___________________________________________________________________ Implicit Bias in Health Care
• Did I think about any socioeconomic and/or environ- mental factors that may contribute to the health and access of this patient? • How was my communication and interaction with this patient? Did it change from my customary pattern? • How could my implicit biases influence care for this patient? When reviewing the SOAP notes, providers can look for recurring themes of stereotypical perceptions, biased com- munication patterns, and/or types of treatment/interventions proposed and assess whether these themes could be influenced by biases related to race, ethnicity, age, gender, sexuality, or other social characteristics. Experts have also formulated questions for each of the three stages of reflection to help increase awareness when guiding nursing students through learning about implicit biases [114; 115]: • Awareness: Recall a patient who you considered chal- lenging, difficult, or uncomfortable to be around. • Critical analysis: Do I or did I have an automatic feeling or judgment about this person? Am I being reminded of someone? What is this person triggering in my background? • New perspective: How might I consciously intervene to mitigate the impact of this bias? What can I do differ- ently when similar thoughts, feelings, or emotions arise? A review of empirical studies conducted on the effectiveness of interventions promoting implicit bias awareness found mixed results. At times, after a peer discussion of IAT scores, participants appeared less interested in learning and employing implicit bias reduction interventions. However, other studies have found that receiving feedback along with IAT scores resulted in a reduction in implicit bias [81]. Any feedback, education, and discussions should be structured to minimize participant defensiveness [81].
The two types of interventions are not mutually exclusive and may be used synergistically. In a similar vein, interventions targeted on implicit biases may be categorized as either those that “de-bias” or neutralize or that raise awareness [116]. PERSPECTIVE TAKING Perspective taking is a strategy of taking on a first-person perspective of a person in order to control one’s automatic response toward individuals with certain social characteris- tics that might trigger implicit biases [82; 117]. The goal is to increase psychological closeness and empathy, anticipate others’ feelings and reactions, and facilitate connection with members of the group [4; 117]. Engaging with media that presents a perspective (e.g., watching documentaries, reading an autobiography) can help promote better understanding of the specific group’s lives, experiences, and viewpoints. In one study, participants who adopted the first-person perspectives of African Americans had more positive automatic evaluations of the targeted group [83]. However, one of the critiques to perspective taking is that instead of highlighting similarities, differences can be emphasized and could result in reinforced stereotypes [117].
inter active activity
Consuming media that presents a viewpoint and life experience different from your own can help minimize implicit biases. Visit the following sites and consider how they might challenge or expand your perception of each group. Internet searches can help identify many more options for various social groups. Think Out Loud Podcast Young Black people share their experiences growing up in Portland, Oregon. https://www.opb.org/article/2020/10/30/young- black-people-share-their-experiences-growing-up-in- portland George Takei: Growing Up Asian-American This PBS clip is a brief introduction, and the subject can be further explored in Takei’s book They Called Us Enemy . https://www.pbs.org/wnet/pioneers-of-television/ video/george-takei-growing-up-asian-american Seattle Public Library LGBTQ Staff Picks A reading list including books and films focusing on LGBTQ+ life, culture, history, and politics. https://www.spl.org/programs-and-services/social- justice/lgbtq/lgbt-staff-picks
INTERVENTIONS TO REDUCE IMPLICIT BIASES
Interventions or strategies designed to reduce implicit bias may be further categorized as change-based or control-based [58]. Change-based interventions focus on reducing or changing cognitive associations underlying implicit biases. These inter- ventions might include challenging stereotypes. Conversely, control-based interventions involve reducing the effects of the implicit bias on the individual’s behaviors [58]. These strategies include increasing awareness of biased thoughts and responses.
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