Increasing health care equity by examining a possible mediator of the relationship between implicit bias and provider behavior: intergroup anxiety

项目摘要。健康差距是一个具有严重公共卫生意义的问题， 使医疗保健更加公平的证据是医疗保健研究和质量机构的一部分， （AHRQ）使命。种族健康差异具有复杂的病因和相关性，但在控制 健康的其他社会决定因素2和患者因素（例如治疗参考3）。剩余差距反映了 提供者对白色和少数民族患者治疗的差异。造成不同的一个因素是 对少数民族患者的治疗提供了内隐的偏见--改变行为的无意识偏见7。提供商 内隐偏见预测与少数民族患者互动时的微妙行为差异，包括更多的焦虑， 相关词8，更多的负面影响9，和不同的非语言10。这些供应商行为预测较低 患者满意度和依从性11，具有较大的健康后果11，12。尽管急于瞄准内隐偏见 在减少差异的干预措施中，大多数研究表明，内隐偏见干预没有影响19。此外，本发明还 内隐偏差很难测量，并显示出中等的重测可靠性13。然而，有公共 考虑到受影响的人数，即使隐性偏见的影响很弱，对健康的影响也很大。 内隐偏见对差异的影响可以通过阐明和检查更复杂的模型来澄清 内隐偏见和提供者行为之间的关系。本研究旨在探讨群际焦虑 （焦虑，表现在跨种族的互动，以回应负面的期望15）作为一个调解人的 内隐偏见和提供者行为之间的关系。众所周知，焦虑会影响行为， 一般人群例如16，提供者焦虑损害患者结果，例如满意度和依从性17，18， 但没有研究探讨群体间焦虑对提供者行为的影响。我们将测试这个模型， 医学生样本（N=70）。每个参与者将与两名患者演员互动-一名黑人， 一个白人来控制与种族无关的焦虑。为了确保对创新的全面分析， 组间焦虑和提供者行为之间的关联，我们建议测量这两个结构， 多层次的我们将通过自我报告情感和生理学来评估焦虑19。我们将研究三个 行为类别：语言（与焦虑相关的词语使用）、全局（温暖）和非语言（微笑和眼神 联系人）。医学院是一个关键的机会之窗，当偏见可能更具可塑性时，学生们 可访问性和培训是预期的。许多医学院使用内隐偏见减少培训，以减少 差异，但组间焦虑可能代表一个更一致的可变和易于测量的结构。 基于所提议的循证模型的减少差异培训可能会产生很大的影响 卫生差距，解决AHRQ的优先重点，改善医疗保健病人的安全。我的长期 职业目标是研究在健康的多种社会决定因素中导致健康差异的因素 设计、测试和传播针对证据支持的目标（如群体间焦虑）的干预措施。

Project summary. Health disparities are a matter of grave public health significance1, and producing evidence to make health care more equitable is part of the Agency for Health Care Research and Quality (AHRQ) mission. Racial health disparities have complex etiologies and correlates, but remain when controlling for other social determinants of health2 and patient factors (e.g. treatment refusal3). Residual disparities reflect differences in provider treatment of White and minority patientse.g.4–6. One factor contributing to disparate treatment of minority patients is provider implicit bias—non-conscious biases that alter behavior7. Provider implicit bias predicts subtle behavioral differences in interactions with minority patients, including more anxiety- related words8, more negative affect9, and different nonverbals10. These provider behaviors predict lower patient satisfaction and adherence11, with large health consequences11,12. Despite haste to target implicit bias in disparity reduction interventions, most studies show no impact of implicit bias interventions19. Further, implicit bias is difficult to measure and demonstrates moderate test-retest reliability13. Still, there are public health implications of even weak effects of implicit bias14 when considering the number of people affected. Effects of implicit bias on disparities may be clarified by articulating and examining more complex models of the relationship between implicit bias and provider behavior. This proposal examines intergroup anxiety (anxiety that manifests in interracial interactions in response to negative expectations15) as a mediator of the relationship between implicit bias and provider behavior. It is well known that anxiety affects behavior in the general populatione.g.16, and provider anxiety impairs patient outcomes, such as satisfaction and adherence17,18, but no research has examined the effects of intergroup anxiety on provider behavior. We will test this model in a sample (N=70) of medical students. Participants will each interact with two patient actors—one Black, and one White—to control for race-irrelevant anxiety. To ensure a comprehensive analysis of the innovative association between intergroup anxiety and provider behavior, we propose to measure both constructs at multiple levels. We will assess anxiety through self-report affect and physiology19. We will examine three classes of behavior: verbal (anxiety-related word use), global (warmth), and nonverbal (smiling and eye contact). Medical school is a key window-of-opportunity when biases may be more malleable20, students are accessible, and training is expected. Many medical schools use implicit bias reduction trainings to decrease disparities, but intergroup anxiety may represent a more consistently alterable and easy-to-measure construct. Disparity-reduction trainings based on evidence-based models such as the proposed may have large impacts on health disparities, addressing the AHRQ priority focus of improving health care patient safety. My long-term career goal is to study factors that contribute to health disparities across multiple social determinants of health and design, test, and disseminate interventions on evidence-supported targets such as intergroup anxiety.