You Don't Know What You Think You Know: Implicit Bias in Health Care and Health Education

Meghan Benson, MPH, CHESDirector of Community Education

[email protected] ext. 1

You Don’t Know What You Think You Know: Implicit Bias in Health Care & Health Education

Safe Healthy Strong 2015 ConferenceJune 5, 2015

mailto:[email protected]

I have received no support or commercial funding for this presentation, or for any products mentioned herein.

Copyright © 2015 Planned Parenthood of Wisconsin, Inc.

Objectives

1. Define implicit bias recognizing that it is invasive and powerful in our society and that it impacts our individual attitudes, intentions, and behaviors toward others.

2. Acknowledge that implicit bias often leads to unconscious categorization of others as either “ingroup” or “outgroup” with the tendency of individuals to favor their own “ingroup.”


Objectives

3. List ways in which implicit bias may impact the delivery of effective health care and the provision of effective health education.

4. Recognize that implicit bias is malleable by replacing old mental associations with new ones through the gradual unlearning of bias.

5. List ways in which individuals can immediately recognize and combat implicit bias in practice as well as ways to engage in the gradual “debiasing” over time.


What is implicit bias?

Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner


http://kirwaninstitute.osu.edu/wp-content/uploads/2014/03/2014-implicit-bias.pdf




What is implicit bias?

These biases – which can be positive or negative – are activated involuntarily and without our awareness or intentional control

These biases are different from known biases that we may choose to act on or choose to conceal from others

They do not necessarily align with our declared beliefs or reflect the stances we would explicitly endorse

We all have implicit biases!


Implicit Bias Research

Research has demonstrated implicit bias toward people based on perceived race, ethnicity, gender expression, age, physical disability, body size, and many more characteristics


Implicit Bias Research

Most people show unconscious favoritism toward their “ingroup,” which are people they perceive to be like them (e.g. the same race, the same age, the same gender, etc…), and bias toward others – those they unconsciously identify as “outgroup”


Group Brainstorm


How might implicit bias impact the delivery of health care or

health education?

Implicit Bias in Health Care Research

Negative implicit bias on behalf of health care providers has been correlated with: Decreased client-centered communication More negative client perception of the

health care provider or health care interaction Interpersonal treatment Communication with health care provider Trust in health care provider Health care provider’s contextual knowledge (e.g.

client’s values and beliefs) Differences in clinical decision-making







The ambivalent nature of contemporary racial prejudice may create a mismatch between a physician’s positive verbal behavior (a function of conscious egalitarian values) and negative non-verbal behavior (indicating implicit bias); this is likely to make a physician seem especially untrustworthy and duplicitous to those who are vigilant for cues of bias. (Dovidio & Fiske, 2012)



At least one study suggests that negative implicit bias may even have an impact on patient health outcomes Chae, Nuru-Jeter, & Adler (2012) found a significant

increase in hypertension among African American men (ages 30-50) correlated to both implicit anti-Black bias on behalf of the patient as well as higher self-reports of discrimination

Additional research is needed to determine if implicit bias impacts other health outcomes among this and other demographic groups


Pair & Share


How might implicit bias impact other areas of work or fields

of study?

Want to test your own implicit biases?

Implicit Association Test (IAT) Project Implicit at Harvard University


https://implicit.harvard.edu/implicit/takeatest.html



Implicit Association Test (IAT)

Measures the strength of associations between concepts (e.g. black people or gay people) and evaluations (e.g. good or bad) or stereotypes (e.g. athletic or clumsy)

If we already have positive associations with certain concepts, the task of connecting those concepts to positive evaluations or positive stereotypes is easier and quicker – and vice versa

Raises awareness about our own implicit biases





It’s how we’re wired…

Brain imaging research has demonstrated that the unconscious structures of our brain activate when we express implicit bias

New research suggests that fMRI scans may be even more reliable at recognizing implicit bias than behavioral tasks, such as the IAT



Our brain is shaped by our life experiences: How, where, and by whom we were raised Interactions with friends, peers, and coworkers School, community, and religion Media and news are particularly influential Politics and policy

Racism, homophobia, sexism, ageism, ableism, and other forms of bias and discrimination are prevalent in our society and in the institutions with which we interact



This ability to quickly form associations in our brain between what we see in front of us and either a good or bad evaluation was probably very valuable at one point in human evolution…




http://brainsontrial.com/tag/race-bias/






Amygdala• Plays a primary role in

emotions, decision-making, and memory processing

• Part of the brain’s “pleasure center”

• Activated in “fight or flight” responses

Fusiform gyrus• Plays a role in facial recognition• May also help with recognition of

colors and words• Influences amygdala responses

…but it doesn’t mean we can’t change.


http://www.nature.com/neuro/journal/v15/n7/abs/nn.3136.html





The physical connections that have been made in the unconscious structures of our brains over a lifetime to support implicit bias can be changed with long-term and ongoing efforts to change negative associations into positive ones



Implicit biases come from the culture. I think of them as the thumbprint of the culture on our minds. Human beings have the ability to learn to associate two things together very quickly—that is innate. What we teach ourselves, what we choose to associate is up to us.

- Dr. Mahzarin R. Banaji, quoted in Hill, Corbett, & Rose, 2010, p. 78


“Debiasing”

Active and ongoing process that should continue throughout one’s career and even one’s life It has taken a lifetime to build and strengthen negative

association, so it will also take some time to undo them and replace them with positive associations

No one will be “debiased” through a one-time activity or a brief training

Tips, tools, and suggestions for “debiasing” will be provided – putting those into practice are up to you!


“Debiasing” Activities

Activities that have demonstrated effectiveness in addressing implicit bias include: Learning about implicit bias Intergroup contact, including genuine

interactions with those perceived as “outgroup”

Putting yourself in other people’s shoes Internal motivation and a sense of personal

responsibility to change your implicit biases


Client-Centered Communication

Centering communication around the client has the potential to remove – or at least distance – your own biases from the dialogue Respectful of client autonomy Collaborative Empowering


Client-Centered Communication in Sexual & Reproductive Health

Open-ended questions or statements “Please tell me more about why you feel that way

about birth control.” Affirmations

“Being the best mom you can be for your kids right now is really important to you.”

Reflections “It’s hard for you to make this decision because you

don’t think your family or friends would approve.” Summaries (see next slide for example)


Client-Centered Communication in Sexual & Reproductive Health

Open-ended questions or statements Affirmations Reflections Summaries

“You’ve made up your mind that you want to start using a more effective method of birth control, even though you hear at church that you shouldn’t try to prevent a pregnancy this way. Being able to take care of your kids and doing what is best for your health is also really important to you and your family. You feel confident that this is one thing you can do right now to help with that.”


Resources & References

Kirwan Institute. (2015). Implicit Bias Research Review, 2014. Columbus, OH: The Ohio State University. Accessed at http://kirwaninstitute.osu.edu/wp-content/uploads/2014/03/2014-implicit-bias.pdf.

Chae DH, Nuru-Jeter AM, & Adler NE. (2012). Implicit racial bias as a moderator of the association between racial discrimination and hypertension: a study of midlife African American men. Psychosomatic Medicine, 74(9), 962-964.

Dovidio JF & Fiske ST. (2012). Under the radar: how unexamined biases in decision-making processes in clinical interactions can contribute to health care disparities. American Journal of Public Health, 102(5), 945-952.

Hill C, Corbett C, & Rose A. (2010). Why So Few? Women in Science, Technology, Engineering, and Mathematics. Washington, D.C.: AAUW.

Kubota JT, Banaji MR, & Phelps EA. (2012). The neuroscience of race. Nature Neuroscience, 15, 940-948.






Please send any feedback or questions to Meghan Benson at [email protected]. Thank you!


mailto:[email protected]

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You Don't Know What You Think You Know: Implicit Bias in Health Care and Health Education