differ based on the race and ethnicity of the patient. To validate this methodological approach, we also assessed the extent to which clinicians perceive linguistic markers to be indicative of bias. Methods In this cross-sectional study, we extracted EHR notes for patients who were aged 18 years or older; had more than 5 years of diabetes diagnosis codes; and received care between 2006 and 2014 from family physicians, general internists, or endocrinologists practicing in an urban, academic network of clinics. The race and ethnicity of patients were defined as White non-Hispanic, Black non-Hispanic, or Hispanic or Latino. We hypothesized that Sentiment Analysis and Social Cognition Engine (SEANCE) components (ie, negative adjectives, positive adjectives, joy words, fear and disgust words, politics words, respect words, trust verbs, and well-being words) and mean word count would be indicators of bias if racial differences emerged. We performed linear mixed effects analyses to examine the relationship between the outcomes of interest (the SEANCE components and word count) and patient race and ethnicity, controlling for patient age. To validate this approach, we asked clinicians to indicate the extent to which they thought variation in the use of SEANCE language domains for different racial and ethnic groups was reflective of bias in EHR notes. Results We examined EHR notes (n=12,905) of Black non-Hispanic, White non-Hispanic, and Hispanic or Latino patients (n=1562), who were seen by 281 physicians. A total of 27 clinicians participated in the validation study. In terms of bias, participants rated negative adjectives as 8.63 (SD 2.06), fear and disgust words as 8.11 (SD 2.15), and positive adjectives as 7.93 (SD 2.46) on a scale of 1 to 10, with 10 being extremely indicative of bias. Notes for Black non-Hispanic patients contained significantly more negative adjectives (coefficient 0.07, SE 0.02) and significantly more fear and disgust words (coefficient 0.007, SE 0.002) than those for White non-Hispanic patients. The notes for Hispanic or Latino patients included significantly fewer positive adjectives (coefficient -0.02, SE 0.007), trust verbs (coefficient -0.009, SE 0.004), and joy words (coefficient -0.03, SE 0.01) than those for White non-Hispanic patients. Conclusions This approach may enable physicians and researchers to identify and mitigate bias in medical interactions, with the goal of reducing health disparities stemming from bias.
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Affiliation(s)
| | - Scott Tonidandel
- Belk College of Business, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Winston R Liaw
- Department of Health Systems and Population Health Sciences, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, United States
| | - Eden King
- Department of Psychological Sciences, Rice University, Houston, TX, United States
| | - Diana N Carvajal
- Department of Family & Community Medicine, University of Maryland, Baltimore, MD, United States
| | - Ayana Taylor
- Department of Physical Medicine and Rehabilitation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Julie Thamby
- Duke University School of Medicine, Durham, NC, United States
| | | | - Cui Tao
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Jacksonville, FL, United States
| | - Michael Hansen
- Depatment of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
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11
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Thompson CM, Bishop MJ, Dillard TC, Maurice JM, Rollins DD, Pulido MD, Salas MJ, Mendelson EA, Yan J, Gerlikovski ER, Benevento SV, Zeinstra C, Kesavadas T. Healing Health Care Disparities: Development and Pilot Testing of a Virtual Reality Implicit Bias Training Module for Physicians in the Context of Black Maternal Health. HEALTH COMMUNICATION 2024:1-12. [PMID: 38711251 DOI: 10.1080/10410236.2024.2347000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Grounded in communication models of cultural competence, this study reports on the development and testing of the first module in a larger virtual reality (VR) implicit bias training for physicians to help them better: (a) recognize implicit bias and its effects on communication, patients, and patient care; (b) identify their own implicit biases and exercise strategies for managing them; and (c) learn and practice communicating with BIPOC patients in a culture-centered manner that demonstrates respect and builds trust. Led by communication faculty, a large, interdisciplinary team of researchers, clinicians, and engineers developed the first module tested herein focused on training goal (a). Within the module, participants observe five scenes between patient Marilyn Hayes (a Black woman) and Dr. Richard Flynn (her obstetrician, a White man) during a postpartum visit. The interaction contains examples of implicit bias, and participants are asked to both identify and consider how implicit bias impacts communication, the patient, and patient care. The team recruited 30 medical students and resident physicians to participate in a lab-based study that included a pretest, a training experience of the module using a head-mounted VR display, and a posttest. Following the training, participants reported improved attitudes toward implicit bias instruction, greater importance of determining patients' beliefs and perspectives for history-taking, treatment, and providing quality health care; and greater communication efficacy. Participants' agreement with the importance of assessing patients' perspectives, opinions, and psychosocial and cultural contexts did not significantly change. Implications for medical education about cultural competency and implicit bias are discussed.
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Affiliation(s)
- Charee M Thompson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Mardia J Bishop
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Joseph M Maurice
- Department of Obstetrics & Gynecology, Creighton University School of Medicine
| | - Déjà D Rollins
- Department of Communication, University of Illinois Urbana-Champaign
| | - Manuel D Pulido
- Department of Communication Studies, California State University, Long Beach
| | - M J Salas
- School of Communication and Information, Rutgers University
| | - Emily A Mendelson
- Department of Communication, University of Illinois Urbana-Champaign
| | - Jia Yan
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Sarah V Benevento
- Department of Communication, University of Illinois Urbana-Champaign
| | | | - Thenkurussi Kesavadas
- Division of Research and Economic Development, University at Albany, The State University of New York
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12
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Merz S, Aksakal T, Hibtay A, Yücesoy H, Fieselmann J, Annaç K, Yılmaz-Aslan Y, Brzoska P, Tezcan-Güntekin H. Racism against healthcare users in inpatient care: a scoping review. Int J Equity Health 2024; 23:89. [PMID: 38698455 PMCID: PMC11067303 DOI: 10.1186/s12939-024-02156-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. METHODS Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. RESULTS Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. DISCUSSION While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.
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Affiliation(s)
- Sibille Merz
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Tuğba Aksakal
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Ariam Hibtay
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Hilâl Yücesoy
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
| | - Jana Fieselmann
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Kübra Annaç
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany
| | - Patrick Brzoska
- Faculty of Health, School of Medicine, Witten/Herdecke University, Health Services Research Unit. Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Hürrem Tezcan-Güntekin
- Faculty of Health and Education, Alice Salomon University of Applied Sciences, Alice-Salomon-Platz 5, 12627, Berlin, Germany
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Chu GM, Almklov E, Wang C, McLean CL, Pittman JOE, Lang AJ. Relationships among race, ethnicity, and gender and whole health among U.S. veterans. Psychol Serv 2024; 21:294-304. [PMID: 37824243 PMCID: PMC11009376 DOI: 10.1037/ser0000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Racial, ethnic, and gender health care disparities in the United States are well-documented and stretch across the lifespan. Even in large integrated health care systems such as Veteran Health Administration, which are designed to provide equality in care, social and economic disparities persist, and limit patients' achievement of health goals across multiple domains. We explore Veterans' Whole Health priorities among Veteran demographic groups. Participants who were enrolling in Veteran Health Administration provided demographics and Whole Health priorities using eScreening, a web-based self-assessment tool. Veterans had similar health care goals regardless of demographic characteristics but differences were noted in current health appraisals. Non-White and women Veterans reported worse health-relevant functioning. Black Veterans were more likely to endorse a low rating for their personal development/relationships. Multiracial Veterans were more likely to endorse a low rating of their surroundings. Asian Veterans were less likely to provide a high rating of their surroundings. Women Veterans reported lower appraisals for body and personal development but higher appraisals of professional care. Results indicated that demographic factors such as race and gender, and to a lesser extent ethnicity, were associated with health disparities. The Whole Health model provides a holistic framework for addressing these disparities. These findings may inform more culturally sensitive care and enhance Veteran Health Administration equal access initiatives. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Erin Almklov
- VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
| | | | - Caitlin L. McLean
- VA San Diego Healthcare System
- Department of Psychiatry, University of California, San Diego
| | - James O. E. Pittman
- VA San Diego Healthcare System
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California, San Diego
| | - Ariel J. Lang
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System
- Department of Psychiatry, University of California, San Diego
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
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14
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Herrera A, Hall M, Alex Ahearn M, Ahuja A, Bradford KK, Campbell RA, Chatterjee A, Coletti HY, Crowder VL, Dancel R, Diaz M, Fuchs J, Guidici J, Lewis E, Stephens JR, Sutton AG, Sweeney A, Ward KM, Weinberg S, Zwemer EK, Harrison WN. Differences in testing for drugs of abuse amongst racial and ethnic groups at children's hospitals. J Hosp Med 2024; 19:368-376. [PMID: 38383949 DOI: 10.1002/jhm.13305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/13/2024] [Accepted: 01/28/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVES Racial and ethnic differences in drug testing have been described among adults and newborns. Less is known regarding testing patterns among children and adolescents. We sought to describe the association between race and ethnicity and drug testing at US children's hospitals. We hypothesized that non-Hispanic White children undergo drug testing less often than children from other groups. METHODS We conducted a retrospective cohort study of emergency department (ED)-only encounters and hospitalizations for children diagnosed with a condition for which drug testing may be indicated (abuse or neglect, burns, malnutrition, head injury, vomiting, altered mental status or syncope, psychiatric, self-harm, and seizure) at 41 children's hospitals participating in the Pediatric Health Information System during 2018 and 2021. We compared drug testing rates among (non-Hispanic) Asian, (non-Hispanic) Black, Hispanic, and (non-Hispanic) White children overall, by condition and patient cohort (ED-only vs. hospitalized) and across hospitals. RESULTS Among 920,755 encounters, 13.6% underwent drug testing. Black children were tested at significantly higher rates overall (adjusted odds ratio [aOR]: 1.18; 1.05-1.33) than White children. Black-White testing differences were observed in the hospitalized cohort (aOR: 1.42; 1.18-1.69) but not among ED-only encounters (aOR: 1.07; 0.92-1.26). Asian, Hispanic, and White children underwent testing at similar rates. Testing varied by diagnosis and across hospitals. CONCLUSIONS Hospitalized Black children were more likely than White children to undergo drug testing at US children's hospitals, though this varied by diagnosis and hospital. Our results support efforts to better understand and address healthcare disparities, including the contributions of implicit bias and structural racism.
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Affiliation(s)
- Adriana Herrera
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matt Hall
- Department of Analytics, Children's Hospital Association, Lenexa, Kansas, USA
| | - Marshall Alex Ahearn
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Arshiya Ahuja
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathleen K Bradford
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert A Campbell
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashmita Chatterjee
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hannah Y Coletti
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Virginia L Crowder
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ria Dancel
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Diaz
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer Fuchs
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jessica Guidici
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emilee Lewis
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John R Stephens
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley G Sutton
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alison Sweeney
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelley M Ward
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven Weinberg
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eric K Zwemer
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wade N Harrison
- Department of Pediatrics, School of Medicine, Division of Pediatric Hospital Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bascom E, Casanova-Perez R, Tobar K, Bedmutha MS, Ramaswamy H, Pratt W, Sabin J, Wood B, Weibel N, Hartzler A. Designing Communication Feedback Systems To Reduce Healthcare Providers' Implicit Biases In Patient Encounters. PROCEEDINGS OF THE SIGCHI CONFERENCE ON HUMAN FACTORS IN COMPUTING SYSTEMS. CHI CONFERENCE 2024; 2024:452. [PMID: 38933286 PMCID: PMC11204363 DOI: 10.1145/3613904.3642756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Healthcare providers' implicit bias, based on patients' physical characteristics and perceived identities, negatively impacts healthcare access, care quality, and outcomes. Feedback tools are needed to help providers identify and learn from their biases. To incorporate providers' perspectives on the most effective ways to present such feedback, we conducted semi-structured design critique sessions with 24 primary care providers. We found that providers seek feedback designed with transparent metrics indicating the quality of their communication with a patient and trends in communication patterns across visits. Based on these metrics and trends, providers want this feedback presented in a dashboard paired with actionable, personalized tips about how to improve their communication behaviors. Our study provides new insights for interactive systems to help mitigate the impact of implicit biases in patient-provider communication. New systems that build upon these insights could support providers in making healthcare more equitable, particularly for patients from marginalized communities.
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Affiliation(s)
- Emily Bascom
- Information School, University of Washington, Seattle, Washington, USA
| | - Reggie Casanova-Perez
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Kelly Tobar
- University of California, San Diego, San Diego, California, USA
| | | | | | - Wanda Pratt
- Information School, University of Washington, Seattle, Washington, USA
| | - Janice Sabin
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Brian Wood
- University of Washington, Seattle, Washington, USA
| | - Nadir Weibel
- Computer Science and Engineering & Design Lab, University of California, San Diego, San Diego, California, USA
| | - Andrea Hartzler
- Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
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16
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Gibbons JB, Harris SJ, Sugarman OK, Hulsey EG, Rwan J, Rosner EM, Saloner B. Piloting racial bias training for hospital emergency department providers treating patients with opioid use disorder. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae049. [PMID: 38757003 PMCID: PMC11095526 DOI: 10.1093/haschl/qxae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/17/2024] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Racial disparities in opioid overdose have increased in recent years. Several studies have linked these disparities to health care providers' inequitable delivery of opioid use disorder (OUD) services. In response, health care policymakers and systems have designed new programs to improve equitable OUD care delivery. Racial bias training has been 1 commonly utilized program. Racial bias training educates providers about the existence of racial disparities in the treatment of people who use drugs and the role of implicit bias. Our study evaluates a pilot racial bias training delivered to 25 hospital emergency providers treating patients with OUDs in 2 hospitals in Detroit, Michigan. We conducted a 3-part survey, including a baseline assessment, post-training assessment, and a 2-month follow-up to evaluate the acceptability and feasibility of scaling the racial bias training to larger audiences. We also investigate preliminary data on changes in self-awareness of implicit bias, knowledge of training content, and equity in care delivery to patients with OUD. Using qualitative survey response data, we found that training participants were satisfied with the content and quality of the training and especially valued the small-group discussions, motivational interviewing, and historical context.
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Affiliation(s)
- Jason B Gibbons
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Samantha J Harris
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Olivia K Sugarman
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
| | - Eric G Hulsey
- Overdose Prevention Program, Vital Strategies, New York, NY 10005, United States
| | - Julie Rwan
- Overdose Prevention Program, Vital Strategies, New York, NY 10005, United States
| | - Esther M Rosner
- Overdose Prevention Program, Vital Strategies, New York, NY 10005, United States
| | - Brendan Saloner
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, United States
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17
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Ruprecht KA, Dunlop WA, Wah E, Phillips C, Martin SJ. Intergroup Contact Improves Medical Student Attitudes and Skill in Transgender Health Care. Transgend Health 2024; 9:162-173. [PMID: 38585241 PMCID: PMC10998020 DOI: 10.1089/trgh.2021.0203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024] Open
Abstract
Purpose Poorer health outcomes for transgender and gender diverse (TGD) individuals have been associated with lack of health care provider knowledge and personal bias. Training at all levels of medical education has been positioned as one strategy to combat these inequities. This study sought to characterize preclinical medical student attitude, skill, and knowledge pre- and post-teaching with TGD community volunteers. Methods This matched pre- and post-test study was conducted from July 2020 to August 2021 capturing two preclinical medical student cohorts exposed to the same teaching intervention. Students completed the Transgender Attitudes and Beliefs Scale (TABS) and the Transgender Development of Clinical Skills Scale (T-DOCSS) at baseline, 1 week, and 1 month after the clinical skills session. Tutors' attitudes to TGD health were measured before facilitating teaching, using the Attitudes Toward Transgender Patients and Beliefs and Knowledge about Treating Transgender Patients scales. Results Fifty-nine students completed questionnaires at three time points and were included in this study. Total TABS and T-DOCCS scores increased from preintervention to 1-week follow-up, maintained at 1 month, with significant changes in Interpersonal Comfort and Sex and Gender Beliefs subscales. Scores on the Human Value subscale did not change, remaining consistently high. Postintervention knowledge-question scores were high. Nine of 13 tutors completed surveys, demonstrating overall positive attitudes toward gender diversity and TGD health. Conclusion This study demonstrates improvement in preclinical medical student attitudes and self-reported skill toward gender health care sustained at 1 month after small-group teaching with TGD community volunteers.
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Affiliation(s)
- Ky A. Ruprecht
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - William A. Dunlop
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Estee Wah
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Christine Phillips
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Sarah J. Martin
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australia
- Canberra Sexual Health Centre, Canberra Health Services, Garran, Australia
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18
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Makki A, Day C, Chaar BB. Professional stigma towards clients with methamphetamine use disorder - a qualitative study. J Pharm Policy Pract 2024; 17:2306869. [PMID: 38456180 PMCID: PMC10919299 DOI: 10.1080/20523211.2024.2306869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
Background Methamphetamine use disorder (MUD) is associated with poor health outcomes. Pharmacists play a role in delivery of substance use treatment, with several studies having examined their attitudes to people with opioid use disorder, but little is known about their attitude towards people with MUD. This study aimed to explore pharmacists' perspectives on the provision of services to clients with MUD. Methods A convenience sampling strategy was used to recruit community pharmacists across Sydney, Australia. Semi structured interviews examined views and ideas of pharmacists surrounding the treatment and management of MUD, followed by coding of transcribed interview data by all members of the research team. Results Nineteen pharmacists completed the interviews. The main theme identified was stigma held by healthcare professionals. The almost unanimous perception amongst pharmacists was fear and apprehension towards people with MUD, including underlying assumptions of criminality, misinformation regarding people with MUD, and lack of education and knowledge surrounding MUD. Conclusion A substantial amount of stigma towards people with MUD was found in this study. Negative attitudes by healthcare professionals can perpetuate healthcare disparities and impede the accessibility of future treatment programs for people with MUD. Appropriate educational interventions on MUD for pharmacists are needed.
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Affiliation(s)
- Ali Makki
- Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Camperdown, Australia
| | - Carolyn Day
- Faculty of Medicine and Health Addiction Medicine, Central Clinical School, Camperdown, Australia
| | - Betty B. Chaar
- Professionalism Committee School of Pharmacy FMH, Faculty of Medicine and Health, The University of Sydney School of Pharmacy, Camperdown, Australia
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19
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Gutman CK, Fernandez R, McFarlane A, Krajewski JMT, Casey Lion K, Aronson PL, Bylund CL, Holmes S, Fisher CL. "Let us take care of the medicine": A qualitative analysis of physician communication when caring for febrile infants. Acad Pediatr 2024:S1876-2859(24)00070-6. [PMID: 38458491 DOI: 10.1016/j.acap.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Guidelines for the management of febrile infants emphasize patient-centered communication. Although patient-centeredness is central to high-quality healthcare, biases may impact physicians' patient-centeredness. We aimed to 1) identify physicians' assumptions that inform their communication with parents of febrile infants and 2) examine physicians' perceptions of bias. METHODS We recruited physicians from three academic pediatric emergency departments (EDs) for semi-structured interviews. We applied a constant comparative method approach to conduct a thematic analysis of interview transcripts. Two coders followed several analytical steps: 1) discovery of concepts and code assignment, 2) identification of themes by grouping concepts, 3) axial coding to identify thematic properties, and 4) identifying exemplar excerpts for rich description. Thematic saturation was based on repetition, recurrence, and forcefulness. RESULTS Fourteen physicians participated. Participants described making assumptions regarding three areas: 1) the parent's affect, 2) the parent's social capacity, and 3) the physician's own role in the parent-physician interaction. Thematic properties highlighted the importance of the physician's assumptions in guiding communication and decision-making. Participants acknowledged an awareness of bias, and specifically noted that language bias influenced the assumptions that informed their communication. CONCLUSIONS ED physicians described subjective assumptions about parents that informed their approach to communication when caring for febrile infants. Given the emphasis on patient-centered communication in febrile infant guidelines, future efforts are necessary to understand how assumptions are influenced by biases, the effect of such behaviors on health inequities, and how to combat this. WHAT'S NEW Physician communication drives health outcomes. In this qualitative investigation, physicians described making assumptions about parents, based on subjective assessments, which informed their communication and decision-making. This represents a step towards understanding how biases inform communication and result in health inequity.
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Affiliation(s)
- Colleen K Gutman
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine, Gainesville, FL.
| | - Rosemarie Fernandez
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | - Antionette McFarlane
- Department of Emergency Medicine and Center for Experiential Learning and Simulation, University of Florida College of Medicine, Gainesville, FL
| | | | - K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA; Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Carma L Bylund
- Department of Health Outcomes & Biomedical Informatics, University of Florida College of Medicine, Gainesville, Fl
| | - Sherita Holmes
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Carla L Fisher
- Departments of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale School of Medicine, New Haven, CT
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20
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Jindal M, Hagiwara N. Strides in Racial Bias Training-A Step Closer to Health Equity. JAMA Netw Open 2024; 7:e242164. [PMID: 38506813 DOI: 10.1001/jamanetworkopen.2024.2164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
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21
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Gonzalez CM, Ark TK, Fisher MR, Marantz PR, Burgess DJ, Milan F, Samuel MT, Lypson ML, Rodriguez CJ, Kalet AL. Racial Implicit Bias and Communication Among Physicians in a Simulated Environment. JAMA Netw Open 2024; 7:e242181. [PMID: 38506811 PMCID: PMC10955368 DOI: 10.1001/jamanetworkopen.2024.2181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/31/2023] [Indexed: 03/21/2024] Open
Abstract
Importance Racial implicit bias can contribute to health disparities through its negative influence on physician communication with Black patients. Interventions for physicians to address racial implicit bias in their clinical encounters are limited by a lack of high-fidelity (realistic) simulations to provide opportunities for skill development and practice. Objective To describe the development and initial evaluation of a high-fidelity simulation of conditions under which physicians might be influenced by implicit racial bias. Design, Setting, and Participants This cross-sectional study, performed on an online platform from March 1 to September 30, 2022, recruited a convenience sample of physician volunteers to pilot an educational simulation. Exposures In the simulation exercise, physicians saw a 52-year-old male standardized patient (SP) (presenting as Black or White) seeking urgent care for epigastric pain, nausea, and vomiting. The case included cognitive stressors common to clinical environments, including clinical ambiguity, stress, time constraints, and interruptions. Physicians explained their diagnosis and treatment plan to the SP, wrote an assessment and management plan, completed surveys, and took the Race Implicit Association Test (IAT) and Race Medical Cooperativeness IAT. The SPs, blinded to the purpose of the study, assessed each physician's communication using skills checklists and global rating scales. Main Outcomes and Measures Association between physicians' IAT scores and SP race with SP ratings of communication skills. Results In 60 physicians (23 [38.3%] Asian, 4 [6.7%] Black, 23 [38.3%] White, and 10 [16.7%] other, including Latina/o/x, Middle Eastern, and multiracial; 31 [51.7%] female, 27 [45.0%] male, and 2 [3.3%] other), the interaction of physicians' Race IAT score and SP race was significant for overall communication (mean [SD] β = -1.29 [0.41]), all subdomains of communication (mean [SD] β = -1.17 [0.52] to -1.43 [0.59]), and overall global ratings (mean [SD] β = -1.09 [0.39]). Black SPs rated physicians lower on communication skills for a given pro-White Race IAT score than White SPs; White SP ratings increased as physicians' pro-White bias increased. Conclusions and Relevance In this cross-sectional study, a high-fidelity simulation calibrated with cognitive stressors common to clinical environments elicited the expected influence of racial implicit bias on physicians' communication skills. The outlined process and preliminary results can inform the development and evaluation of interventions that seek to address racial implicit bias in clinical encounters and improve physician communication with Black patients.
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Affiliation(s)
- Cristina M. Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York
- Department of Medicine, New York University Grossman School of Medicine, New York
- Department of Population Health, New York University Grossman School of Medicine, New York
| | | | - Marla R. Fisher
- Department of Psychiatry, Mount Sinai Morningside-West, New York, New York
| | - Paul R. Marantz
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Diana J. Burgess
- Department of Medicine, University of Minnesota, Minneapolis
- Center for Care Delivery and Outcomes Research in the Minneapolis Veterans Affairs Healthcare System, Minneapolis, Minnesota
| | - Felise Milan
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
| | | | - Monica L. Lypson
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Carlos J. Rodriguez
- Department of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York
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22
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Saxena I, Swaroop R, Kumar A, Gupta AK, Kumari S, Kumar M. Sensitization Lectures for Reducing Weight Bias in Undergraduate Medical Students. Cureus 2024; 16:e56431. [PMID: 38505142 PMCID: PMC10949035 DOI: 10.7759/cureus.56431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Discrimination exists in one form or another in every society, usually against those who are weaker, in fewer numbers, or different from the rest. Most physicians are empathetic towards their patients but can either not keep an eye on their subordinates or lack the power to act against such employees. Persons experiencing discrimination in healthcare centers may try to avoid or postpone future visits, resulting in delayed diagnosis and treatment of ailments. Obesity bias present in society has crept into healthcare centers and intimidates persons with obesity who are seeking medical aid. Implicit and explicit obesity bias has been recorded in healthcare students. METHODS Data from 102 undergraduate medical students (23 female) who completed this study was analyzed. Implicit bias (tested online using the Implicit Association Test) and explicit bias (measured using four types of tool kits) were measured before and after conducting an obesity sensitization program (OSP) comprising four lectures on the causes and consequences of obesity and obesity discrimination and its consequences. RESULTS The change in implicit bias was not significant. However, a significant reduction was noted in the four different types of tools for explicit bias after conducting the OSP. CONCLUSION OSP helped medical students identify obesity bias and reduce explicit bias. Sensitization lectures conducted in medical colleges and schools can help reduce such discrimination in healthcare centers.
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Affiliation(s)
- Indu Saxena
- Biochemistry, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Rohit Swaroop
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Apurva Kumar
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Arun K Gupta
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Shweta Kumari
- Medicine, All India Institute of Medical Sciences, Gorakhpur, IND
| | - Manoj Kumar
- Physiology, Maharshi Vashishtha Autonomous State Medical College, Rampur, IND
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Parvez M, Barnes L, Gonzalez R, Prestegaard K, Rick TJ. Health Care Students' Perceptions of Bias During Their Clinical Training and Insights on Mitigating It. J Physician Assist Educ 2024; 35:88-93. [PMID: 38377463 DOI: 10.1097/jpa.0000000000000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
PURPOSE To understand health care students' perception of implicit bias and examine their insights to create a bias-free training environment. METHODS Clinical phase students from one university's 4 health care programs participated in this study. Students were surveyed regarding their knowledge of implicit bias and perception of their experiences in the clinical learning environment. RESULTS The response rate was 50.9%, N = 161. In total, 52.6% reported having prior training on implicit bias, and 55% self-reported that they had personally observed preceptors who exhibited an implicit bias toward patients based on race, ethnicity, or other qualities. There was no statistically significant relationship between those with prior training on implicit bias and being able to identify implicit bias exhibited by preceptors. Participants also expressed their unwillingness to report an incident unless it is confidential due to fear of retribution. CONCLUSION This study found that health care students from one university's 4 health care programs perceived implicit bias in their clinical learning environment, which they believe could be improved by taking intentional steps. Some suggestions provided were "Safe space to report and openly discuss bias," "Education/training on implicit bias," "Time for self-reflection," and "Hiring process that evaluates/trains against implicit bias." The implication of our study is to create a bias-free training environment that will help interrupt the propagation of biases contributing to health disparity. Further research should examine a national population and identify interventional methods and outcomes in multiple health care disciplines.
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Affiliation(s)
- Mehnaz Parvez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Lisa Barnes
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Rebecca Gonzalez
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Keanna Prestegaard
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
| | - Tara J Rick
- Mehnaz Parvez, MBBS, MS, is an associate professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
- Lisa Barnes, MPAS-PAC, is a physician assistant, Colon & Rectal Surgery Associates, Minneapolis, Minnesota
- Rebecca Gonzalez, MPAS-PAC, is a physician assistant, Spine and Orthopedic Center, Santa Barbara, California
- Keanna Prestegaard, MPAS-PAC, is a physician assistant, Summit Orthopedics, Woodbury, Minnesota
- Tara J. Rick, PhD, MPAS-PAC, is a physician assistant, University of Minnesota Physicians, Greater Minneapolis - St. Paul Area Research Associate in Cancer Survivorship, University of Minnesota, Minneapolis, Minnesota. She is also an adjunct professor, Master of Physician Assistant Studies Program, St. Catherine University, St. Paul, Minnesota
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Willson MN, Frazier CC, McKeirnan KC. Training Student Pharmacists in Microaggressions and Gender Inclusive Communication. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100676. [PMID: 38360189 DOI: 10.1016/j.ajpe.2024.100676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/30/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The objectives of this study were to describe the implementation of a microaggression and gender inclusive communication (MGIC) module in a required course in a Doctor of Pharmacy curriculum; and to evaluate the impact on student pharmacist knowledge, comfort, and confidence using gender inclusive communication and addressing microaggressions. METHODS Students participated in MGIC module, which included training on microaggressions, and terminology related to gender. The module implementation was evaluated through a pre and post training knowledge assessment and survey of student confidence, comfort, and perceived importance of gender inclusive care. Additional evaluation included qualitative review of the graphics depicting the terminology and rephrasing statement with a microaggression to inclusive language. Survey responses were analyzed using Mann-Whitney U test and knowledge responses were analyzed using the Fisher exact test in SPSS. RESULTS A total of 106 students completed the module, 105 completed presurvey and knowledge assessment, and 92 completed the postsurvey and knowledge assessment. Results demonstrated a statistically significant increase from pre to post on the comfort and importance domain questions. A statistically significant increase in the student confidence was seen on all questions except for 2. The pre and postknowledge assessment results on all questions showed improvement from pre to post, although not all changes were statistically significant. CONCLUSION The MGIC module was effective in increasing to evaluate the impact on student pharmacist knowledge, comfort, and confidence using gender inclusive communication and addressing microaggressions. Reflections echoed the value and need for this training.
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Affiliation(s)
- Megan N Willson
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA.
| | - Cheyenne C Frazier
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
| | - Kimberly C McKeirnan
- Washington State University, College of Pharmacy and Pharmaceutical Sciences, Spokane, WA, USA
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Shen J, Carmichael A, Clinton AJ. A scoping review of research on potential impact of implicit bias in healthcare settings for children with acquired brain injuries. Rehabil Psychol 2024; 69:36-44. [PMID: 37796578 PMCID: PMC10843613 DOI: 10.1037/rep0000519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE/OBJECTIVE Acquired brain injury (ABI) is a leading cause of disability in children and adolescents. Implicit biases within pediatric ABI healthcare settings may exert negative effects on clinical interactions and medical decision-making processes. This study aimed to conduct a scoping review of current research that examines the potential impact of implicit biases in such healthcare settings for children with ABI. RESEARCH METHOD/DESIGN Following PRISMA-ScR guidelines, a search among five databases (CINAHL, Cochrane CENTRAL, PubMed, PsycArticles, and PsycInfo) was conducted, followed by abstract/full-text screening and data extraction. Main characteristics of the included studies, including research design, relevance to implicit biases, and public health impact were synthesized. The risk of bias of included studies was assessed. RESULTS Out of the 203 articles returned from the literature search, a total of three studies met the inclusion criteria for the present review. All studies examined the relevance of racial/ethnic biases for evaluating abusive head trauma or nonaccidental trauma. The included studies had an overall unclear to low risk of biases. CONCLUSIONS/IMPLICATIONS This scoping review identified scarce but emerging evidence of the presence and detrimental impact of potential implicit biases on the access and quality of care received by children with ABI. More research is needed to examine the causes, process mechanisms, and consequences of implicit biases in pediatric ABI healthcare settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Jiabin Shen
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
| | - Amanda Carmichael
- Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | - Alexander J Clinton
- Department of Psychology, University of Massachusetts Lowell, Lowell, MA, USA
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Decker H, Combs RM, Noonan EJ, Black C, Weingartner LA. LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment. JOURNAL OF HOMOSEXUALITY 2024; 71:528-544. [PMID: 36190747 DOI: 10.1080/00918369.2022.2122367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Microaggressions are subtle derogatory behaviors that unintentionally communicate hostility toward marginalized social groups. This article describes the preliminarily validation of a framework for observing LGBTQ+ microaggressions in health care, which can lead to distrust and disengagement from the healthcare system. Coders used the framework to observe microaggressions in video-recorded clinical-skills assessments with medical students who elicited health histories from standardized patients. Microaggression classifications were reviewed to determine construct reliability and the presence/absence among eight framework categories. Among 177 encounters with sexual and gender minority standardized patients, heteronormative/cisnormative language and assumptions occurred in the largest proportion of encounters (85.3%). Only identity-based referrals decreased significantly after a clinical skills intervention (20.0% to 4.9%, p = .01). These outcomes show that LGBTQ+ healthcare microaggressions are pervasive and will likely require nuanced training to address them. This groundwork can also be used to develop scales for patients and observers to identify microaggressions and assess perceived impact.
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Affiliation(s)
- Hallie Decker
- Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Ryan M Combs
- Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Emily J Noonan
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Caison Black
- Health Promotion and Behavioral Sciences, University of Louisville School of Public Health and Information Sciences, Louisville, Kentucky, USA
| | - Laura A Weingartner
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Benau EM, Zavodnick JH, Jaffe RC. Initial evidence of reliability and validity of an implicit association test assessing attitudes toward individuals who use substances. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024; 50:64-74. [PMID: 38295383 DOI: 10.1080/00952990.2023.2300398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
Background: Substance use disorders (SUDs) are stigmatized conditions, with individual biases driving poor health outcomes. There are surprisingly few validated measures of bias or stigma toward individuals who use substances. Bias can be classified as explicit (self-report) or implicit (behaviorally based).Objectives: The goal of the present study was to establish preliminary indices of reliability and validity of an implicit association test (IAT) designed to measure implicit bias toward individuals who use substances.Methods: A large United States-based, crowd-sourced sample (n = 394, 51.5% male, 45.4% female, 2.5% nonbinary) completed the IAT and a small battery of survey instruments that assessed social distance to mental illness (including heroin use), attitude toward and perceived controllability of injection drug use, perception of public stigma, and social desirability.Results: Nearly all (92%; n = 363) scores on the IAT indicated greater negative than positive attitudes toward those who use substances. Spearman-Brown corrected split-half reliability on the IAT scores was excellent, r = .953. Controlling for social desirability, IAT scores positively correlated with all included measures pertaining to substance use as well as social distance for heroin and schizophrenia (but not diabetes). A principal component analysis resulted in two interpretable components representing disapproval (perceived controllability and negative attitudes) and perceived stigma (social stigma and social distance). Scores on the IAT positively correlated to scores on both components, again, controlling for social desirability.Conclusion: These results provide compelling preliminary evidence of validity of an IAT designed to measure bias toward individuals who use substances.
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Affiliation(s)
- Erik M Benau
- Department of Psychology, SUNY Old Westbury, Old Westbury, NY, USA
| | | | - Rebecca C Jaffe
- Department of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Lewis BE, Naik AR. A scoping review to identify and organize literature trends of bias research within medical student and resident education. BMC MEDICAL EDUCATION 2023; 23:919. [PMID: 38053172 DOI: 10.1186/s12909-023-04829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
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.
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Affiliation(s)
- Brianne E Lewis
- Department of Foundational Sciences, Central Michigan University College of Medicine, Mt. Pleasant, MI, 48859, USA
| | - Akshata R Naik
- Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, 586 Pioneer Dr, Rochester, MI, 48309, USA.
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Chowdhury SK. Racism and access to maternal health care among garo indigenous women in Bangladesh: A qualitative descriptive study. PLoS One 2023; 18:e0294710. [PMID: 38032894 PMCID: PMC10688635 DOI: 10.1371/journal.pone.0294710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 11/07/2023] [Indexed: 12/02/2023] Open
Abstract
Racism as social determinant of health significantly affects Indigenous women's maternal healthcare access. This study uses Jones' 'Three Levels of Racism' theory and an intersectional lens to explore how racism shapes the experience of maternal health care access among Garo Indigenous women in Bangladesh. Semi-structured interviews were conducted with 24 women of diverse backgrounds and pregnancy statuses using snowball sampling. Thematic analysis, incorporating inductive and deductive approaches, was employed for data analysis. The findings reveal a significant deviation from Jones' theory regarding the level of internalized racism within the specific context of Garo Indigenous women's experiences. Jones' theory usually focuses on how racism is internalized due to institutional and personally-mediated factors. On the contrary, this study uncovers a unique theme: 'women agency.' This theme emerges as a robust response among the Garo Indigenous women to their encounters with institutional and personally-mediated racism, highlighting their cultural resistance and resilience. The findings suggest that the complex relationship between these two forms of racism contributes to the strengthening of agency among Garo Indigenous women. Their agency stems from avoiding hospitals that disrespect their culture, manifesting their cultural resistance practice against the encountered racism at the institutional and relational levels. To increase biomedical healthcare access among Garo Indigenous women, it is recommended to address racism through intercultural competency training with the 'cultural safety' 'cultural humility' approach. This approach would foster inclusivity and empowerment, recognizing the agency of Garo women in healthcare decisions. Additionally, it would facilitate constructive dialogues between clinicians and Garo Indigenous women, acknowledging the shared experiences of racism within the latter group.
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Daya S, Illangasekare T, Tahir P, Bochatay N, Essakow J, Ju M, van Schaik S. Using Simulation to Teach Learners in Health Care Behavioral Skills Related to Diversity, Equity, and Inclusion: A Scoping Review. Simul Healthc 2023; 18:312-320. [PMID: 36194859 DOI: 10.1097/sih.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SUMMARY STATEMENT Bias is commonplace in the health care environment and can negatively impact patients and their health outcomes. Simulation has long been shown to be an effective teaching tool for communication skills in health care, but it has rarely been used to deliver concrete behavioral skills that address issues of diversity, equity, and inclusion (DEI). This scoping review examines 23 published articles surrounding the use of simulation in health care education to impart behavioral skills that reduce bias and promote DEI. Included articles described various behavioral skills including communication, history-taking, and system/community-level advocacy. The most commonly used simulation modality to teach these skills included the use of simulated participants (16 articles, 70%). The main DEI topics addressed in the trainings included sexual orientation/gender identity, language, and culture/ethnicity. Based on findings from this review, the authors suggest recommendations for educators who are considering teaching DEI-related skills through simulation.
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Affiliation(s)
- Sneha Daya
- From the Department of Internal Medicine and Pediatrics (S.D.), Department of Obstetrics & Gynecology (T.I.), Department of Pediatrics (J.E. M.J., S.v.S.), University of California San Francisco (P.T., N.B.), San Francisco, CA
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Armstrong-Mensah E, Rasheed N, Williams D, Moyer K, Alema-Mensah E, Tetteh AK. Implicit Racial Bias, Health Care Provider Attitudes, and Perceptions of Health Care Quality Among African American College Students in Georgia, USA. J Racial Ethn Health Disparities 2023; 10:2600-2612. [PMID: 36331715 DOI: 10.1007/s40615-022-01439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Due to racism, over 20% of African Americans, including college students in Georgia, receive poor quality health care. Consequently, most students are reluctant to utilize health care services in the state. This study examined biased racial attitudes of health care providers in Georgia, and African American Georgia State University (GSU) School of Public Health (SPH) students' perceptions of the quality of health care they receive from providers, the effects of such care, and student recommendations for the way forward. DESIGN A mixed-methods cross-sectional design was used to collect data from 63 students across six domains using Qualtrics. RESULTS Provider brushes off patient concerns when providing medical care (29.9%), stereotyping (26.9%), and the lack of communication during medical care (25.4%) were the three main implicit racial attitudes identified by GSU SPH students. Owing to the poor quality of care they receive from their health care providers, some students (28.4%) are reluctant to utilize health care services, distrust doctors that are not from their race (34.3%), do not adhere to treatment (19.4%), and prefer to use home remedies (28.4%) when ill. Students recommended cultural competency training, holding health care providers accountable for their actions, and increasing African American health care providers in Georgia as ways to address health care provider attitudes and quality of care. CONCLUSION Negative provider attitudes impact the health and health-seeking behavior of African American college students in Georgia. These attitudes must be eliminated so barriers to clinical participation are removed, and student health outcomes optimized.
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Affiliation(s)
- Elizabeth Armstrong-Mensah
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA.
| | - Nina Rasheed
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
| | - Darylisha Williams
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
| | - Keianna Moyer
- Department of Health Policy & Behavioral Sciences, Department of Atlanta, Georgia State University, Atlanta, GA, 30303, USA
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Rekhtman D, Iyengar A, Song C, Weingarten N, Shin M, Patel M, Herbst DA, Helmers M, Cevasco M, Atluri P. Emerging Racial Differences in Heart Transplant Waitlist Outcomes for Patients on Temporary Mechanical Circulatory Support. Am J Cardiol 2023; 204:234-241. [PMID: 37556892 DOI: 10.1016/j.amjcard.2023.07.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
Temporary mechanical circulatory support (tMCS) is increasingly used for patients awaiting heart transplantation. Although examples of systemic inequity in cardiac care have been described, biases in tMCS use are not well characterized. This study explores the racial disparities in tMCS use and waitlist outcomes. The United Network for Organ Sharing database was used to identify adults listed for first-time heart transplantation from 2015 to 2021. White and non-White patients on extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary left ventricular assist device were identified. Waitlist outcomes of mortality, transplantation, and delisting were analyzed by race using competing risks regression. The effect of the new heart allocation system was also assessed. A total of 16,811 patients were included in this study, with 10,377 self-identifying as White and 6,434 as non-White. White patients were more often male, privately ensured, and had less co-morbidities (p <0.05). tMCS use was found to be significantly higher in non-White patients (p <0.001). Among those on tMCS, non-White patients were more likely to be delisted because of illness (subhazard ratio 1.34 [1.09 to 1.63]) and less likely to die while on the waitlist (subhazard ratio 0.76 [0.61 to 0.93]). This disparity was not present before the implementation of the new heart allocation system. tMCS use was proportional to the risk factors identified in the non-White cohort. After the implementation of the new heart allocation system, White patients were more likely to die, whereas non-White patients were more likely to be delisted. Further work is needed to determine the causes of and potential solutions for disparities in the waitlist outcomes.
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Affiliation(s)
- David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cindy Song
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Weingarten
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mrinal Patel
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Alan Herbst
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Helmers
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Kutney-Lee A, Rodriguez KL, Ersek M, Carthon JMB. "They Did Not Know How to Talk to Us and It Seems That They Didn't Care:" Narratives from Bereaved Family Members of Black Veterans. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01790-4. [PMID: 37733285 DOI: 10.1007/s40615-023-01790-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/22/2023]
Abstract
Racial disparities in the quality of health care services, including end of life (EOL) care, are well-documented. While several explanations for these inequities have been proposed, few studies have examined the underlying mechanisms. This paper presents the results of the qualitative phase of a concurrent mixed-methods study (QUANT + QUAL) that sought to identify explanations for observed racial differences in quality of EOL care ratings using the Department of Veterans Affairs Bereaved Family Survey (BFS). The objective of the qualitative phase of the study was to understand the specific experiences that contributed to an unfavorable overall EOL quality rating on the BFS among family members of Black Veterans. We used inductive thematic analysis to code BFS open-ended items associated with 165 Black Veterans whose family member rated the overall quality of care received by the Veteran in the last month of life as "poor" or "fair." Four major themes emerged from the BFS narratives, including (1) Positive Aspects of Care, (2) Unmet Care Needs, (3) Lack of Empathy, Dignity, and Respect, and (4) Poor Communication. Additionally, some family members offered recommendations for care improvements. Our discussion includes integrated results from both our qualitative and previously reported quantitative findings that may serve as a foundation for future evidence-based interventions to improve the equitable delivery of high-quality EOL care.
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Affiliation(s)
- Ann Kutney-Lee
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Mary Ersek
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - J Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Garrett SB, Jones L, Montague A, Fa-Yusuf H, Harris-Taylor J, Powell B, Chan E, Zamarripa S, Hooper S, Chambers Butcher BD. Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders. Health Equity 2023; 7:506-519. [PMID: 37731787 PMCID: PMC10507933 DOI: 10.1089/heq.2023.0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation. Methods We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20). Results We identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions. Health Equity Implications These stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Linda Jones
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Alexandra Montague
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
| | - Haleemat Fa-Yusuf
- Independent Researcher and Community Advisor, San Francisco, California, USA
| | - Julie Harris-Taylor
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Breezy Powell
- California Preterm Birth Initiative, University of California, San Francisco, California, USA
| | - Erica Chan
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephen Zamarripa
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Sarah Hooper
- UCSF-UC Law Consortium on Law, Science & Health Policy, University of California College of the Law, San Francisco, California, USA
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Vitale K, Powell WR, Krekeler BN, Yee J, Rogus-Pulia N. Stratifying Risk of Nonadherence in Lingual Strengthening Dysphagia Rehabilitation. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2111-2127. [PMID: 37566883 PMCID: PMC10569446 DOI: 10.1044/2023_ajslp-22-00338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/14/2023] [Accepted: 04/27/2023] [Indexed: 08/13/2023]
Abstract
PURPOSE Exercise-based treatments may improve swallowing safety and efficiency; yet, it is not clearly understood which factors predict nonadherence to recommended treatment protocols. The aim of this study was to construct an algorithm for stratifying risk of nonadherence to a lingual strengthening dysphagia treatment program. METHOD Using recursive partitioning, we created a classification tree built from a pool of sociodemographic, clinical, and functional status indicators to identify risk groups for nonadherence to an intensive lingual strengthening treatment program. Nonadherence, or noncompletion, was defined as not completing two or more follow-up sessions or a final session within 84 days. RESULTS The study cohort consisted of 243 Veterans enrolled in the Intensive Dysphagia Treatment program across six sites from January 2012 to August 2019. The overall rate of nonadherence in this cohort was 38%. The classification tree demonstrated good discriminate validity (C-statistic = 0.74) and contained eight groups from five variables: primary diagnosis, marital status, Penetration-Aspiration Scale (PAS) severity score, race/ethnicity, and age. Nonadherence risk was categorized as high (range: 69%-77%), intermediate (27%-33%), and low risk (≤ 13%-22%). CONCLUSIONS This study identified distinct risk groups for nonadherence to lingual strengthening dysphagia rehabilitation. Additional research is necessary to understand how these factors may drive nonadherence. With external validation and refinement through prospective studies, a clinically relevant risk stratification tool can be developed to identify patients who may be at high risk for nonadherence and provide targeted patient support to mitigate risk and provide for unmet needs.
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Affiliation(s)
- Kailey Vitale
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Otolaryngology, Boston Medical Center, MA
- Department of Otolaryngology-Head and Neck Surgery, Boston University Chobanian & Avedisian School of Medicine, MA
| | - W. Ryan Powell
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison
| | - Brittany N. Krekeler
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Otolaryngology–Head & Neck Surgery, University of Cincinnati College of Medicine, OH
- Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, OH
| | - Joanne Yee
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - Nicole Rogus-Pulia
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
- Department of Surgery-Otolaryngology, University of Wisconsin–Madison
- Department of Communication Sciences and Disorders, University of Wisconsin–Madison
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Buie J, McMillan E, Kirby J, Cardenas LA, Eftekhari S, Feldman CH, Gawuga C, Knight AM, Lim SS, McCalla S, McClamb D, Polk B, Williams E, Yelin E, Shah S, Costenbader KH. Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research. ACR Open Rheumatol 2023; 5:454-464. [PMID: 37531095 PMCID: PMC10502817 DOI: 10.1002/acr2.11590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The complex relationships between race and ethnicity and social determinants of health (SDOH) in influencing SLE and its course are increasingly appreciated. Multiple SDOH have been strongly associated with lupus incidence and outcomes and contribute to health disparities in lupus. Measures of socioeconomic status, including economic instability, poverty, unemployment, and food insecurity, as well as features of the neighborhood and built environment, including lack of safe and affordable housing, crime, stress, racial segregation, and discrimination, are associated with race and ethnicity in the US and are risk factors for poor outcomes in lupus. In this scientific statement, we aimed to summarize current evidence on the role of SDOH in relation to racial and ethnic disparities in SLE and SLE outcomes, primarily as experienced in the U.S. Lupus Foundation of America's Health Disparities Advisory Panel, comprising 10 health disparity experts, including academic researchers and patients, who met 12 times over the course of 18 months in assembling and reviewing the data for this study. Sources included articles published from 2011 to 2023 in PubMed, Centers for Disease Control and Prevention data, and bibliographies and recommendations. Search terms included lupus, race, ethnicity, and SDOH domains. Data were extracted and synthesized into this scientific statement. Poorer neighborhoods correlate with increased damage, reduced care, and stress-induced lupus flares. Large disparities in health care affordability, accessibility, and acceptability exist in the US, varying by region, insurance status, and racial and minority groups. Preliminary interventions targeted social support, depression, and shared-decision-making, but more research and intervention implementation and evaluation are needed. Disparities in lupus across racial and ethnic groups in the US are driven by SDOH, some of which are more easily remediable than others. A multidimensional and multidisciplinary approach involving various stakeholder groups is needed to address these complex challenges, address these diminish disparities, and improve outcomes.
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Affiliation(s)
- Joy Buie
- Lupus Foundation of AmericanWashingtonDC
| | | | | | | | - Sanaz Eftekhari
- Asthma and Allergy Foundation of AmericaGreater LandoverMaryland
| | - Candace H. Feldman
- Harvard Medical School and Brigham and Women's HospitalBostonMassachusetts
| | - Cyrena Gawuga
- Preparedness and Treatment Equity CoalitionNew York CityNew York
| | - Andrea M. Knight
- Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - S. Sam Lim
- Emory University and Grady Health SystemAtlantaGeorgia
| | | | | | - Barbara Polk
- John F. Kennedy Center for the Performing Arts and Amplify People AdvisorsWashingtonDC
| | | | - Ed Yelin
- University of California San Francisco
| | - Sanoja Shah
- Charles River AssociatesSan FranciscoCalifornia
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Lim I, Korfmacher J, Steier A, Zeanah C, Zeanah PD. The ethics of infant and early childhood mental health practice. Infant Ment Health J 2023; 44:651-662. [PMID: 37000438 DOI: 10.1002/imhj.22055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023]
Abstract
Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision-making when there is a sense of moral conflict or ambiguity about the "right" course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress' four principles framework (respect for autonomy, beneficence, non-maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants.
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Affiliation(s)
- Izaak Lim
- Early in Life Mental Health Service, Monash Health, Clayton, Victoria, Australia
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Jon Korfmacher
- Chapin Hall, University of Chicago, Chicago, Illinois, USA
| | | | - Charles Zeanah
- Department of Psychiatry and Behavioural Sciences, Tulane University, New Orleans, Louisiana, USA
| | - Paula D Zeanah
- College of Nursing and Health Sciences and Picard Centre for Child Development, University of Louisiana, Lafayette, Louisiana, USA
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Rattan J, Bartlett TR. Potential influence of nurses' implicit racial bias on maternal mortality. Public Health Nurs 2023; 40:773-781. [PMID: 37141152 PMCID: PMC10775957 DOI: 10.1111/phn.13201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/05/2023]
Abstract
Stark disparities persist in maternal mortality and perinatal outcomes for Black and other birthing people of color, such as Native Americans, and their newborns compared to White people in the United States. An increasing body of research describes the phenomenon of implicit racial bias among providers and how it may affect communication, treatment decisions, the patient care experience, and health outcomes. This synthesis of literature reviews and distills current research on the presence and influence of implicit racial bias among nurses as it may relate to maternal and pregnancy-related care and outcomes. In this paper, we also summarize what is known about implicit racial bias among other types of healthcare providers and interventions that can mitigate its effects, identify a gap in research, and recommend next steps for nurses and nurse researchers.
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Affiliation(s)
- Jesse Rattan
- Joint Nursing Science PhD Program, The University of Alabama and University of Alabama in Huntsville, Tuscaloosa
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Byrn MA, Buys EA, Mujahid M, Madsen K. Disparities in the provision of perinatal care based on patient race in the United States. Birth 2023; 50:627-635. [PMID: 36945902 DOI: 10.1111/birt.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND In the United States, there are significant health inequities in perinatal care. This study examined differences in perinatal care provided to women based on the birthing person's designated race, within a large and diverse cohort of women. METHODS This retrospective electronic medical record review identified patients receiving perinatal care within a large hospital system between January 2012 and September 2018 and examined associations between maternal designated race/ethnicity (Hispanic or non-Hispanic [NH] Black, Asian or White) and various provider treatment decisions. RESULTS The study sample (N = 7056) was comprised of 36% Hispanic, 34% NH White, 21% NH Black, and 4% NH Asian women, aged 29.7 ± 6.3 years; 53% of the sample had private insurance, and 45% had Medicaid. Few differences by race were seen in perinatal care based on guidelines or expert recommendations (nondiscretionary care). Discretionary care, however, varied by race: Compared with NH White women, NH Black women were less likely to receive a prenatal depression screen (OR 0.8 [95% CI: 0.7, 0.9]) and more likely to have a urine drug test when denying drug use (OR 1.6 [95% CI 1.3, 2.0]), whereas Hispanic (OR 0.6 [95% CI: 0.5, 0.8]) and NH Asian (0.4 [95% CI 0.2, 0.9]) women were less likely to have a urine drug test completed when denying drug use. DISCUSSION Perinatal care differs by maternal race/ethnicity, particularly when guidelines or expert recommendations are absent. Greater efforts need to be made to identify and mitigate providers' implicit and explicit biases; expanded professional guidelines may offer some protections against inequitable, discretionary care.
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Affiliation(s)
- Mary A Byrn
- Loyola University Chicago, Chicago, Illinois, USA
| | - Elizabeth A Buys
- Mountain Area Health Education Center, Asheville, North Carolina, USA
| | - Mahasin Mujahid
- University of California Berkeley, School of Public Health, Berkeley, California, USA
| | - Kristine Madsen
- University of California Berkeley, School of Public Health, Berkeley, California, USA
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Pennington CR, Ploszajski M, Mistry P, NgOmbe N, Back C, Parsons S, Shaw DJ. Relationships between the race implicit association test and other measures of implicit and explicit social cognition. Front Psychol 2023; 14:1197298. [PMID: 37575432 PMCID: PMC10415041 DOI: 10.3389/fpsyg.2023.1197298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Background The race-based Implicit Association Test (IAT) was proposed to measure individual differences in implicit racial bias subsumed within social cognition. In recent years, researchers have debated the theoretical tenets underpinning the IAT, questioning whether performance on this task: (1) measures implicit attitudes that operate automatically outside of conscious awareness; (2) reflects individual differences in social cognition; and (3) can predict social behavior. One way to better address these research questions is to assess whether the race-IAT correlates with other implicit processes that are subsumed within social cognition. Aims The current study assessed whether the race-IAT was related to other commonly used individual difference measures of implicit (and explicit) social cognition. Experiment 1 assessed whether dissociable patterns of performance on the race-IAT were related to measures of implicit imitative tendencies, emotion recognition and perspective taking toward White task actors, as well as explicit measures of trait and state affective empathy and racial bias. Overcoming limitations of task conceptual correspondence, Experiment 2 assessed whether these latter tasks were sensitive in detecting racial biases by using both White and Black task actors and again examined their relationships with the race-IAT. Method In two lab-based experiments, 226 and 237 participants completed the race-IAT followed by an extensive battery of social cognition measures. Results Across both experiments, pro-White/anti-Black bias on the race-IAT was positively related to a pro-White bias on explicit measures of positive affective empathy. However, relationships between the race-IAT and implicit imitative tendencies, perspective taking, emotion recognition, and explicit trait and negative state affective empathy were statistically equivalent. Conclusion The race-IAT was consistently related to explicit measures of positive state affective empathy but not to other individual difference measures of implicit social cognition. These findings are discussed with regards to the theoretical underpinnings of the race-IAT as an individual difference measure of implicit social cognition, as well as alternative explanations relating to the reliability of social cognition measures and the various combinations of general-purpose (social and non-social) executive processes that underpin performance on these tasks.
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Affiliation(s)
| | - Matthew Ploszajski
- Department of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Parmesh Mistry
- School of Psychology, Aston University, Birmingham, United Kingdom
| | - Nicola NgOmbe
- School of Psychology, Aston University, Birmingham, United Kingdom
- Chair of Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Charlotte Back
- Department of Health and Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Sam Parsons
- Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Daniel J. Shaw
- School of Psychology, Aston University, Birmingham, United Kingdom
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Comeau D, Johnson C, Bouhamdani N. Review of current 2SLGBTQIA+ inequities in the Canadian health care system. Front Public Health 2023; 11:1183284. [PMID: 37533535 PMCID: PMC10392841 DOI: 10.3389/fpubh.2023.1183284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
Gender identity and sexual orientation are determinants of health that can contribute to health inequities. In the 2SLGBTQIA+ community, belonging to a sexual and/or gender minority group leads to a higher risk of negative health outcomes such as depression, anxiety, and cancer, as well as maladaptive behaviors leading to poorer health outcomes such as substance abuse and risky sexual behavior. Empirical evidence suggests that inequities in terms of accessibility to health care, quality of care, inclusivity, and satisfaction of care, are pervasive and entrenched in the health care system. A better understanding of the current Canadian health care context for individuals of the 2SLGBTQIA+ community is imperative to inform public policy and develop sensitive public health interventions to make meaningful headway in reducing inequity. Our search strategy was Canadian-centric and aimed at highlighting the current state of 2SLGBTQIA+ health inequities in Canada. Discrimination, patient care and access to care, education and training of health care professionals, and crucial changes at the systemic and infrastructure levels have been identified as main themes in the literature. Furthermore, we describe health care-related disparities in the 2SLGBTQIA+ community, and present available resources and guidelines that can guide healthcare providers in narrowing the gap in inequities. Herein, the lack of training for both clinical and non-clinical staff has been identified as the most critical issue influencing health care systems. Researchers, educators, and practitioners should invest in health care professional training and future research should evaluate the effectiveness of interventions on staff attitudinal changes toward the 2SLGBTQIA+ community and the impact on patient outcomes.
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Affiliation(s)
- Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Claire Johnson
- School of Public Policy Studies, Université de Moncton, Moncton, NB, Canada
| | - Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Medicine and Health Sciences Faculty, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
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Hassan S, Gujral UP, Quarells RC, Rhodes EC, Shah MK, Obi J, Lee WH, Shamambo L, Weber MB, Narayan KMV. Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. Lancet Diabetes Endocrinol 2023; 11:509-524. [PMID: 37356445 PMCID: PMC11070656 DOI: 10.1016/s2213-8587(23)00129-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 06/27/2023]
Abstract
Type 2 diabetes disparities in the USA persist in both the prevalence of disease and diabetes-related complications. We conducted a literature review related to diabetes prevention, management, and complications across racial and ethnic groups in the USA. The objective of this review is to summarise the current understanding of diabetes disparities by examining differences between and within racial and ethnic groups and among young people (aged <18 years). We also examine the pathophysiology of diabetes as it relates to race and ethnic differences. We use a conceptual framework built on the socioecological model to categorise the causes of diabetes disparities across the lifespan looking at factors in five domains of health behaviours and social norms, public awareness, structural racism, economic development, and access to high-quality care. The range of disparities in diabetes prevalence and management in the USA calls for a community-engaged and multidisciplinary approach that must involve community partners, researchers, practitioners, health system administrators, and policy makers. We offer recommendations for each of these groups to help to promote equity in diabetes prevention and care in the USA.
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Affiliation(s)
- Saria Hassan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA.
| | - Unjali P Gujral
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Rakale C Quarells
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Elizabeth C Rhodes
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - Megha K Shah
- Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Jane Obi
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA
| | - Wei-Hsuan Lee
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Luwi Shamambo
- Department of Medicine, Emory University, Atlanta, GA, USA
| | - Mary Beth Weber
- Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
| | - K M Venkat Narayan
- Department of Medicine, Emory University, Atlanta, GA, USA; Emory School of Medicine, and the Nutrition and Health Sciences Doctoral Program, Laney Graduate School, Emory University, Atlanta, GA, USA; Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA, USA
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Hoffman BL, Sidani JE, Jonassaint CR, Wolynn R, Donovan AK. Utilizing Television Clips for Graduate Medical Education Anti-racist Curricula: An Acceptability Study. Cureus 2023; 15:e41526. [PMID: 37551225 PMCID: PMC10404454 DOI: 10.7759/cureus.41526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/03/2023] [Indexed: 08/09/2023] Open
Abstract
Introduction Racism is a pervasive social problem that influences medicine, highlighting the need for interventions. One promising educational technique, referred to as edutainment, utilizes clips from television shows as an instructive strategy. The objective of this study was to examine the acceptability of edutainment around anti-racist curricula for residents. Methods We conducted a survey of underrepresented in medicine (URM) medical faculty to inform content for subsequent focus groups with medicine, psychiatry, and pediatrics residents. For the survey, URM faculty were randomly assigned to view four of eight clips and responded to close- and open-ended items. Focus group participants viewed selected clips and provided feedback. All study procedures occurred in 2020-2021. We calculated descriptive statistics for close-ended survey items and employed thematic analysis for open-ended items and focus group transcripts. Results Twelve URM faculty completed the survey. Feedback was uniformly positive so we included all eight clips in the resident focus groups. For each of the three participating specialties, we conducted two focus groups (2-11 participants each, total n=25) with participants viewing four of the eight clips. Analysis of focus group transcripts found that participants were receptive to the edutainment approach. Feedback as to the realism and acceptability of certain clips differed by specialty. Triangulation of survey and focus group results found differences in the acceptability of specific clips between residents and faculty. Conclusion Edutainment with medical television shows may be a promising avenue for anti-racist curricular content for residents. The educational methods described here are being incorporated into a multi-pronged, hospital system wide graduate medical education anti-racist curriculum.
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Affiliation(s)
- Beth L Hoffman
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA
| | - Jaime E Sidani
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA
| | - Charles R Jonassaint
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Riley Wolynn
- Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, Pittsburgh, USA
| | - Anna K Donovan
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
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Hutcheson NR, Carter B, Cowden J, Turner B. Implicit Racial Bias Attitudes and Mitigation in Neonatal Nurse Practitioners: A Quality Improvement Project. Neonatal Netw 2023; 42:192-201. [PMID: 37491036 DOI: 10.1891/nn-2023-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE to assess the impact of education using the implicit bias recognition and management (IBRM) teaching approach. DESIGN longitudinal quasi-experimental design. Surveys at baseline, immediate postimplementation, and 4-week postimplementation using the modified version of the Attitudes Toward Implicit Bias Instrument (ATIBI). The 4-week survey included items about implicit bias recognition and mitigation strategies. SAMPLE thirty-six neonatal nurse practitioners assigned to the NICU in a Midwest urban children's hospital. RESULTS one-way repeated-measures analysis of variance was used, and the score range was 16-96. The results showed a statistically significant model, F (1.49, 707.97) = 34.46, p <.001, partial η2 = 0.496. Pairwise comparisons showed improvement from pre (M = 73.08, SD = 9.36) to immediate postimplementation (M = 80.06, SD = 8.19), p <.001. Scores were sustained at 4-week postimplementation (M = 79.28, SD = 10.39), p = .744. CONCLUSIONS The IBRM teaching approach improved scores from baseline on a modified ATIBI that remained improved 4 weeks after the education.
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Joshi S, Karki A, Rushton S, Koirala B, Basnet S, Rijal B, Karki J, Pohl G, Baidya M, Chater T, Green D, Lee A. Gender and caste inequalities in primary healthcare usage by under-5 children in rural Nepal: an iterative qualitative study into provider perspectives and the potential role of implicit bias. BMJ Open 2023; 13:e069060. [PMID: 37369413 PMCID: PMC10410982 DOI: 10.1136/bmjopen-2022-069060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE This study explored provider perspectives on: (1) why inequalities in health service usage persist; and (2) their knowledge and understanding of the role of patient experience and implicit bias (also referred to as unconscious bias). DESIGN A three stage, iterative qualitative study was conducted involving two rounds of in-depth interviews and a training session with healthcare staff. Interview transcripts were analysed using a reflexive thematic approach in relation to the study's aims. SETTING Participants were recruited from rural hill districts (Mugu, Humla, Bajura, Gorkha and Sindhupalchok) of Nepal. PARTICIPANTS Clinical staff from 22 rural health posts. RESULTS Healthcare providers had high levels of understanding of the cultural, educational and socioeconomic factors behind inequalities in healthcare usage in their communities. However, there was less knowledge and understanding of the role of patient experience-and no recognition at all of the concept of implicit bias. CONCLUSION It is highly likely that implicit bias affects provider behaviours in Nepal, just as it does in other countries. However, there is currently not a culture of thinking about the patient experience and how that might impact on future usage of health services. Implicit bias training for health students and workers would help create greater awareness of unintended discriminatory behaviours. This in turn may play a part in improving patient experience and future healthcare usage, particularly among disadvantaged groups.
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Affiliation(s)
| | | | - Simon Rushton
- Department of Politics and International Relations, The University of Sheffield, Sheffield, UK
| | | | | | | | - Jiban Karki
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Tim Chater
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, UK
| | - Dan Green
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Andrew Lee
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Thompson J, Bujalka H, McKeever S, Lipscomb A, Moore S, Hill N, Kinney S, Cham KM, Martin J, Bowers P, Gerdtz M. Educational strategies in the health professions to mitigate cognitive and implicit bias impact on decision making: a scoping review. BMC MEDICAL EDUCATION 2023; 23:455. [PMID: 37340395 DOI: 10.1186/s12909-023-04371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/17/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Cognitive and implicit biases negatively impact clinicians' decision-making capacity and can have devastating consequences for safe, effective, and equitable healthcare provision. Internationally, health care clinicians play a critical role in identifying and overcoming these biases. To be workforce ready, it is important that educators proactively prepare all pre-registration healthcare students for real world practice. However, it is unknown how and to what extent health professional educators incorporate bias training into curricula. To address this gap, this scoping review aims to explore what approaches to teaching cognitive and implicit bias, for entry to practice students, have been studied, and what are the evidence gaps that remain. METHODS This scoping review was guided by the Joanna Briggs Institute (JBI) methodology. Databases were searched in May 2022 and included CINAHL, Cochrane, JBI, Medline, ERIC, Embase, and PsycINFO. The Population, Concept and Context framework was used to guide keyword and index terms used for search criteria and data extraction by two independent reviewers. Quantitative and qualitative studies published in English exploring pedagogical approaches and/or educational techniques, strategies, teaching tools to reduce the influence of bias in health clinicians' decision making were sought to be included in this review. Results are presented numerically and thematically in a table accompanied by a narrative summary. RESULTS Of the 732 articles identified, 13 met the aim of this study. Most publications originated from the United States (n=9). Educational practice in medicine accounted for most studies (n=8), followed by nursing and midwifery (n=2). A guiding philosophy or conceptual framework for content development was not indicated in most papers. Educational content was mainly provided via face-to-face (lecture/tutorial) delivery (n=10). Reflection was the most common strategy used for assessment of learning (n=6). Cognitive biases were mainly taught in a single session (n=5); implicit biases were taught via a mix of single (n=4) and multiple sessions (n=4). CONCLUSIONS A range of pedagogical strategies were employed; most commonly, these were face-to-face, class-based activities such as lectures and tutorials. Assessments of student learning were primarily based on tests and personal reflection. There was limited use of real-world settings to educate students about or build skills in biases and their mitigation. There may be a valuable opportunity in exploring approaches to building these skills in the real-world settings that will be the workplaces of our future healthcare workers.
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Affiliation(s)
- John Thompson
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia.
| | - Helena Bujalka
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Stephen McKeever
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Adrienne Lipscomb
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Sonya Moore
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Nicole Hill
- Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Sharon Kinney
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
- Royal Children's Hospital, Parkville, Australia
| | - Kwang Meng Cham
- Department of Optometry and Vision Sciences, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Martin
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
| | - Patrick Bowers
- Department of Audiology and Speech Pathology, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Level 6, Alan Gilbert Building, 161 Barry Street, Victoria, 3010, Australia
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Gonzalez CM, Onumah CM, Walker SA, Karp E, Schwartz R, Lypson ML. Implicit bias instruction across disciplines related to the social determinants of health: a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:541-587. [PMID: 36534295 DOI: 10.1007/s10459-022-10168-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/27/2022] [Indexed: 05/11/2023]
Abstract
One criticism of published curricula addressing implicit bias is that few achieve skill development in implicit bias recognition and management (IBRM). To inform the development of skills-based curricula addressing IBRM, we conducted a scoping review of the literature inquiring, "What interventions exist focused on IBRM in professions related to social determinants of health: education, law, social work, and the health professions inclusive of nursing, allied health professions, and medicine?"Authors searched eight databases for articles published from 2000 to 2020. Included studies: (1) described interventions related to implicit bias; and (2) addressed knowledge, attitude and/or skills as outcomes. Excluded were interventions solely focused on reducing/neutralizing implicit bias. Article review for inclusion and data charting occurred independently and in duplicate. Investigators compared characteristics across studies; data charting focused on educational and assessment strategies. Fifty-one full-text articles for data charting and synthesis, with more than 6568 learners, were selected. Educational strategies included provocative/engagement triggers, the Implicit Association Test, reflection and discussion, and various active learning strategies. Most assessments were self-report, with fewer objective measures. Eighteen funded studies utilized federal, foundation, institutional, and private sources. This review adds to the literature by providing tangible examples of curricula to complement existing frameworks, and identifying opportunities for further research in innovative skills-based instruction, learner assessment, and development and validation of outcome metrics. Continued research addressing IBRM would enable learners to develop and practice skills to recognize and manage their implicit biases during clinical encounters, thereby advancing the goal of improved, equitable patient outcomes.
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Affiliation(s)
- Cristina M Gonzalez
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, USA.
| | - Chavon M Onumah
- Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Sydney A Walker
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Elisa Karp
- Department of Pediatrics, North Central Bronx Hospital, Bronx, NY, USA
| | | | - Monica L Lypson
- Columbia University Irving Medical Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
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Rider EA, Chou C, Abraham C, Weissmann P, Litzelman DK, Hatem D, Branch W. Longitudinal faculty development to improve interprofessional collaboration and practice: a multisite qualitative study at five US academic health centres. BMJ Open 2023; 13:e069466. [PMID: 37076167 PMCID: PMC10124268 DOI: 10.1136/bmjopen-2022-069466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVES Interprofessional (IP) collaboration and effective teamwork remain variable in healthcare organisations. IP bias, assumptions and conflicts limit the capacity of healthcare teams to leverage the expertise of their members to meet growing complexities of patient needs and optimise healthcare outcomes. We aimed to understand how a longitudinal faculty development programme, designed to optimise IP learning, influenced its participants in their IP roles. DESIGN In this qualitative study, using a constructivist grounded theory approach, we analysed participants' anonymous narrative responses to open-ended questions about specific knowledge, insights and skills acquired during our IP longitudinal faculty development programme and applications of this learning to teaching and practice. SETTING Five university-based academic health centres across the USA. PARTICIPANTS IP faculty/clinician leaders from at least three different professions completed small group-based faculty development programmes over 9 months (18 sessions). Site leaders selected participants from applicants forecast as future leaders of IP collaboration and education. INTERVENTIONS Completion of a longitudinal IP faculty development programme designed to enhance leadership, teamwork, self-knowledge and communication. RESULTS A total of 26 programme participants provided 52 narratives for analysis. Relationships and relational learning were the overarching themes. From the underlying themes, we developed a summary of relational competencies identified at each of three learning levels: (1) Intrapersonal (within oneself): reflective capacity/self-awareness, becoming aware of biases, empathy for self and mindfulness. (2) Interpersonal (interacting with others): listening, understanding others' perspectives, appreciation and respect for colleagues and empathy for others. (3) Systems level (interacting within organisation): resilience, conflict engagement, team dynamics and utilisation of colleagues as resources. CONCLUSIONS Our faculty development programme for IP faculty leaders at five US academic health centres achieved relational learning with attitudinal changes that can enhance collaboration with others. We observed meaningful changes in participants with decreased biases, increased self-reflection, empathy and understanding of others' perspectives and enhanced IP teamwork.
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Affiliation(s)
- Elizabeth A Rider
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Calvin Chou
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Corrine Abraham
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Peter Weissmann
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Debra K Litzelman
- Department of Medicine, Regenstrief Institute, Indianapolis, Indiana, USA
- Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Hatem
- Department of Medicine, University of Massachusetts T H Chan School of Medicine, Worcester, Massachusetts, USA
| | - William Branch
- Medicine, Emory University, Atlanta, Georgia, USA
- Medicine, Emory Clinic, Atlanta, Georgia, USA
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Renbarger KM, Phelps B, Broadstreet A. Provider Characteristics That Hinder Relationships with Black Women in the Perinatal Period. West J Nurs Res 2023; 45:215-225. [PMID: 36016493 DOI: 10.1177/01939459221120390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Black women have often reported challenges in their relationships with health care providers during the perinatal period. This study synthesized the findings of qualitative studies to describe health care providers' characteristics that hinder therapeutic relationships with Black women in the perinatal period. A systematic search was conducted and findings from 12 qualitative studies were synthesized using a thematic synthesis approach. Two overarching themes that included seven descriptive themes were discovered. The seven descriptive themes include the following: (1) provides differential treatment; (2) expresses biased attitudes; (3) lacks empathy; (4) limits choices; (5) communicates inadequate health information; (6) provides deficient care; and (7) dismisses concerns. Participants experienced challenged relationships with health care providers who held implicit biases and discouraged them from participating in their care. The findings suggest the importance of confronting implicit biases, promoting a bias-free health care system, and providing quality care that is respectful to Black women in the perinatal period.
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Garrett SB, Walia A, Miller F, Tahir P, Jones L, Harris J, Powell B, Chambers B, Simon MA. Antibias Efforts in United States Maternity Care: A Scoping Review of the Publicly Funded Health Equity Intervention Pipeline. Clin Obstet Gynecol 2023; 66:110-123. [PMID: 36583638 PMCID: PMC9851967 DOI: 10.1097/grf.0000000000000761] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Antibias training is increasingly identified as a strategy to reduce maternal health disparities. Evidence to guide this work is limited. We conducted a community-guided scoping review to characterize new antibias research. Four of 508 projects met our criteria: US-based, publicly funded, initiated from January 1, 2018 to June 30, 2022, and featuring an intervention to reduce bias or racism in maternal health care providers. Training was embedded in multicomponent interventions in 3 projects, limiting its evaluation as a stand-alone intervention. Major public funders have sponsored few projects to advance antibias training research in maternal health. More support is needed to develop a rigorous and scalable evidence base.
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Affiliation(s)
- Sarah B. Garrett
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Anjali Walia
- School of Medicine, University of California, San Francisco, CA
| | - Fiona Miller
- School of Medicine, University of California, San Francisco, CA
| | - Peggy Tahir
- University of California San Francisco Library, University of California, San Francisco, CA
| | - Linda Jones
- California Preterm Birth Initiative, University of California, San Francisco, CA
| | - Julie Harris
- California Preterm Birth Initiative, University of California, San Francisco, CA
| | - Breezy Powell
- California Preterm Birth Initiative, University of California, San Francisco, CA
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