Attitudes Toward Implicit Bias Among Athletic Trainers

Implicit biases are attitudes, emotions, or stereotypes that occur in an unconscious manner and have the potential to negatively affect behaviors, actions, and decisions. Recent studies have suggested that even when certain factors are controlled for, health care workers do not provide equitable care to patients from different demographics. When patients are not receiving equitable health care, there is a potential for disparities in patient-related outcomes. The purpose of this study was to determine attitudes toward implicit bias among athletic trainers. A secondary purpose of this study was to assess differences and correlations between attitudes toward implicit bias and demographic factors including age, years of experience, gender identity, sexual orientation, and race. Participants were recruited for this study by emailing athletic trainers from publicly available staff directories at institutions of higher education and high schools, and athletic training education program directors. The survey consisted of questions gathering demographic information and questions taken from the Attitudes Toward Implicit Bias Instrument. A total of 218 athletic trainers (age = 38 [11] y, years of certified experience = 14 [11] y) opened and completed the survey. On average, participants scored 71.0 [11.2] on the Attitudes Toward Implicit Bias Instrument. This mean score indicated that the average participant felt that implicit bias had the potential to negatively impact patient care and needed to be addressed through education. There was a significant, negligible negative correlation between age and attitudes toward implicit bias (r[216] = -.157, P = .02). Examining implicit bias among athletic trainers warrants further research to understand how implicit bias can negatively affect access to equitable health care opportunities. The development of high-quality interventions for identifying and addressing implicit bias is crucial to ensuring optimal patient outcomes in athletic training and all medical settings.

Implicit racial bias among dental hygienists practicing in the United States

PURPOSE

Provider bias has been shown to be a contributing factor to racial and ethnic disparities observed in health care settings. The purpose of this study was to examine implicit racial bias among dental hygienists.

METHODS

A convenience sample of licensed and practicing dental hygienists within the United States was recruited through email and national dental hygiene social media groups via snowball sampling. A two-part survey design was used for data collection. Participants completed a 10-item demographic survey through an online platform and were then routed to the Race Implicit Association Test (IAT). Descriptive statistics and linear regression analyses were used to compare demographic data and implicit racial preference scores (d-scores).

RESULTS

Data from 404 licensed dental hygienists were included in this study. Over two-thirds (67.8%) of participants showed a preference for European Americans over African Americans. A significant difference was found between implicit racial preference scores and participant age (Estimate: 0.01, 95% CI: 0.00, 0.01), years worked comparing <5 years to 21 or more years (Estimate: 0.19, 95% CI: -0.30, -0.09) and race comparing non-White to White (Estimate: -0.17, 95% CI: -0.27, -0.07). No difference was found with task order, previous Race IAT experience, or previous self-reported implicit bias training.

CONCLUSIONS

Findings suggest that dental hygienists may harbor implicit racial preferences for European Americans over African Americans. Non-White participants had more positive implicit preferences toward African Americans compared to White participants. Further research is needed to determine the extent to which implicit racial biases contribute to disparities in oral health.

Using facial expressions instead of response keys in the implicit association test

Previous research found that when people are instructed to smile toward liked objects and show negative facial expressions toward disliked objects, their facial response is faster and more intense than when they are required to smile toward disliked objects and express negative facial response toward liked objects. The present research tested a technologically innovative indirect evaluation measure that was based on that finding. Participants completed an implicit association test (IAT)-a common indirect measure of evaluation, responding with their emotional facial expressions, rather than by pressing response keys. In two web studies, using emotional facial expression detection through a webcam, we found that the Facial Response IAT (FR-IAT) is a reliable and valid measure of evaluations, comparable to the keyboard IAT. Because facial responses provide more information than key responses, pursuing future improvements of the FR-IAT's methodology, software, and data analysis is a promising direction for enhancing the quality of indirect evaluation measurement. The same methodology and technology may also enhance other indirect measures of evaluation and cognitive tests related to emotion and judgment.

Implicit Sexual Cognitions in Women with Ambiphilic Sexual Attractions: A Comparison to Androphilic and Gynephilic Women

Previous research using indirect cognitive measures (sometimes referred to as implicit measures) of sexual attraction have shown that women who are attracted to men (androphilic women) show category non-specific responses, whereas those who are attracted to women (gynephilic) show a category-specific bias to women. The purpose of the present study was to examine whether women who explicitly report approximately equal attraction to men and women (ambiphilic) would show similar non-category specific attraction at this implicit level or whether their responses would be more similar to those of gynephilic women. An implicit association task and a priming task were given to 169 women alongside measures of their self-labelled sexual orientation and an explicit measure of their sexual attraction to men and women. The results replicated previous findings of little bias towards either gender in androphilic women and of a strong bias towards females in gynephilic women. The ambiphilic women also showed a strong bias towards females. The findings clearly show that early automatic associations to sex are biased towards females in ambiphilic women and are not consistent with their explicit statements of preference.

The Good, the Bad and the Hijab: A Study of Implicit Associations Made by Practicing Muslims in Their Native Muslim Country

Recent research indicates that wearing the hijab reduces the attractiveness of female faces perceived by practicing Muslim men and women in their native Muslim country (the United Arab Emirates). The purpose of the current research was to develop this finding to investigate whether other aspects of person perception are also affected when women wear the hijab in this Muslim country. Of particular relevance is that changes in physical attractiveness often affect the personal qualities assigned to individuals. Accordingly, we sought to determine whether such effects occur when the physical attractiveness of women is altered by wearing the hijab. To do this, we used an Implicit Association Test (IAT) to investigate how native Muslim participants in the UAE associated pleasant and unpleasant connotations with images of women either wearing the hijab or with their heads uncovered. As in previous research with native Muslim participants, female faces were again perceived as significantly less attractive when the hijab was worn. However, the accompanying IAT findings showed that these less attractive hijab-wearing images were associated more with pleasant connotations than were the matched uncovered images. These findings provide fresh insight into the effects of the hijab on perceptions of Muslim women in a Muslim country and provide support for the view that cultural clothing can influence person perception beyond physical attractiveness alone.

Forgive or complain: Interpersonal distance modulates reactive attitudes and neural responses toward wrongdoers

While the effect of interpersonal distance on forgiveness has been investigated over the past few years, it remains unclear whether this facilitating effect holds even when measured implicitly. Meanwhile, though cognitive control and the corresponding prefrontal cortex play a prominent role in forgiveness processing, the neural mechanism underlying forgiveness toward varied wrongdoers is largely unexplored. Here, forty-two participants initially underwent noise offense either from their friend or stranger, followed by a word identification test to examine their implicit attitude, during which they were presented with word-name combinations and required to categorize forgive- or complain-label words while ignoring the names of their friends or strangers below. A shorter reaction time reflects more congruence with one's implicit attitude. Electroencephalogram was recorded during the word identification test. Behaviorally, while individuals reacted faster to forgive-friend relative to complain-friend pairings, no such reaction bias was found for the stranger-wrongdoer, which suggests that individuals were more inclined to forgive someone close. Regarding the EEG/ERP results, forgive-friend elicited lower alpha oscillation and more negative frontal alpha asymmetry (FAA) value than complain-friend combinations, suggesting increased and dominant activity in the right prefrontal network during forgiveness toward friends. Whereas complain- relative to forgive-stranger combinations elicited larger P3 amplitudes, suggesting a neural encoding bias to information associated with complaints about stranger-wrongdoer. These multimodal findings provide evidence for the benefits of closeness in forgiveness and shed light on the neural mechanisms underlying forgiveness toward different types of wrongdoers.

Relationships between the race implicit association test and other measures of implicit and explicit social cognition

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.

Optimizing appreciation and persuasion of embodied conversational agents for health behavior change: A design experiment and focus group study

Embodied Conversational Agents (ECAs) can increase user engagement and involvement and can strengthen the effect of an intervention on health outcomes that is provided via an ECA. However, evidence regarding the effectiveness of ECAs on health outcomes is still limited. In this article, we report on a study that has the goal to identify the effect of a match between a health topic and the ECAs' appearance on ratings of personality characteristics, persuasiveness and intention to use. We report on an online experiment with three different ECAs and three different health topics, conducted among 732 older adults. We triangulated the quantitative results with qualitative insights from a focus group. The results reveal that older adults prefer an ECA that has an appearance matching a certain health topic, resulting in higher ratings on persuasiveness and intention to use. Personality characteristics should be measured embedded within a health topic, but are not rated higher because of a match. We furthermore provide guidelines for designing the content of the ECA.

Crossmodal associations between visual textures and temperature concepts

Visual textures are critical in how individuals form sensory expectations about objects, which include somatosensory properties such as temperature. This study aimed to uncover crossmodal associations between visual textures and temperature concepts. In Experiment 1 (N = 193), we evaluated crossmodal associations between 43 visual texture categories and different temperature concepts (via temperature words such as cold and hot) using an explicit forced-choice test. The results revealed associations between striped, cracked, matted, and waffled visual textures and high temperatures and between crystalline and flecked visual textures and low temperatures. In Experiment 2 (N = 247), we conducted six implicit association tests (IATs) pairing the two visual textures most strongly associated with low (crystalline and flecked) and high (striped and cracked) temperatures with the words cold and hot as per the results of Experiment 1. When pairing the crystalline and striped visual textures, the results revealed that crystalline was matched to the word cold, and striped was matched to the word hot. However, some associations found in the explicit test were not found in the IATs. In Experiment 3 (N = 124), we investigated how mappings between visual textures and concrete entities may influence crossmodal associations with temperature and these visual textures. Altogether, we found a range of association strengths and automaticity levels. Importantly, we found evidence of relative effects. Furthermore, some of these crossmodal associations are partly influenced by indirect mappings to concrete entities.

The project implicit international dataset: Measuring implicit and explicit social group attitudes and stereotypes across 34 countries (2009-2019)

For decades, researchers across the social sciences have sought to document and explain the worldwide variation in social group attitudes (evaluative representations, e.g., young-good/old-bad) and stereotypes (attribute representations, e.g., male-science/female-arts). Indeed, uncovering such country-level variation can provide key insights into questions ranging from how attitudes and stereotypes are clustered across places to why places vary in attitudes and stereotypes (including ecological and social correlates). Here, we introduce the Project Implicit:International (PI:International) dataset that has the potential to propel such research by offering the first cross-country dataset of both implicit (indirectly measured) and explicit (directly measured) attitudes and stereotypes across multiple topics and years. PI:International comprises 2.3 million tests for seven topics (race, sexual orientation, age, body weight, nationality, and skin-tone attitudes, as well as men/women-science/arts stereotypes) using both indirect (Implicit Association Test; IAT) and direct (self-report) measures collected continuously from 2009 to 2019 from 34 countries in each country's native language(s). We show that the IAT data from PI:International have adequate internal consistency (split-half reliability), convergent validity (implicit-explicit correlations), and known groups validity. Given such reliability and validity, we summarize basic descriptive statistics on the overall strength and variability of implicit and explicit attitudes and stereotypes around the world. The PI:International dataset, including both summary data and trial-level data from the IAT, is provided openly to facilitate wide access and novel discoveries on the global nature of implicit and explicit attitudes and stereotypes.

Diversity training experiences and factors associated with implicit racial bias among recent genetic counselor graduates of accredited programs in the United States and Canada

Implicit racial bias in healthcare settings can impact delivery of patient care. Exploration of this bias is necessary to improve patient experiences. We sought to understand implicit racial bias among graduates of accredited genetic counseling programs in the United States and Canada in the class of 2020 as they enter the genetics workforce and assess how this bias is associated with training and life experiences. Implicit racial bias was quantified through use of the Black-White Implicit Association Test (BW-IAT). Participants also completed an online survey focused on didactic and clinical training and personal experiences with diverse populations. Participants (n = 100) were majority White (88%), and 44% demonstrated an implicit bias favoring White individuals. Respondents reported a lack of interaction with Black healthcare professionals during their training. A concerning proportion (38%) reported experiencing or witnessing racial insensitivity perpetrated by genetic counselors or physicians in supervisory roles. Graduates reported diversity coursework as significantly less effective overall than other general genetic counseling coursework. This study reveals prevalence of implicit racial bias among genetic counselor graduates, lack of exposure to diverse populations within and outside of graduate training, and concerns regarding racial insensitivity and effectiveness of didactic and clinical genetic counseling training. Employers and program directors should implement revisions to ongoing training and graduate curriculum with consideration of these findings.

Anomalies in implicit attitudes research

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

Implicit associations related to physical disability among nursing students

BACKGROUND

Negative beliefs about disability are associated with poorer outcomes for individuals with disabilities; understanding disability-related attitudes is critical for clinical care. Recently, interest in attitudes toward people with disabilities has increased; however, most studies focus on explicit attitudes. In contrast, the Disability Attitude Implicit Association Test (DA-IAT) is designed to evaluate respondents' underlying automatic preferences regarding physical ability.

OBJECTIVE

The aim of this pilot study was to expand the literature on health professionals' implicit disability attitudes by analyzing the DA-IAT in a sample of nursing students.

METHODS

A cross-sectional design was utilized with a sample of nursing students (n = 95; 88.7% female). Respondents completed the DA-IAT online before responding to some basic demographic questions.

RESULTS

Participants associated able-bodied status with positive descriptors more quickly than disability related stimuli.

CONCLUSIONS

Most participants in this sample of nursing students (87%) mentally associated able-bodiedness with desirable traits in a more efficient manner than disability. Future research should focus on developing models to better understand the relationship between automatic processing, disability-related attitudes, and how this relationship informs clinician behavior.

Invalid Claims About the Validity of Implicit Association Tests by Prisoners of the Implicit Social-Cognition Paradigm

In a prior publication, I used structural equation modeling of multimethod data to examine the construct validity of Implicit Association Tests. The results showed no evidence that IATs measure implicit constructs (e.g., implicit self-esteem, implicit racial bias). This critique of IATs elicited several responses by implicit social-cognition researchers, who tried to defend the validity and usefulness of IATs. I carefully examine these arguments and show that they lack validity. IAT proponents consistently ignore or misrepresent facts that challenge the validity of IATs as measures of individual differences in implicit cognitions. One response suggests that IATs can be useful even if they merely measure the same constructs as self-report measures, but I find no support for the claim that IATs have practically significant incremental predictive validity. In conclusions, IATs are widely used without psychometric evidence of construct or predictive validity.

Brain responses of dysphoric and control participants during a self-esteem implicit association test

Previous studies have reported lowered implicit self-esteem at the behavioral level among depressed individuals. However, brain responses related to the lowered implicit self-esteem have not been investigated in people with depression. Here, event-related potentials were measured in 28 dysphoric participants (individuals with elevated amounts of depressive symptoms) and 30 control participants during performance of an implicit association task (IAT) suggested to reflect implicit self-esteem. Despite equivalent behavioral performance, differences in brain responses were observed between the dysphoric and the control groups in late positive component (LPC) within 400-1,000 ms poststimulus latency. For the dysphoric group, self-negativity mapping stimuli (me with negative word pairing and not-me with positive word pairing) induced significantly larger LPC amplitude as compared to self-positivity mapping stimuli (me with positive pairing and not-me with negative pairing), whereas the control group showed the opposite pattern. These results suggest a more efficient categorization toward implicit self-is-negative association, possibly reflecting lower implicit self-esteem among the dysphoric participants, in comparison to the controls. These results demonstrate the need for further investigation into the functional significance of LPC modulation during IAT and determination of whether LPC can be used as a neural marker of depressive-related implicit self-esteem.

Can the Implicit Association Test Serve as a Valid Measure of Automatic Cognition? A Response to Schimmack (2021)

Much of human thought, feeling, and behavior unfolds automatically. Indirect measures of cognition capture such processes by observing responding under corresponding conditions (e.g., lack of intention or control). The Implicit Association Test (IAT) is one such measure. The IAT indexes the strength of association between categories such as “planes” and “trains” and attributes such as “fast” and “slow” by comparing response latencies across two sorting tasks (planes–fast/trains–slow vs. trains–fast/planes–slow). Relying on a reanalysis of multitrait–multimethod (MTMM) studies, Schimmack (this issue, p. 396) argues that the IAT and direct measures of cognition, for example, Likert scales, can serve as indicators of the same latent construct, thereby purportedly undermining the validity of the IAT as a measure of individual differences in automatic cognition. Here we note the compatibility of Schimmack’s empirical findings with a range of existing theoretical perspectives and the importance of considering evidence beyond MTMM approaches to establishing construct validity. Depending on the nature of the study, different standards of validity may apply to each use of the IAT; however, the evidence presented by Schimmack is easily reconcilable with the potential of the IAT to serve as a valid measure of automatic processes in human cognition, including in individual-difference contexts.