___________________________________________________________________ Implicit Bias in Health Care
Stereotype A stereotype is a general association of particular attributes or characteristics to a collective or social group [106]. Positive and negative stereotypes exist related to most individual attributes. Racism Racism is the “systematic subordination of members of tar- geted racial groups who have relatively little social power…by members of the agent racial group who have relatively more social power” [29]. Racism is perpetuated and reinforced by social values, norms, and institutions. There is some controversy regarding whether unconscious (implicit) racism exists. Experts assert that images embedded in our unconscious are the result of socialization and personal observations, and negative attributes may be unconsciously applied to racial minority groups [30]. These implicit attributes affect individuals’ thoughts and behaviors without a conscious awareness. Structural racism refers to the laws, policies, and institutional norms and ideologies that systematically reinforce inequities resulting in differential access to services such as health care, education, employment, and housing for racial and ethnic minorities [31; 32].
Visit https://implicit.harvard.edu/implicit and complete an assessment. Does it reflect your perception of your own biases? Did you learn anything about yourself? inter active activity
Measuring implicit bias is complex, because it requires an instrument that is able to access underlying unconscious processes. While many of the studies on implicit biases have employed the IAT, there are other measures available. They fall into three general categories: the IAT and its variants, prim- ing methods, and miscellaneous measures, such as self-report, role-playing, and computer mouse movements [36]. This course will focus on the IAT, as it is the most commonly employed instrument. It is also important to note that the IAT is more a procedure and less a discrete measurement, because there is not a single IAT. Instead, each specific dimension (e.g., race, gender, age, disability) has its own set of items. After complet- ing the IAT, respondents are provided with results regarding their measured preference such as: “Your responses suggested a strong automatic preference for White people over Black people” [108]. The key term here is “preferences,” which does not necessarily mean implicit bias or negativity. The IAT is not without controversy. One of the debates involves whether IAT scores focus on a cognitive state or if they reflect a personality trait. If it is the latter, the IAT’s value as a diagnostic screening tool is diminished [37]. There is also concern with its validity in specific arenas, including jury selection and hiring [37]. Some also maintain that the IAT is sensitive to social context and may not accurately predict behavior [37]. Essentially, a high IAT score reflecting implicit biases does not necessarily link to discriminating behaviors, and correlation should not imply causation. A meta-analysis involving 87,418 research participants found no evidence that changes in implicit biases affected explicit behaviors [38]. EXTENT OF IMPLICIT BIASES AND RISK FACTORS Among the more than 40 million participants who have completed the IAT at the Project Implicit website, individuals generally exhibited implicit preference for White faces over Black or Asian faces. In addition, there is a general preference for heterosexual people over gay individuals, young over old individuals, thin over obese people, and cisgender over gender and sexual minorities (LGBTQ+) [107]. The Pew Research Center also conducted an exploratory study on implicit biases, focusing on the extent to which individuals adhered to implicit racial biases [40]. A total of 2,517 IATs were completed and used for the analysis. Almost 75% of the respondents exhibited some level of implicit racial biases. Only 20% to 30% did not exhibit or showed very little implicit bias against the minority racial groups tested. Approximately half of all single-race White individuals displayed an implicit preference for White faces over Black faces. For single-race Black individuals, 45% had
MEASUREMENT OF IMPLICIT BIAS: A FOCUS ON THE IAT
Project Implicit is a research project sponsored by Harvard University and devoted to the study and monitoring of implicit biases. It houses the Implicit Association Test (IAT), which is one of the most widely utilized standardized instruments to measure implicit biases. The IAT is based on the premise that implicit bias is an objective and discreet phenomenon that can be measured in a quantitative manner. Developed and first introduced in 1998, it is an online test that assesses implicit bias by measuring how quickly people make associa- tions between targeted categories with a list of adjectives [33]. For example, research participants might be assessed for their implicit biases by seeing how rapidly they make evaluations among the two groups/categories career/family and male/ female. Participants tend to more easily affiliate terms for which they hold implicit or explicit biases. So, unconscious biases are measured by how quickly research participants respond to stereotypical pairings (e.g., career/male and family/female). The larger the difference between the individual’s performance between the two groups, the stronger the degree of bias [34; 35; 107]. Since 2006, more than 4.6 million individuals have taken the IAT, and results indicate that the general population holds implicit biases [3]. By late 2023, more than 80 million study sessions had been conducted and more than 40 million IATs completed at the Project Implicit website [107].
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