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

项目总结。健康差距是一个具有严重公共卫生意义的问题1，并产生 医疗保健更公平的证据是卫生保健研究和质量机构的一部分 (AHRQ)任务。种族健康差异有复杂的病因和相关性，但在控制的时候仍然存在 关于健康的其他社会决定因素2和患者因素(例如，拒绝治疗3)。残留的差距反映了 白人和少数族裔患者在提供者治疗上的差异。例如，4-6.造成不同的一个因素 对少数族裔患者的治疗是提供者的隐性偏见--改变行为的无意识偏见7。提供商 在与少数族裔患者的互动中，隐性偏见预示着细微的行为差异，包括更多的焦虑- 相关的词汇8、更多的负面影响和不同的非言语10。这些提供商行为预测较低 患者满意度和依从性11，对健康有很大影响11，12.尽管急于瞄准隐性偏见 在缩小差距的干预中，大多数研究表明内隐偏见干预没有影响19。此外， 内隐偏倚很难测量，并表现出中等的重测信度13。尽管如此，还是有公众 考虑到受影响的人数时，即使是隐性偏见的微弱影响也会对健康产生影响。 内隐偏见对差异的影响可以通过阐述和研究更复杂的模型来阐明 内隐偏见和提供者行为之间的关系。这项建议考察了群体间的焦虑。 (在种族间的互动中表现出来的对消极期望的反应的焦虑15)作为 内隐偏见与提供者行为之间的关系。众所周知，焦虑会影响老年人的行为。 一般人群，例如16，并且提供者焦虑损害患者的结果，例如满意度和依从性17，18， 但还没有研究考察群体间焦虑对提供者行为的影响。我们将在以下方面测试此模型 医学生样本(N=70)。参与者将分别与两名耐心的演员互动-一名布莱克，以及 一个白人--控制与种族无关的焦虑。确保全面分析创新的 组间焦虑和提供者行为之间的关联，我们建议在 多个级别。我们将通过自我报告情感和生理来评估焦虑。我们将考察三个 行为类别：语言(与焦虑有关的用词)、全球(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，当偏见可能更容易改变时，学生们 无障碍，预计将进行培训。许多医学院使用内隐减少偏见的培训来减少 差异，但群体间焦虑可能代表了一个更一致的变化和易于测量的结构。 基于循证模型的缩小差距培训可能会产生很大的影响 关于健康差距，解决了AHRQ的优先重点，即改善保健患者的安全。我的长期生活 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 并设计、测试和传播针对证据支持的目标的干预措施，如群体间焦虑。

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.