Reducing implicit verbal and nonverbal bias toward Hispanic patients

减少对西班牙裔患者的隐性言语和非言语偏见

• 批准号: 8773897
• 负责人: JEFFREY A STONE
• 金额: $ 39.87万
• 依托单位: UNIVERSITY OF ARIZONA
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-25 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8773897
• 关键词: Address; African American; Arizona; Attitude; Award; Belief; Caring; Client satisfaction; Clinical; Code; Communication; Complex; Conscious; Discrimination; Educational Curriculum; Effectiveness; Ethnic Origin; Exposure to; Health Personnel; Health Sciences; Healthcare; Hispanics; Hybrids; Knowledge; Language; Lead; Learning Module; Linguistics; Measures; Medial; Mediating; Mediator of activation protein; Medical; Minority; Modeling; Nonverbal Communication; Patient Education; Patients; Perception; Play; Prejudice; Process; Provider; Psychology; Publishing; Reporting; Research; Research Support; Role; Socioeconomic Status; Stereotyping; Testing; Training; Training Programs; Trust; Unconscious State; Universities; Withdrawal; Work; design; effective intervention; impression; improved; insight; meetings; novel; public health relevance; satisfaction

DESCRIPTION (provided by applicant): The current proposal seeks support for research to document and reduce the expression of implicit verbal and nonverbal bias by medical residents when they interact with Hispanic patients. Research shows that while stereotyping, prejudice and acts of discrimination can be conscious and deliberate, the expression of bias among healthcare providers is often unintentional because many hold negative attitudes and stereotypes at an implicit or unconscious level. Thus, implicit verbal and nonverbal biases may leak into the way residents interact with Hispanic patients, but training residents to control thei verbal and nonverbal implicit biases can mitigate the negative effect on patients during a clinical encounter. Whereas previous research shows that healthcare providers hold implicit negative attitudes and stereotypes about stigmatized patients, and that these biases can negatively impact both the way providers interact with minority patients, and the satisfaction that minority patients report after a clinical encounter, no research to date has documented the mediators of the relationship between implicit bias and patient satisfaction. The current proposal addresses this void by developing and testing a new model of Implicit Linguistic Bias. The Implicit Linguisti Bias model proposes that interactions between Hispanic patients and residents, who hold implicit biases toward them and their group are characterized by lower linguistic matching, higher use of demand-withdrawal language, and higher intergroup linguistic bias language. The presence of these implicit linguistic biases, in turn, make the patient feel less involved in the conversation, feel less confidence and trust in the provider, and feel less desire to see the provider again. Reducing the expression of implicit verbal and nonverbal biases, including implicit linguistic biases, during a clinical encounter, however, can be achieved by training residents in the psychology of implicit bias, how it is communicated during a clinical encounter, and how they can control their verbal and nonverbal expressions of implicit bias when they interact with Hispanic patients. In three large-scale studies over five years, the proposed research will examine the presence and reduction of verbal and nonverbal forms of implicit bias, including the effects of implicit linguistic bias, during clinical encounters between medical residents and Hispanic patients. Study 1 will develop and test the proposed model of Implicit Linguistic Bias by recording and coding interactions between medical residents and Hispanic patients. Study 2 will develop and test the effectiveness of a new hybrid-learning module for training medical residents in the psychology of implicit bias. Study 3 will then examine if completing the implicit bias training module reduces the expression of implicit verbal and nonverbal bias, including the expression of implicit linguistic bias, and improves patient satisfaction ratings when medial residents interact with Hispanic patients.

描述（由申请人提供）：目前的提案寻求研究的支持，以记录和减少医疗居民与西班牙裔患者互动时的隐性口头和非口头偏见的表达。研究表明，虽然陈规定型观念、偏见和歧视行为可能是有意识和故意的，但医疗保健提供者的偏见表达往往是无意的，因为许多人在隐性或无意识的层面上持有负面态度和陈规定型观念。因此，隐性语言和非语言偏见可能会渗透到居民与西班牙裔患者的互动方式中，但培训居民控制他们的语言和非语言隐性偏见可以减轻临床治疗期间对患者的负面影响。 遭遇虽然以前的研究表明，医疗服务提供者对污名化的患者持有隐性的负面态度和刻板印象，这些偏见会对提供者与少数民族患者的互动方式以及少数民族患者在临床接触后报告的满意度产生负面影响，但迄今为止还没有研究记录了内隐偏见与患者满意度之间关系的中介。目前的建议通过开发和测试一种新的隐性语言偏见模型来解决这一空白。隐式语言偏见模型提出，西班牙裔患者和居民之间的互动，谁持有对他们和他们的组的隐式偏见的特点是较低的语言匹配，较高的使用需求撤回语言，和较高的组间语言偏见的语言。这些隐含的语言偏见的存在，反过来，使病人感到参与对话，感到不太自信和信任的提供者，并感到不太希望再次见到提供者。然而，减少隐性语言和非语言偏见的表达，包括隐性语言偏见，在临床遇到，可以通过培训居民在心理学的隐性偏见，它是如何在临床遇到沟通，以及他们如何可以控制他们的语言和非语言表达的隐性偏见时，他们与西班牙裔患者互动。在五年的三项大规模研究中，拟议的研究将研究在医疗居民和西班牙裔患者之间的临床接触中，语言和非语言形式的内隐偏见的存在和减少，包括内隐语言偏见的影响。研究1将通过记录和编码住院医师和西班牙裔患者之间的互动来开发和测试所提出的内隐语言偏见模型。研究2将开发和测试一个新的混合学习模块的有效性，培训实习医生的心理学内隐偏见。然后，研究3将检查完成隐式偏见训练模块是否减少了隐式言语和非言语偏见的表达，包括隐式语言偏见的表达，并提高了患者的满意度，当医疗居民与西班牙裔患者互动时。