The target/perpetrator brief-implicit association test (B-IAT): an implicit instrument for efficiently measuring discrimination based on race/ethnicity, sex, gender identity, sexual orientation, weight, and age

Implicit Bias in Nursing: Student Reflections

ABSTRACT

Implicit bias can lead to health disparities related to a patient's race, religion, sexual identity, and mental illness. Students responded to the Implicit Association Test for race followed by a structured reflection. Student reflections were evaluated qualitatively. Results hold a key to future educational interventions/training to help nursing students become consciously aware of implicit biases and choose behaviors that are non-biased.

Contextualizing Response Rates During the COVID-19 Pandemic: Experiences From a Boston-Based Community Health Centers Study

OBJECTIVES

The focus of this study was to calculate and contextualize response rates for a community-based study conducted during the COVID-19 pandemic, a topic on which scant data exist, and to share lessons learned from recruiting and enrolling for implementation of future studies.

DESIGN

The Life+Health Study, a cross-sectional population-based study designed to advance novel methods to measure and analyze multiple forms of discrimination for population health research.

SETTING

The study recruited participants from 3 community health centers in Boston, Massachusetts, between May 2020 and July 2022.

PARTICIPANTS

A total of 699 adult participants between the ages of 25 and 64 years who were born in the United States and had visited one of the health centers within the last 2 years.

MAIN OUTCOME MEASURES

The response rate was calculated as follows: (number of completions + number of dropouts)/(dropouts + enrollments). To contextualize this response rate, we synthesized evidence pertaining to local COVID-19 case counts, sociopolitical events, pandemic-related restrictions and project protocol adjustments, and examples of interactions with patients.

RESULTS

Our study had a lower-than-expected response rate (48.4%), with the lowest rates from the community health centers serving primarily low-income patients of color. Completion rates were lower during periods of higher COVID-19 case counts. We describe contextual factors that led to challenges and lessons learned from recruiting during the pandemic, including the impact of US sociopolitical events.

CONCLUSIONS

The Life+Health Study concluded recruitment during the pandemic with a lower-than-expected response rate, as also reported in 4 other US publications focused on the impact of COVID-19 on response rates in community-based studies. Our results provide an example of the impact of the pandemic and related US sociopolitical events on response rates that can serve as a framework for contextualizing other research conducted during the pandemic and highlight the importance of best practices in research recruitment with underserved populations.

Explicit and implicit attitudes toward smoking: Dissociation of attitudes and different characteristics for an implicit attitude in smokers and nonsmokers

Smoking is a global health risk for premature death and disease. Recently, addictive behaviors, like smoking, were considered to be guided by explicit and implicit processes. The existence of a dissociation between the two attitudes in nonsmokers and the causes of the differences in implicit attitudes toward smoking have not been fully investigated. We investigated the explicit and implicit attitudes toward smoking via a self-reported scale and the single category implicit association test (SC-IAT), respectively, among undergraduate and graduate health sciences students. In addition, we applied the drift-diffusion model (DDM) on the SC-IAT and examined the behavioral characteristics that caused differences in implicit attitude toward smoking between smokers and nonsmokers. The results showed the existence of a dissociation between explicit and implicit attitudes toward smoking among nonsmokers. In addition, nonsmokers had a higher decision threshold than smokers and a higher drift rate in the condition where negative words were associated with smoking. Nonsmokers engaged in SC-IAT with more cautious attitudes and responded more easily in a negative condition since it was consistent with their true attitudes. Conversely, smokers did not show a significant difference in the drift rate between the conditions. These results suggested that the differences in an implicit attitude between smokers and nonsmokers were caused by differences in evidence accumulation speed between the positive and negative conditions. The existence of dissociation between implicit and explicit attitudes toward smoking may indicate the difficulty of measuring true attitude in nonsmokers in a questionnaire survey. Additionally, the DDM results explained the difference of implicit attitude between smokers and nonsmokers; it may provide information on the mechanisms of addictive behaviors and a basis for therapy. However, whether these results are affected by cultural differences requires further investigation.

Using Implicit Measures of Discrimination: White, Black, and Hispanic Participants Respond Differently to Group-Specific Racial/Ethnic Categories vs. the General Category "People of Color" in the USA

Recent studies showed that implicit measures are valuable instruments for assessing exposure to discrimination and predicting negative physical conditions. Between March 10, 2020, and April 1, 2020, we conducted three experiments (577 participants) in the USA to evaluate the use of group-specific vs. general race/ethnicity categories in implicit measures of discrimination. We measured implicit discrimination and attitudes towards the general race/ethnicity category "people of color" (POC) and two specific race/ethnicity categories (i.e., "Black people" and "Hispanic people"). Implicit discrimination and attitudes were assessed using the Brief Implicit Association Test (B-IAT). Among participants (mean age = 37, standard deviation = 10.5), 50% identified as White non-Hispanic (NH), 33.3% as Black NH, and 16.7% as Hispanic; 71.7% were female and 72.2% had a bachelor's degree or higher. We found an implicit discrimination towards target groups and an in-group preference among all participant groups only when specific race/ethnicity categories were used in the B-IAT. When the general category POC was used, we observed a discrimination towards POC only for Black NH participants, while White NH participants showed no discrimination. Similarly, Black NH participants showed no in-group preference for POC, but did show an in-group preference for Black people. These results suggest that using the category POC in implicit measures may be inappropriate when evaluating discrimination and attitudes towards Black and Hispanic individuals as it may not capture specific experiences of discrimination and identity in these groups.

Investigating Healthcare Provider Bias Toward Patients Who Use Drugs Using a Survey-based Implicit Association Test: Pilot Study

OBJECTIVES

Negative bias against people who use illicit drugs adversely affects the care that they receive throughout the hospital. We hypothesized that emergency providers would display stronger negative bias toward these patients due to life-threatening contexts in which they treat this population. We also hypothesized that negative implicit bias would be associated with negative explicit bias.

METHODS

Faculty, nurses, and trainees at a midwestern tertiary care academic hospital were invited (June 26, 2019-September 5, 2019) to complete an online implicit association test and explicit bias survey.

RESULTS

Mean implicit association test results did not vary across demographics (n = 79). There were significant differences in explicit bias scores between departments regarding whether patients who use drugs deserve quality healthcare access (P = 0.017). We saw no significant associations between implicit and explicit bias scores.

CONCLUSION

Though limited by sample size, the results indicate that emergency and obstetrics/gynecology providers display more negative explicit bias toward this patient population than other providers.

Implicit Associations between Adverbs of Place and Actions in the Physical and Digital Space

Neuropsychological, behavioral, and neurophysiological evidence indicates that the coding of space as near and far depends on the involvement of different neuronal circuits. These circuits are recruited on the basis of functional parameters, not of metrical ones, reflecting a general distinction of human behavior, which alternatively attributes to the individual the role of agent or observer. Although much research in cognitive psychology was devoted to demonstrating that language and concepts are rooted in the sensorimotor system, no study has investigated the presence of implicit associations between different adverbs of place (far vs. near) and actions with different functional characteristics. Using a series of Implicit Association Test (IAT) experiments, we tested this possibility for both actions performed in physical space (grasp vs. look at) and those performed when using digital technology (content generation vs. content consumption). For both the physical and digital environments, the results showed an association between the adverb near and actions related to the role of agent, and between the adverb far and actions related to the role of observer. Present findings are the first experimental evidence of an implicit association between different adverbs of place and different actions and of the fact that adverbs of place also apply to the digital environment.